Accurate population-based data are needed on the incidence of esophageal adenocarcinoma
and high-grade dysplasia among patients with Barrett's esophagus.
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.
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.
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.).