Esophageal cancer screening might not be worthwhile for most GERD patients, modeling study finds

Although gastroesophageal reflux increases patients' relative risk for esophageal adenocarcinoma, the absolute risk is too low to merit screening in most patients, a new study found.

The study used a Markov model to extrapolate based on incidence of gastroesophageal reflux disease (GERD) and its association with esophageal cancer. According to the results, women with GERD have a very low risk of developing esophageal cancer no matter their age. For example, 60-year-old women with weekly GERD have an esophageal cancer incidence rate of 3.9 per 100,000 person-years. Having daily symptoms increases their risk only slightly, the model found.

Men with GERD have a higher risk of esophageal cancer and it increases with age. For example, 70-year-old men have a risk of 60.8 per 100,000 person-years. The study authors compared these risks to those for cancer for which experts have recommended screening. For example, the risk of breast cancer is 100.5 per 100,000 in 40-year-old women and the risk for colorectal cancer is 47.2 per 100,000 in 50-year-old men. The lowest incidence rate at which screening has been recommended was for colorectal cancer in 50-year-old women: 35.6 per 100,000. If the latter rate is taken as a benchmark for cancer screening, the researchers concluded that esophageal cancer screening would be worthwhile only for men over 60 years of age with at least weekly GERD. Because risk increases with more frequent GERD, men with daily GERD would pass the benchmark at age 55.

However, the authors noted, this calculation assumes that esophageal cancer screening effectively reduces mortality, an assumption there is not yet evidence to support. Decisions about the value of screening would also need to consider the cost, accuracy and safety of screening, the authors said. They suggested that identification of additional risk factors for esophageal adenocarcinoma (obesity and tobacco are possibilities) might increase the value of screening, but data on the effects of these factors are still needed. The study was published online Dec. 7 by the American Journal of Gastroenterology.

The findings of this study don't support current practice of American gastroenterologists, as identified by a recent survey, the authors said. More than 70% of gastroenterologists said they would screen a 35-year-old man with GERD and 42% would screen a 55-year-old woman. The gap between evidence and practice may be due to an inappropriate focus on the relative increase in risk posed by GERD rather than the fairly low absolute risk of esophageal cancer, the authors concluded.