Does heartburn signal esophageal cancer? Not necessarily, says epidemiologist Nicholas Shaheen. When your patients indicate they are taking medication for reflux, they might also be concerned about the cancer possibilities, but there is new information published from the University of North Carolina. The cause of heartburn is a weakening of the lower esophageal valve, which allows stomach acid to flow back into the esophagus. Certain foods—spicy, acidic, and fatty—can aggravate the condition as can lying down after a meal. While 87 million Americans suffer with acid reflux, 8,000 per year (0.009%) are diagnosed with one of the 2 types of esophageal cancer. Patients think that endoscopies can prevent this type of cancer, but there isnít any evidence that they save lives. Endoscopies are expensive, and there is a risk of complications. While the risk of cancer is low, gastroenterologists have noted that the number of adenocarcinoma cases has risen 300% to 500% over the last 30 to 40 years. There is a question that this increase may be linked to obesity, especially in men, who tend to gain weight in their abdomen, as opposed to women, who tend to gain in their hips and buttocks. The risk is 8 times more likely in men than in women. The additional weight might push acid back through the valve, and with greater weight in the abdomen there is more production of insulin and insulin growth factor, which is associated with other types of cancers. The risk is highest with white, overweight men more than 60 years old. Development of Barrettís esophagus, a precancerous condition, does not always lead to cancer. However, insurance companies have been known to increase insurance costs based on the possibility of full-blown cancer occurring in the future. Treatment for heartburn is important, but not to eliminate the possibility of cancer. It is to ensure a better quality of life.
(Source: Endeavors, University of North Carolina, Fall 2006)
