Esophageal cancer tends to be a “silent killer,” and it’s on the rise among middle-aged Americans, according to new evidence.
The rate of this cancer has almost doubled among people aged 45 to 64, and the prevalence of Barrett’s esophagus – a precancerous condition – has increased by about 50% in this age group between 2012 and 2019. The esophagus is a hollow tube responsible for transporting food and liquid from the throat to the stomach.
The exact reason for the rise in esophageal cancer in young people is not fully known, but high rates of obesity, unhealthy diets, and chronic heartburn or gastroesophageal reflux disease (GERD) are likely factors, and they all tend to travel together, according to the study. author Dr. Bashar Qumseya. He is an Associate Professor of Medicine and Chief of Endoscopy at the University of Florida.
Chronic heartburn leads to Barrett’s esophagus, which is characterized by abnormal changes in the cells that line the esophagus.
This increase in rates of esophageal cancer in young people mirrors what has been observed with colon cancer.
“With colon cancer, we used to recommend screening at age 50, then we saw compelling evidence that the rate was increasing in younger people, so some groups are now asking for screening at age 45” , Qumseya said.
It may be time to do the same for esophageal cancer screening if a person has other risk factors, he said. These include alcohol consumption and smoking.
“If you have reflux and other risk factors for esophageal cancer, consider having a screening endoscopy when you have your colonoscopy to screen for colon cancer,” Qumseya said. Both tests can be performed at the same time. Esophageal cancer screening guidelines do not yet exist.
The disease is called the silent killer because the symptoms often go unnoticed until the cancer has progressed.
For the study, the researchers tapped into the electronic health records of about 5 million people in Florida. They looked for rates of esophageal and Barrett’s esophageal cancer in people in three age categories: 18 to 44, 45 to 64, and 65 and older.
The researchers found peaked rates among the oldest age group. They said the rise in esophageal cancer rates in middle-aged adults is not due to more aggressive screening. There was no increase in endoscopy rate during the study period.
The findings are set to be presented at Digestive Disease Week 2022, which will be held virtually and in San Diego May 21-24. Results presented at medical meetings should be considered preliminary until published in a peer-reviewed journal.
Going forward, Qumseya and her colleagues plan to review the data to differentiate between the two types of esophageal cancer: esophageal adenocarcinoma and squamous cell carcinoma.
That’s key, because each type has different potential causes and risks to consider, said Dr. Devika Rao, a medical oncologist at Memorial Sloan Kettering Cancer Center in New Jersey.
“Squamous cell cancers are most common in Eastern Europe and Asia and are triggered by smoking and tobacco exposure,” said Rao, who is unrelated to the new study. In contrast, in Barrett’s esophagus, obesity and diet are linked to esophageal adenocarcinoma.
“Population studies like these are important for raising awareness in both the general public and the medical communities,” she said.
“It is alarming that cancers that were once considered a disease of the elderly are rapidly becoming lifestyle-dependent and affecting younger and younger individuals,” Rao said.