April is National Esophageal Cancer Awareness month. While many people are familiar with March as National Colon Cancer Awareness month fewer people pay attention to esophageal cancer which is steadily rising (6 fold increase for adenocarcinoma of the esophagus over the past several decades). My hope is that patients will take symptoms of reflux seriously and report them. Patient care and community service is one of the priorities of my practice.
As you know, 20% of people complain of reflux at least once a week. While some may respond to lifestyle changes, many will respond to antacids, H2 blockers, or PPI medications. Patients with dysphagia, hemetemesis, hemoptyosis, odynophagia, microcytic anemia, and unexplained weight loss should undergo endoscopy. The American College of Physician guidelines further recommends endoscopy in patients with new onset dyspepsia or reflux after the age of 50.
Endoscopy should be considered in Caucasian males over the age of 40 who have had reflux symptoms for over 10 years. The later two groups of patients are at risk for Barrett’s esophagus. About 10% of patients with reflux develop Barrett’s esophagus. They have a 30-40 fold risk of developing adenocarcinoma. Because of this risk endoscopic surveillance is performed every 3 years unless dysplasia is found. Twenty five to forty percent of patient’s with untreated high grade dysplasia develop cancer within 5 years. The overall survival rate among all stages of esophageal cancer is 17% at 5 years and only 3% at 5 years for patients with metastatic disease.
The estate of Humphrey Bogart, who died of esophageal cancer in 1957, has supported the Esophageal Cancer Action Network (ECAN) in its campaign to promote national public awareness for esophageal cancer. ECAN is hosting an online auction and providing free Reach Out Kits that contain posters, brochures and wristbands bearing the life-saving message that heartburn can be a serious condition that can cause cancer. ECAN is located at www.ecan.org.