title: Total cancer incidence and overall mortality are not increased among patients with Barrett's esophagus.
abstract: OBJECTIVE
  Barrett's esophagus (BE) increases risk for esophageal adenocarcinoma, but it is not clear how it affects risk for other cancers or overall mortality. We analyzed data from a population-based cohort of subjects with BE.
  
  
  METHODS
  The Netherlands Cohort Study was initiated in 1986 and included 120,852 participants (55-69 years old at baseline). Until December 2002, 626 incident cases of BE (excluding nonintestinal metaplasia) were identified by record linkage with the nationwide Pathology Registry. This cohort was followed for a median period of 5.7 years; data on cancer and mortality were obtained from record linkage to the Netherlands Cancer Registry and Statistics Netherlands. The expected number of cases was calculated using national cancer incidence and mortality data.
  
  
  RESULTS
  In the BE cohort, 13 individuals developed esophageal cancer and 5 developed gastric cancer. The ratio of observed:expected (O:E) incidence of esophageal and gastric cancer was 10.0 (95% confidence interval [CI], 5.3-17.1) and 1.8 (95% CI, 0.6-4.2), respectively. Total cancer incidence (excluding esophageal and gastric cancer) increased in the BE cohort, although not by a statistically significant amount (O:E, 1.3; 95% CI, 1.0-1.6). Of cancer subtypes, incidences of small intestinal and pancreatic cancer increased in subjects with BE, but not by a statistically significant amount, after exclusion of data from the first 6 months of follow-up. During the follow-up period, 225 individuals with BE died. Mortality from all causes (excluding esophageal and gastric cancer) was not increased among subjects with BE (O:E, 1.0; 95% CI, 0.9-1.2), nor was mortality from specific causes of death.
  
  
  CONCLUSIONS
  The incidence of esophageal cancer was increased in a population-based cohort of subjects with BE. However, when esophageal and gastric cancers were excluded, total cancer incidence and overall mortality were not increased among subjects with BE.
authors.affiliation: Department of Epidemiology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands. lj.schouten@maastrichtuniversity.nl
authors.forename: Leo J
authors.initials: LJ
authors.lastname: Schouten
authors.forename: Jessie
authors.initials: J
authors.lastname: Steevens
authors.forename: Clément J R
authors.initials: CJ
authors.lastname: Huysentruyt
authors.forename: Ceciel E
authors.initials: CE
authors.lastname: Coffeng
authors.forename: Yolande C A
authors.initials: YC
authors.lastname: Keulemans
authors.forename: Floor E
authors.initials: FE
authors.lastname: van Leeuwen
authors.forename: Ann L C
authors.initials: AL
authors.lastname: Driessen
authors.forename: Piet A
authors.initials: PA
authors.lastname: van den Brandt
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology / Q000401:mortality*; D000368:Aged; D001471:Barrett Esophagus / Q000150:complications*; D015331:Cohort Studies; D004938:Esophageal Neoplasms / Q000453:epidemiology* / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D013274:Stomach Neoplasms / Q000453:epidemiology / Q000401:mortality