Dr. C. Joseph Bennett, American Cancer Society, 02/21/12

Through the years of writing this column, I have covered the topic of Barrett’s esophagus (BE) on many different occasions.

One of the hot topics regarding Barrett’s esophagus is its relationship to the eventual development of esophageal cancer.

The incidence of esophageal cancer is on the rise in developed countries, and a great deal of research is going into understanding the cause, detecting the disease early, and improving treatment outcomes.

It is felt that many, if not all, cancers of the esophagus originate from the premalignant condition called BE, presumably progressing through several different phases before turning into a full­-blown cancer. However, thankfully, progression from normal to precancerous to cancer along this pathway is uncommon, and the vast majority of BE patients never develop esophageal cancer or high-grade dysplasia precancerous changes.

However, some do, and the factors distinguishing the small minority of patients who do progress remain unknown at this time. We certainly have our suspicion about many possible causes, including smoking, drinking and chronic reflux, but to date, the true cause has not been determined.

This highlights the importance of identifying lifestyle factors that may contribute to cancer progression, and thus give us a plan to modify our lifestyle to lower the risk. Now, according to a new study in the journal Gastroenterology, scientist have found that patients who have BE and smoke tobacco have a two-fold increased risk of developing esophageal cancer. BE patients who smoke also double their risk for developing advanced precancerous cells.

While looking at many different factors and potential causes, researchers found that tobacco smoking emerged as the strongest lifestyle risk factor for cancer progression. Contrary to popular belief, alcohol consumption, which I mentioned above, did not seem to increase the cancer risk in this group of patients with Barrett’s esophagus.

In this study, researchers analyzed data on patients from 1993 to 2005 who were involved in one of the largest population-based studies ever done, with more than 3,000 BE patients worldwide followed for many years. In this group, doctors found that 117 of the patients developed dysplasia or cancers of the esophagus or stomach.

For the first time in such a large study, researchers were able to get information about smoking at the time a person was first diagnosed with BE to see how this influenced cancer risk years later. This is important for reducing bias known to be associated with asking patients about their smoking habits in the past.

Current tobacco smoking, regardless of the number of daily cigarettes, was significantly associated with an increased risk of esophageal cancer.

This is very good news, but it also highlights a point I have made many times in the past. If you smoke, you need to quit, not just slow down. There is no safe level of smoking activity.

This suggests that reducing the number of cigarettes smoked per day will not reduce the risk of cancer in BE patients. Yes, you need to quit, not just cut back.

Now, the news of tobacco use being tied to cancer is not new to any of you. Tobacco smoking has long been established as highly carcinogenic or cancer-causing agent. Barrett’s esophagus patients who smoke should start a smoking cessation program immediately. The faster you stop, the better.

Although these findings need to be confirmed in future studies, the study’s researchers suggest that tobacco smoking be discouraged, and smoking-cessation strategies considered in BE patients in order to reduce future cancer risk. Further, identifying modifiable lifestyle factors that influence cancer progression may provide an additional cost-effective method of alleviating future cancer burden in this group of cancer patients.

Dr. C. Joseph Bennett is a board-certified radiation oncologist, member of the Citrus County Unit and Florida Division Board of Directors of the American Cancer Society. Watch “Navigating Cancer,” hosted by Dr. Bennett, on WYKE TV, at 6:30 p.m. Mondays and 10 a.m. Thursdays. If you have any suggestions for topics, or have any questions, contact him at 522 N. Lecanto Highway, Lecanto, FL 34461, or email at cjbennett@rboi.com. ­