The perception of cancer risk in patients with prevalent Barrett's esophagus enrolled in an endoscopic surveillance program.
OBJECTIVE
Patients with Barrett's esophagus (BE) have a risk of esophageal adenocarcinoma of approximately 0.5% per year. Patients may have difficulty understanding this risk. This study assessed the perceived risk of cancer in patients with BE, and correlated their risk estimates with their health care use behaviors.


METHODS
We performed a survey of patients with BE participating in an endoscopic surveillance program at 2 sites: a university teaching hospital and a Veterans' Administration hospital. A questionnaire also elicited their demographics as well as their sources of health information. Health care behaviors, including physician visits and endoscopic surveillance behaviors, were assessed. Patients were classified as either overestimators or nonoverestimators of risk. Characteristics of overestimators, as well as health care use patterns, were assessed.


RESULTS
One hundred eighteen patients met entry criteria, and 92 (78%) completed all the questionnaires. Sixty-eight percent of patients overestimated their 1-year risk of cancer, with a mean estimated 1-year cancer risk being 13.6%. The lifetime risk also was overestimated by 38% of patients. Patients who overestimated risk were more likely to be Veterans' Administration medical center patients, have more symptomatic reflux, and were more likely to use the Internet to get health care information. There was no significant difference in physician visits between overestimators and nonestimators (1.2 visits per year vs 1.0, P = .20), nor in endoscopy use (5.7 endoscopies per 5-year period vs 5.0, P = .42).


CONCLUSIONS
The majority of patients with prevalent BE participating in an endoscopic surveillance program overestimated their chances of developing adenocarcinoma of the esophagus. Efforts to improve education of such patients with BE are warranted.
Shaheen
Nicholas J
NJ
Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, University of North Carolina Schools of Medicine and Public Health, Chapel Hill, 27599, USA. nshaheen@med.unc.edu
Green
Bryan
B
Medapalli
Raj K
RK
Mitchell
Kate L
KL
Wei
Jeffrey T
JT
Schmitz
Sarah M
SM
West
Lindsay M
LM
Brown
Alphonso
A
Noble
Marc
M
Sultan
Shahnaz
S
Provenzale
Dawn
D
D000230:Adenocarcinoma / Q000453:epidemiology / Q000473:pathology*; D017677:Age Distribution; D000368:Aged; D001294:Attitude to Health; D001471:Barrett Esophagus / Q000175:diagnosis / Q000473:pathology*; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D004938:Esophageal Neoplasms / Q000453:epidemiology / Q000473:pathology*; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000592:standards / Q000639:trends; D009657:North Carolina / Q000453:epidemiology; D016017:Odds Ratio; D010358:Patient Participation; D011159:Population Surveillance; D011230:Precancerous Conditions / Q000473:pathology*; D015995:Prevalence; D012308:Risk Management; D012309:Risk-Taking; D017678:Sex Distribution; D011795:Surveys and Questionnaires