title: The minimal incubation period from the onset of Barrett's oesophagus to symptomatic adenocarcinoma.
abstract: BACKGROUND
  The interval between the onset of Barrett's oesophagus (BO) and oesophageal adenocarcinoma (OAC) can be termed the incubation period. However, the unrecorded onset of BO precludes its direct observation.
  
  
  METHODS
  Determining the range of intervals between BO diagnosis and OAC within the longest observational BO follow-up study. Exclusion criteria were presence of high-grade dysplasia (HGD) or OAC at baseline, death within <2 years of BO diagnosis, oesophagectomy without HGD/OAC and loss to follow-up. A total of 133 patients (M/F 73/60) were taken into account.
  
  
  RESULTS
  In 1967 person years of follow-up there were 13 cases of HGD/OAC, (0.66% p.a.; 95% CI 0.58-0.74), 96 patients died without HGD/OAC and 24 survived without HGD/OAC. The mean intervals between BO diagnosis and either HGD/OAC, death or end of follow-up were 10.8, 12.6 and 25.5 years, respectively, and the mean ages at endpoint were 72.5, 80.0 and 68.3 years, respectively. The survivors without HGD/OAC had a lower age at BO diagnosis (mean 42.8 vs 61.2 and 67.4 years, P<0.001). Baseline presence of low-grade dysplasia was associated with progression to HGD/OAC (log rank P<0.001).
  
  
  CONCLUSIONS
  The Rotterdam BO follow-up cohort revealed a long incubation period between onset of BO and development of HGD/OAC, in patients without HGD/OAC at baseline as illustrated by 24 patients diagnosed with BO at a young age and followed for a mean period of 25.5 years. Their tumour-free survival established a minimum incubation period, suggesting a true incubation period of three decades or more.
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus Medical Centre, Room Ba393, PO Box 2040, 3000 CA Rotterdam, The Netherlands. C.denhoed@erasmusmc.nl
authors.forename: C M
authors.initials: CM
authors.lastname: den Hoed
authors.forename: M
authors.initials: M
authors.lastname: van Blankenstein
authors.forename: J
authors.initials: J
authors.lastname: Dees
authors.forename: E J
authors.initials: EJ
authors.lastname: Kuipers
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology*; D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000453:epidemiology / Q000473:pathology*; D015331:Cohort Studies; D018450:Disease Progression; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D013997:Time Factors; D055815:Young Adult