Esophageal Adenocarcinoma-the White Man’s Disease

Development of Barrett's esophagus and esophageal adenocarcinoma appears to be strongly affected by ethnic factors, with populations resident at the west end of the Eurasian continent, such as Anglo-Celtics, being more prone to both conditions. On the other hand, ethnic groups from the eastern and southern ends of Eurasia, such as Chinese, Koreans and Japanese, and Africans might be more prone to developing esophageal squamous cell carcinoma.

Esophageal adenocarcinoma (EAC) is the most rapidly increasing cancer in the Western world and Barrett’s esophagus (BE) is the only known precursor lesion for this lethal cancer. Long-term survival may be improved if EAC is diagnosed early, providing an opportunity for early intervention. Surveillance of all patients with known BE is probably not cost effective and factors predictive of BE progression to dysplasia/EAC are poorly understood. Screening and surveillance examinations are also faced with challenges in the endoscopic detection of intestinal metaplasia and dysplasia. Future application of molecular biomarkers may help identify the patients with BE most likely to progress, and the use of novel imaging methods may improve outcomes of BE screening and surveillance

Esophageal squamous cell carcinoma (ESCC) used to be the dominant type of esophageal malignancy both in Western and Asian countries. The rapid increase of EAC in Western countries has occurred in parallel with an increased prevalence of gastroesophageal reflux disease (GERD) and its major determinant, obesity.
Such an increase in EAC has not yet been observed in Asia, despite a recent increase in prevalence of GERD.

Hongo, Michio et al.Journal of Gastroenterology and Hepatology, Volume 24, Number 5, May 2009 , pp. 729-735(7)
Jeff Michalak et al. Current Gastroenterology ReportsVolume 11, Number 3 / June, 2009

COMMENT: The incidence of esophageal cancer is greatest in those people with chronic heartburn. Yet the screening of these patients for cancer is not deemed “cost effective.”

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