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If I have Barrett's esophagus will I get cancer?

Fortunately, the results of multiple studies of patients followed for many years, indicate that about 90-95% of patients who have Barrett's esophagus DO NOT develop cancer. It is not known why some people who have Barrett's esophagus get cancer, while the majority do not.

Chronic heartburn (GERD)

Chronic heartburn (or GERD - gastroesophageal reflux disease) is the most important risk factor for the development of adenocarcinoma of the esophagus (Barrett's associated cancer). It has been shown that the risk of cancer increases in proportion to how often you get heartburn symptoms and the length of time that you have had a problem with heartburn. In other words, the more frequent your heartburn symptoms and the greater the number of years you have had heartburn, the greater your risk of cancer. In one large study of heartburn and the development of adenocarcinoma of the esophagus, the majority of patients who had esophageal adenocarcinoma also had Barrett's esophagus. Others have shown that the majority of patients who have chronic GERD and develop esophageal adenocarcinoma also have Barrett's esophagus. What this probably means is that the more heartburn you have, the more likely you are to develop Barrett's and it is the Barrett's esophagus that increases the risk of developing cancer. No one knows whether Barrett's esophagus patients who continue to have GERD have a higher risk of developing cancer as compared to Barrett's esophagus patients whose GERD is controlled with medication or anti-reflux surgery. There is certainly no convincing evidence that controlling heartburn symptoms with medication or anti-reflux surgery prevents the development of cancer in Barrett's esophagus.

Family history

There is no strong evidence that having a close relative with esophageal adenocarcinoma significantly increases your risk of developing esophageal adenocarcinoma. There are at least four recent studies looking at relatives of patients who developed esophageal adenocarcinoma. Three of these studies reported that having a close relative with esophageal adenocarcinoma did not increase the risk of developing esophageal adenocarcinoma. The fourth study reported that  patients who had Barrett's esophagus or esophageal adenocarcinoma were more likely to have a relative with Barrett's esophagus or esophageal adenocarcinoma compared to patients who had GERD but no Barrett's esophagus. However, most patients who have an esophageal adenocarcinoma do not have a known family history of esophageal adenocarcinoma.

Length of Barrett's esophagus

The length of your Barrett's esophagus segment may be a risk factor in the development of esophageal adenocarcinoma. Longer segments may be at increased risk, however, some studies have not shown this increase to be significant and short segments can also progress to cancer.

Diet

A diet high in fat and low in fruits and vegetables has been associated with the development of esophageal adenocarcinoma. Alternatively, a diet high in vegetable fiber may be protective.

Asthma, smoking and obesity

There are other factors that may increase the risk of esophageal adenocarcinoma. Asthma and the use of asthma medications may also be associated with an increased risk of esophageal adenocarcinoma. Cigarette smoking has been shown to be a significant risk factor for the development of esophageal adenocarcinoma. Obesity also appears to be a strong risk factor for esophageal adenocarcinoma, especially in non-smokers and in younger patients. One recent study suggests that it is actually the amount of fat around the abdominal area (between the hips and chest) and not how fat you are in general, that increases the risk of developing esophageal adenocarcinoma in Barrett's esophagus. This study found that in Barrett's esophagus patients, the greater the size of the abdominal area compared to the size of the hips, the greater the chance of having genetic abnormalities and flow cytometric abnormalities in the Barrett's cells that are associated with an increased risk of developing esophageal adenocarcinoma.

Alcohol consumption

Alcohol consumption does not appear to increase the risk of adenocarcinoma of the esophagus. Consumption of wine, aspirin (NSAIDs), and the presence of certain strains of the bacterium H. pylori, may be protective and lessen the risk of esophageal adenocarcinoma. Heavy alcohol use is NOT recommended and increases the risk of developing another type of esophageal cancer called squamous cell carcinoma of the esophagus.

Whether or not you have any of the above suspected risk or protective factors for esophageal adenocarcinoma, if you have Barrett's esophagus, the ONLY way to know if you are at increased risk of developing cancer is to undergo periodic endoscopic biopsy surveillance.

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