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Tobacco Smoking Doubles Cancer Risk in Patients With Barrett’s Esophagus

Thomas3.20.2010
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Smoking tobacco increases the risk for progression of Barrett’s esophagus (BE) to high-grade dysplasia (HGD) or cancer by twofold compared with never smoking. This risk was found in a study by Coleman et al, published in the February issue of Gastroenterology (2012;142:233-240).

Lead study author Helen Coleman, PhD, a postdoctoral research fellow at the Centre for Public Health, Queen’s University Belfast, in Northern Ireland, told Gastroenterology & Endoscopy News, “It has previously been known that smoking was a risk factor for esophageal adenocarcinoma, but what wasn’t known was the stage at which carcinogens in tobacco smoke act.”

Historically, it was not clear whether smoking promoted the conversion of healthy tissue to inflamed tissue, inflamed tissue to BE, or BE to HGD or cancer.

“This study has shown for the first time that smoking is a major reason for progression from BE to high-grade dysplasia/cancer,” Dr. Coleman said.

 

For their study, Dr. Coleman and colleagues analyzed data from the population-based Northern Ireland BE register, which includes all adults diagnosed with columnar-lined epithelium of the esophagus between 1993 and 2005 in Northern Ireland. The researchers identified 3,167 patients who had ever been diagnosed with specialized intestinal metaplasia, and they collected data on lifestyle and clinical and demographic characteristics from hospital case notes. Linking the Northern Ireland BE register to the Northern Ireland Cancer Registry, the researchers identified which of these patients later developed esophageal HGD or adenocarcinomas of the esophagus or gastric cardia.

By Dec. 31, 2008, a total of 117 patients with BE had developed esophageal HGD or adenocarcinomas of the esophagus or gastric cardia. Using Cox proportional hazard models, the researchers determined that current tobacco smoking was significantly associated with increased risk for progression compared with never smoking, across all strata of smoking intensity (hazard ratio, 2.03; 95% confidence interval, 1.29-3.17).

 

Additionally, the researchers found that risk for progression of BE was not related to alcohol consumption. Body mass index was not associated with risk for neoplastic progression, although caution in interpretation was advised because of inconsistent collection of data on height and weight.

The researchers recommended that smoking cessation strategies be considered in patients with BE. Previously, there was no “evidence base to specifically target these patients with dedicated smoking cessation programs,” Dr. Coleman said. “Therefore, this would be a change of practice.”

About the Author
63 years old. 20 year smoker. 11 Years FREE! Diagnosed with COPD. Choosing a Quality LIFE! It is for freedom that Christ has set us free. Stand firm, then, and do not let yourselves be burdened again by a yoke of slavery. -Galatians 5:1