One of the most important questions in the whole field of Barrett’s oesophagus is whether diagnosing it makes any difference.
For most people, Barrett’s is a curiosity – the lining of the gullet changes from the normal pale pink to a salmon red colour. It is thought that this decreases the sensitivity to acid and bile reflux which is usually quite bad in those people in whom Barrett’s arises. The problem is that for a very small proportion, probably no more than 5%, this eventually leads to cancer. Oesophageal cancer is rapidly becoming one of the biggest causes of cancer deaths. It is now the fourth commonest cancer killer in men in the UK.
Since most people with Barrett’s oesophagus will never get cancer, does it matter if it is diagnosed?
The answer is important for those who do eventually develop that most dreaded of diseases. A research group from the USA studied this question in detail. They looked at almost 3000 patients who had developed oesophageal cancer between 1994 and 2002. In the study, they showed that those in whom Barrett’s oesophagus had previously been diagnosed were twice as likely to be cured as those in whom it was. The reason appeared to be due to earlier diagnosis of cancer which led to an improved outcome as people with a diagnosis of BE were four times more likely to be diagnosed with an earlier, less fatal type of cancer.
There are caveats to this type of study. It is possible that the patients with a previous diagnosis of Barrett’s oesophagus actually had less aggressive tumours which led to better survival. This study cannot answer this type of potential bias, but it gives a clue that we should certainly continue to try to diagnose Barrett’s earlier and in more people if we want to minimize the risk of people dying from oesophageal cancer.