Gastroesophageal reflux disease (GERD) or acid reflux from the stomach into the esophagus is a known risk factor for Barrett’s metaplasia and subsequently an esophageal cancer known as adenocarcinoma. According to the National Cancer Institute (Cancer.gov) in 2012 there were 17,460 new cases of esophageal cancer in the United States and 15,070 deaths from the disease. Surgery, with or without chemotherapy and radiation may be curative for esophageal cancer, especially for those patients with early stage disease.

Unlike breast and colorectal cancer, screening criteria for esophageal cancer is debatable. Many primary care providers don’t know 1) who is at risk for esophageal cancer, and 2) who needs to be screened.

The ACP helps clarify some of these questions with their Best Practice Advice for screening upper endoscopy criteria for those patients with GERD.

The key points from their guidelines are as follows:

• Everyone with Barrett’s metaplasia should be in an endoscopic surveillance program at least every three years, if there is dysplasia, then surveillance should be more frequent
• Everyone should get a screening endoscopy if they have heartburn [GERD] + additional symptoms (including dysphagia, anemia, vomiting, etc…)
• Everyone should get screening endoscopy if they have GERD symptoms that do not respond to 4-8 weeks of proton-pump inhibitor therapy
• Men over 50 with chronic GERD and additional risk factors (including elevated body mass index, smoking, etc…) should get screening endoscopy

From our perspective, although being male is an independent risk factor for adenocarcinoma of the esophagus (male to female ratio of incidence is 3:1), we would still recommend counseling a woman on screening endoscopy if she fit the above demographics.

For more information on the ACP Best Practice Advice see the below URL:

http://annals.org/article.aspx?articleid=1467417