Medicina

new england journal of medicine
The
established in 1812

october 13, 2011

vol. 365

no. 15

Incidence of Adenocarcinoma among Patients with Barrett’s Esophagus
Frederik Hvid-Jensen, M.D., Lars Pedersen, Ph.D., Asbjørn Mohr Drewes, M.D., Dr. Med. Sci., Henrik Toft Sørensen, M.D., Dr. Med. Sci., and Peter Funch-Jensen, M.D., Dr. Med. Sci.

A bs t r ac t

Background

Accuratepopulation-based data are needed on the incidence of esophageal adenocarcinoma and high-grade dysplasia among patients with Barrett’s esophagus.
Methods

We conducted a nationwide, population-based, cohort study involving all patients with Barrett’s esophagus in Denmark during the period from 1992 through 2009, using data from the Danish Pathology Registry and the Danish Cancer Registry. Wedetermined the incidence rates (numbers of cases per 1000 person-years) of adenocarcinoma and high-grade dysplasia. As a measure of relative risk, standardized incidence ratios were calculated with the use of national cancer rates in Denmark during the study period.
Results

From the Departments of Surgical Gastroenterology L (F.H.-J.) and Clinical Epidemiology (L.P., H.T.S.), Aarhus UniversityHospital, Aarhus; Mech-Sense Department of Gastroenterology, Aarhus University Hospital, Aalborg (A.M.D.); and Hamlet Hospital and Clinical Institute, University of Aarhus, Aarhus (P.F.-J.) — all in Denmark. Address reprint requests to Dr. FunchJensen at Hamlet Hospital and Clinical Institute, University of Aarhus, Brendstrupgårdsvej 21, DK-8200 Aarhus N, Denmark, or at funchjensen@gmail.com. N Engl JMed 2011;365:1375-83.
Copyright © 2011 Massachusetts Medical Society.

We identified 11,028 patients with Barrett’s esophagus and analyzed their data for a median of 5.2 years. Within the first year after the index endoscopy, 131 new cases of adenocarcinoma were diagnosed. During subsequent years, 66 new adenocarcinomas were detected, yielding an incidence rate for adenocarcinoma of 1.2 cases per1000 person-years (95% confidence interval [CI], 0.9 to 1.5). As compared with the risk in the general population, the relative risk of adenocarcinoma among patients with Barrett’s esophagus was 11.3 (95% CI, 8.8 to 14.4). The annual risk of esophageal adenocarcinoma was 0.12% (95% CI, 0.09 to 0.15). Detection of low-grade dysplasia on the index endoscopy was associated with an incidence rate foradenocarcinoma of 5.1 cases per 1000 person-years. In contrast, the incidence rate among patients without dysplasia was 1.0 case per 1000 person-years. Risk estimates for patients with high-grade dysplasia were slightly higher.
Conclusions

Barrett’s esophagus is a strong risk factor for esophageal adenocarcinoma, but the absolute annual risk, 0.12%, is much lower than the assumed risk of0.5%, which is the basis for current surveillance guidelines. Data from the current study call into question the rationale for ongoing surveillance in patients who have Barrett’s esophagus without dysplasia. (Funded by the Clinical Institute, University of Aarhus, Aarhus, Denmark.)
n engl j med 365;15 nejm.org october 13, 2011

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The New England Journal of Medicine Downloaded from nejm.org onOctober 7, 2012. For personal use only. No other uses without permission. Copyright © 2011 Massachusetts Medical Society. All rights reserved.

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arrett’s esophagus, defined as intestinal metaplasia in the distal esophagus, is considered to be a complication of gastroesophageal reflux disease and a precursor lesion in most cases ofesophageal adenocarcinoma.1 The transition from Barrett’s esophagus to adenocarcinoma is believed to progress through lowgrade and high-grade dysplasia, thus justifying endoscopic surveillance for these premalignant stages.2-4 However, an estimated 95% of patients with a new diagnosis of adenocarcinoma do not have a previous diagnosis of Barrett’s esophagus.5-10 Since surveillance programs have...