GERD Associated With Increased Risk of Malignancy of the Upper Aerodigestive Tract

MedicalResearch.com Interview with:

Dr. Edward D. McCoul, MD, MPH Ochsner Medical Center

Dr. McCoul

Dr. Edward D. McCoul, MD, MPH
Ochsner Medical Center

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Population-level data suggests a link between gastroesophageal reflux disease and cancer of the throat and sinuses in adults over 65 years of age.  T

he strength of association between reflux and cancer is strongest for anatomic sites closest to the esophagus, where acid and other stomach contents may have the greatest exposure.

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Genetic Diversity Test Distinguishes Risk of Cancer in Barrett’s Esophagus

MedicalResearch.com Interview with:

Prof. Trevor A Graham, MSc, MRes, PhD Lead, Evolution and Cancer Laboratory Centre for Tumour Biology Barts Cancer Institute, Queen Mary University of London John Vane Science Centre London

Prof. Trevor Graham

Prof. Trevor A Graham, MSc, MRes, PhD
Lead, Evolution and Cancer Laboratory
Centre for Tumour Biology
Barts Cancer Institute, Queen Mary University of London
John Vane Science Centre
London

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Barrett’s Oesophagus is a common condition that affects an estimated 1.5 million people in the UK alone, although many are undiagnosed . This condition involves normal cells in the oesophagus (food pipe) being replaced by a different, unusual cell type called Barrett’s Oesophagus, and the replacement of the cells is thought to be a consequence of chronic reflux (heartburn).

People with Barrett’s have an increased risk of developing oesophageal cancer – a cancer that sadly still has a five year survival of 15% . But although the overall lifetime risk of developing oesophageal cancer in people with Barrett’s is significant (some estimates suggest the risk is comparable to that associated with smoking and lung cancer), the risk for each patient per year is very low.

This presents a big problem – most Barrett’s patients will never develop cancer in their lifetime, but the unfortunate few develop an aggressive cancer. Doctors urgently need better tools to distinguish which people with Barrett’s are actually at risk of developing cancer, so that they can receive the best treatment, and everyone else at low risk of cancer can be reassured and not need to endure unnecessary treatment. But because good a way to distinguish high-risk people doesn’t exist, all people with Barrett’s have regular (every 3 years or thereabouts) endoscopy; a camera pushed into the oesophagus to look for early signs of cancer.

Together with Prof Sheila Krishnadath  and her colleagues at the Amsterdam Medical Centre, Holland, we confirmed that we can identify people at high risk of developing cancer from pre-cancerous condition Barrett’s oesophagus by measuring the genetic diversity of Barrett’s cells.

Importantly, we also showed level of genetic diversity amongst a person’s Barrett’s cells essentially being fixed over time – no significant changes in genetic diversity were found during the ~4 years that the patients were followed. This means that whenever someone’s Barrett’s is tested, it looks like their future risk of developing cancer can be predicted regardless of how long it’s been since the abnormal Barrett’s cells began to appear.

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Bacteria P. gingivalis Could Be Risk Factor for Esophageal Cancer

MedicalResearch.com Interview with:

Dr. Huizhi Wang Assistant Professor Department of Oral Immunology and Infectious Diseases University of Louisville School of Dentistry Louisville, KY

Dr. Huizhi Wang

Dr. Huizhi Wang
Assistant Professor
Department of Oral Immunology and Infectious Diseases
University of Louisville School of Dentistry
Louisville, KY 

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Wang: Esophageal cancer is the eighth most frequent tumor and sixth leading cause of cancer death worldwide, characterized by rapid development and poor prognosis, including high mortality. Whereas the majority of cases occur in Asia, particularly in central China, recent data suggest that the frequency of new cases is rising in Western Europe and the USA. Mounting evidence suggests a causal relationship between specific bacterial infections and the development of certain malignancies. However, the possible role of the keystone periodontal pathogen, Porphyromonas gingivalis, in esophageal squamous cell carcinoma (ESCC) was unknown before our study. We found P. gingivalis infects epithelium of cancerous tissues up to 61%, as compared with 12% of adjacent tissues and non-infected in normal esophageal mucosa. A similar distribution of lysine-specific gingipain, a catalytic endoprotease uniquely secreted by P. gingivalis, and P. gingivalis DNA was observed. Moreover, we found infection of P. gingivalis was positively associated with the multiple clinicopathologic characteristics, including differentiation status, metastasis, and overall survival rate.  Continue reading

PET Scans May Be Overused To Detect Recurrent Lung Cancer

MedicalResearch.com Interview with:

Mark A. Healy, MD Department of Surgery Center for Healthcare Outcomes & Policy, University of Michigan Ann Arbor, MI

Dr. Mark Healy

Mark A. Healy, MD
Department of Surgery
Center for Healthcare Outcomes & Policy, University of Michigan
Ann Arbor, MI  

Medical Research: What is the background for this study? What are the main findings?

Dr. Healy: In our study, we found high overall use of PET as a primary study for recurrence detection in lung and esophageal cancers, with substantial hospital-based variation in the use of PET. Despite this, there was not a significant difference in survival for patients across high and low PET use hospitals.

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Does Malpractice Fear Drive Overuse of Esophageal Cancer Screening?

Megan A. Adams, MD Gastroenterology Fellow University of MichiganMedicalResearch.com Interview with
Megan A. Adams, MD
Gastroenterology Fellow
University of Michigan

 

Medical Research: What are the main findings of the study?

Dr. Adams: Surveys of doctors indicate that their fear of a malpractice lawsuit for missing a diagnosis of esophageal cancer might drive the overuse of tests called upper endoscopies in patients who are at low risk for the cancer. To examine whether this perception of medical liability risk accurately reflects the real likelihood of a malpractice claim, we looked at a national database of malpractice claims, and compared the rate of claims for delay in diagnosis of esophageal cancer in patients without alarm symptoms (weight loss, dysphagia, iron deficiency anemia), with the rate of claims alleging performance of an upper endoscopy without a good reason for performing the procedure.

The database contained 278,220 claims filed against physicians in 1985-2012. The incidence of reported medical liability claims for failure to screen for esophageal cancer in patients without alarm features was quite low (19 claims in 11 years, 4 paid). In contrast, there were 17 claims in 28 years for complications of upper endoscopies with questionable indication (8 paid).

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Tallness May Be Protective Against Esophageal Cancer

Dr. Aaron P. Thrift PhD Public Health Sciences Division Fred Hutchinson Cancer Research Center Seattle, WA.MedicalResearch.com: Interview with:
Dr. Aaron P. Thrift PhD
Public Health Sciences Division
Fred Hutchinson Cancer Research Center
Seattle, WA.


Medical Research: What are the main findings of the study?

Dr. Thrift: We conclude that height is inversely associated with risk of esophageal adenocarcinoma, both in men and women. The association is not due to confounding from known risk factors or bias.
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Barrett’s Esophagus, Erosive Esophagitis, GI Symptoms and H. Pylori

Joel H. Rubenstein, MD, MSc, FACG, FASGE Research Scientist, Veterans Affairs Center for Clinical Management Research Assistant Professor, Division of Gastroenterology, University of Michigan Medical School VA Medical Center 111-D 2215 Fuller Rd. Ann Arbor, MI 48105MedicalResearch.com Interview with:
Joel H. Rubenstein, MD, MSc, FACG, FASGE
Research Scientist, Veterans Affairs Center for Clinical Management Research
Assistant Professor, Division of Gastroenterology, University of Michigan Medical School
VA Medical Center Ann Arbor, MI 48105
MedicalResearch.com: What are the main findings of the study?

Dr. Rubenstein: In a set of case-control studies within the same population, we found that H. pylori was inversely associated with erosive esophagitis, and with Barrett’s esophagus, but we did not find such a relation with symptoms of gastroesophageal reflux disease (GERD).
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Esophageal Cancer Risk and Dietary Flavonoids

DR. RAUL ZAMORA-ROS, PhD.

POSDOCTORAL FELLOW
UNIT OF NUTRITION, ENVIRONMENT AND CANCER
CATALAN INSTITUTE OF ONCOLOGY (ICO) –
BELLVITGE BIOMEDICAL RESEARCH INSTITUTE (IDIBELL)
BARCELONA, SPAIN

MedicalResearch.com: What are the main findings of the study?

Dr. Zamora-Ros:  Our study shows that diets rich on flavonoids (polyphenols ubiquitously distributed in the plant kingdom, such as in fruit, vegetables, tea, wine and chocolate), particularly flavonols, are associated with less esophageal cancer risk, especially in current smokers. Tobacco smoking causes oxidative stress, and both oxidative stress and smoking tobacco are related to increased esophageal cancer risk. Therefore, our data suggest that the possible protective mechanism of dietary flavonoids may be related to their antioxidant properties, which may not be attributed to the direct antioxidant action, but to the ability to modulate antioxidant enzymatic pathways.

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