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Risk of Mortality and Cancer Incidence in Barrett's Esophagus

¹ Centre for Epidemiology and Biostatistics, Leeds Institute for Genetics, Health, and Therapeutics, Faculty of Medicine and Health, University of Leeds, Leeds, England, United Kingdom; ² Department of Surgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan; and ³ School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand

Requests for reprints: David Forman, Centre for Epidemiology and Biostatistics, Leeds Institute of Genetics, Health, and Therapeutics, University of Leeds, Arthington House, Cookridge Hospital, Leeds LS16 6QB, United Kingdom. Phone: 44-3392-4164; Fax: 44-3392-4178. E-mail: d.forman{at}leeds.ac.uk

Background: There are very few prospective follow-up studies of Barrett esophagus (BE) cohorts assessing the risk of extraesophageal cancer incidence or mortality. Such studies are necessary in order to understand the overall risks of cancer and death experienced by patients with BE.

Methods: A cohort of 502 patients with BE were identified at Leeds General Infirmary, England. Mortality and cancer incidence information were provided by the Office for National Statistics. Standardized mortality ratios (SMR) and standardized incidence ratios (SIR) were calculated using indirect standardization.

Results: All-cause mortality was found to be elevated in patients with BE [SMR, 1.21; 95% confidence interval (95% CI), 1.06, 1.37] and remained so after esophageal cancers were excluded (SMR, 1.16; 95% CI, 1.01-1.32). Increased mortality risks were also found for malignant neoplasms of the esophagus (SMR, 7.26; 95% CI, 3.87-12.42) and diseases of the digestive system (SMR, 2.03; 95% CI, 1.11-3.40). The remaining disease categories produced no altered risk estimates. Circulatory disease mortality was borderline statistically significant (SMR, 1.24; 95% CI, 1.00-1.52; P = 0.053) for those with a specialized intestinal metaplasia diagnosis of BE. In the cancer incidence analyses, esophageal malignancies (SIR, 8.66; 95% CI, 4.73-14.53) and esophageal adenocarcinomas (SIR, 14.29; 95% CI, 7.13-22.56) were found to be increased in BE. All remaining analyses provided unaltered risks, including that of colorectal cancer.

Conclusions: This study has shown evidence of an increased risk of esophageal cancer incidence and mortality in BE. It has also shown that those who have a histologic BE diagnosis may also have an increased risk of circulatory disease mortality. (Cancer Epidemiol Biomarkers Prev 2007;16(10):2090–6)