MedWire News: Patients with Barrett's esophagus (BE) should be encouraged to give up smoking, say researchers who found the habit doubles the risk for progression to esophageal cancer.
"We found that tobacco smoking emerged as the strongest lifestyle risk factor for cancer progression," commented lead author Helen Coleman (Queen's University Belfast, UK) in a press release.
"Contrary to popular belief, alcohol consumption didn't increase cancer risk in this group of patients with [BE]," she added.
The researchers examined for lifestyle factors that predict progression using data from 3167 patients in Northern Ireland who were diagnosed with BE between 1993 and 2005. The patients were followed up until 2008 using the Northern Ireland Cancer Registry.
Overall, 117 of the patients were diagnosed with esophageal adenocarcinoma or other esophageal malignancies (n=70), gastric cardia adenocarcinoma (n=10), or esophageal high-grade dysplasia (n=37).
The researchers found that patients who progressed to cancer were more likely than those who did not to be male, have long-segment BE, and have an initial diagnosis of indefinite or low-grade dysplasia. There was no significant difference in reflux symptoms or socioeconomic status between the groups.
Analysis showed that current tobacco smoking in any form was significantly linked to BE progression, with a hazard ratio of 2.03 compared with individuals who had never smoked, after adjustment for confounding factors such as age, gender, low-grade dysplasia, and reflux symptoms.
By contrast, the risk for progression was not significantly linked to body mass index, weekly alcohol intake, or type of alcohol drunk.
"We can only recommend that BE patients follow the advice of current public health guidelines for cancer prevention to consume alcohol in moderation, if taken," Coleman et al say.
Writing in the journal Gastroenterology, the team comments that smoking is known to cause DNA damage in Barrett's mucosa, which may explain the increased risk for progression.
"There are also suggestions that smoking is associated with an increased number of reflux episodes, and that nicotine may reduce lower esophageal sphincter pressure, which would contribute to excess acid/bile exposure that may consequently increase neoplastic progression risk in BE," they add.
"Further research into the effects of smoking in Barrett's mucosa would prove useful insights into the mechanisms involved."
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