• DOI:10.1056/NEJMoa1103042
• Corpus ID: 7699058

Incidence of adenocarcinoma among patients with Barrett's esophagus.

@article{HvidJensen2011IncidenceOA,
  title={Incidence of adenocarcinoma among patients with Barrett's esophagus.},
  author={Frederik Hvid-Jensen and Lars Pedersen and Asbj{\o}rn Mohr Drewes and Henrik Toft S{\o}rensen and P. Funch‐jensen},
  journal={The New England journal of medicine},
  year={2011},
  volume={365 15},
  pages={
          1375-83
        }
}

• F. Hvid-Jensen, L. Pedersen, +2 authors P. Funch‐jensen
• Published 12 October 2011
• Medicine
• The New England journal of medicine

BACKGROUND
Accurate population-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. We determined 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
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 per 1000 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 for adenocarcinoma 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 of 0.5%, 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.).