title: Incidence of adenocarcinoma among patients with Barrett's esophagus.
abstract: BACKGROUND
  Accurate population-based data are needed on the incidence of esophageal adenocarcinoma and high-grade dysplasia among patients with Barrett's esophagus.
  
  
  METHODS
  We conducted a nationwide, population-based, cohort study involving all patients with Barrett's esophagus in Denmark during the period from 1992 through 2009, using data from the Danish Pathology Registry and the Danish Cancer Registry. We determined the incidence rates (numbers of cases per 1000 person-years) of adenocarcinoma and high-grade dysplasia. As a measure of relative risk, standardized incidence ratios were calculated with the use of national cancer rates in Denmark during the study period.
  
  
  RESULTS
  We identified 11,028 patients with Barrett's esophagus and analyzed their data for a median of 5.2 years. Within the first year after the index endoscopy, 131 new cases of adenocarcinoma were diagnosed. During subsequent years, 66 new adenocarcinomas were detected, yielding an incidence rate for adenocarcinoma of 1.2 cases per 1000 person-years (95% confidence interval [CI], 0.9 to 1.5). As compared with the risk in the general population, the relative risk of adenocarcinoma among patients with Barrett's esophagus was 11.3 (95% CI, 8.8 to 14.4). The annual risk of esophageal adenocarcinoma was 0.12% (95% CI, 0.09 to 0.15). Detection of low-grade dysplasia on the index endoscopy was associated with an incidence rate for adenocarcinoma of 5.1 cases per 1000 person-years. In contrast, the incidence rate among patients without dysplasia was 1.0 case per 1000 person-years. Risk estimates for patients with high-grade dysplasia were slightly higher.
  
  
  CONCLUSIONS
  Barrett's esophagus is a strong risk factor for esophageal adenocarcinoma, but the absolute annual risk, 0.12%, is much lower than the assumed risk of 0.5%, which is the basis for current surveillance guidelines. Data from the current study call into question the rationale for ongoing surveillance in patients who have Barrett's esophagus without dysplasia. (Funded by the Clinical Institute, University of Aarhus, Aarhus, Denmark.).
authors: Department of Surgical Gastroenterology L, Aarhus University Hospital, Aarhus, Denmark.
authors: Frederik
authors: F
authors: Hvid-Jensen
authors: Lars
authors: L
authors: Pedersen
authors: Asbjørn Mohr
authors: AM
authors: Drewes
authors: Henrik Toft
authors: HT
authors: Sørensen
authors: Peter
authors: P
authors: Funch-Jensen
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology* / Q000209:etiology; D000328:Adult; D000368:Aged; D001471:Barrett Esophagus / Q000150:complications*; D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D004938:Esophageal Neoplasms / Q000453:epidemiology* / Q000209:etiology; D004947:Esophagus / Q000473:pathology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011230:Precancerous Conditions / Q000453:epidemiology* / Q000209:etiology; D016016:Proportional Hazards Models; D012307:Risk Factors