Esophageal Cancer Linked to Heartburn

Medical Revising Editor: Jay W. Marks, MD

Esophageal cancer is the eighth most common type of cancer and causes 12,000 deaths per year in the U.S. (2% of all cancer deaths). One type of esophageal cancer, adenocarcinoma, accounts for 50% of esophageal cancers and occurs primarily in Caucasian men. The incidence of adenocarcinoma and deaths from esophageal cancer have been increasing steadily in the U.S. and western Europe.

Gastroesophageal reflux disease (GERD), in which acid refluxes from the stomach into the esophagus (known primarily for causing heartburn) is a condition that afflicts 20% of the populations of the U.S. and western Europe.

It has been hypothesized that GERD is an important cause of adenocarcinoma of the esophagus. Specifically, the hypothesis is that chronic reflux of acid into the esophagus causes changes in the cells lining the lower esophagus--changes that are referred to as Barrett's esophagus--that ultimately lead the cells to become cancerous. It is estimated that ½ to 1% of patients with Barrett's esophagus develop adenocarcinoma each year they are followed. (This means that during 20 years a patient with Barrett's esophagus has a 10 to 20% risk of developing adenocarcinoma.) Therefore, it has been recommended that patients with Barrett's esophagus undergo regular and frequent endoscopy (every year) and biopsy of the esophagus so that early malignant changes can be detected and treated early before cancer spreads.