Oesophageal cancer rates up 500%

Rates of oesophageal adenocarcinoma have increased by 500% in the past 40 years, data suggests, with obesity being one possible explanation for the rise. Professor Ian Norton, director of endoscopy at Sydney’s Royal North Shore Hospital, said obesity could cause gastroesophageal reflux, setting off a chain that in some patients could lead to Barrett’s oesophagus with dysplasia. Earlier misdiagnoses as squamous cell carcinoma might also account for some of the increase in rates of adenocarcinoma, he said. The increase in oesophageal adenocarcinoma had seen death rates rise concordantly, according to researchers writing in the New England Journal of Medicine (28 May). They noted that 10% of patients with chronic reflux have Barrett’s oesophagus. “Longitudinal studies have shown that most cases of Barrett’s oesophagus do not progress beyond nondys plastic intestinal metaplasia or transient low-grade dys plasia,” the authors said. “However, in cases of progression to high-grade dysplasia, the risk of oesophageal cancer may be more than 10% per patient-year.” Oesophageal adenocarcinoma remained highly lethal, they added, with a five-year survival rate of less than 15%. The authors were examining the relatively new technique of radiofrequency ablation for Barrett’s oesophagus with dysplasia and found it eradicated all abnormal cells in 77.4% of patients. Professor Norton said radiofrequency ablation was rarely used in Australia because it cost up to $5000 per treatment and was not funded by Medicare. “The equipment has only been around for a couple of years so we’re still waiting for long-term data [on its effectiveness],” he said. The procedure might occasionally result in missing an early-stage cancer, he said, but the benefits still seemed to outweigh the risks, given the high rates of morbidity and mortality associated with oesophagectomy surgery. NEJM 2009; 360:2277-88. Australian Doctor...