Low Risk of Progression of Barrett’s Esophagus to Neoplasia in Women

Abstract

Background and Aims: Men are at a higher risk for Barrett’s esophagus (BE) and esophageal adenocarcinoma (EAC), but little is known about BE progression to dysplasia and EAC in women. We performed a retrospective, multicenter cohort study to assess risk of BE progression to dysplasia and EAC in women compared with men. We also investigated comorbidities, medication use, and endoscopic features that contribute to sex differences in risk of BE progression. Methods: We collected data from large cohort of patients with BE seen at 6 centers in the United States and Europe, followed for a median 5.7 years. We obtained demographic information (age, sex, ethnicity), clinical history (tobacco use, body mass index, comorbidities), endoscopy results (procedure date, BE segment length), and histopathology findings. Neoplasia was graded as low-grade dysplasia, high-grade dysplasia (HGD), or EAC. Rates of disease progression between women and men were compared using χ2 analysis and the Student t test. Multivariable logistic regression was used to assess the association between sex and disease progression after adjusting for possible confounding variables. Results: Of the total 4263 patients in the cohort, 2145 met the inclusion criteria, including 324 (15%) women. There was a total of 34 (1.6%) incident EACs, with an overall annual incidence of 0.3% (95% confidence interval: 0.2%-0.4%). We found significant differences between women and men in annual incidence rates of EAC (0.05% for women vs. 0.3% in men; P=0.04) and in the combined endpoint of HGD or EAC (0.1% for women vs. 1.1% for men; P<0.001). Female gender was an independent predictor for reduced progression to HGD or EAC when rates of progression were adjusted for body mass index, smoking history, race, use of aspirin, nonsteroidal anti-inflammatory drugs, proton-pump inhibitors, or statins, hypertriglyceridemia, BE length, and histology findings at baseline (hazard ratio: 0.11; 95% confidence interval: 0.03-0.45; P=0.002). Conclusions: In a multicenter study of men versus women with BE, we found a significantly lower risk of disease progression to cancer and HGD in women. The extremely low risk of EAC in women with BE (0.05%/y) indicates that surveillance endoscopy may not be necessary for this subgroup of patients with BE.

Sex Differences in Neoplastic Progression in Barrett’s Esophagus: A Multicenter Prospective Cohort Study

“…Our findings with respect to a higher absolute risk of neoplastic progression and shorter time to neoplasia in males than in females are in line with previous results [9,[19][20][21]. These findings suggest that females might benefit less from current surveillance intervals than males.…”

“…These findings suggest that females might benefit less from current surveillance intervals than males. Prolonging surveillance intervals for patients with a low neoplastic progression risk could increase the cost-effectiveness of BE surveillance substantially, which is worth considering given the debatable cost-effectiveness of current surveillance strategies [21][22][23]. However, while the number (and thus costs) of surveillance endoscopies will decrease with prolonging surveillance intervals, the risk of interval carcinoma's will simultaneously increase.…”

Barrett Esophagus

“…A meta-analysis of 4097 patients with Barrett esophagus and without dysplasia reported annual rates of progression to esophageal adenocarcinoma of 0.06% (95% CI, 0.01%-0.10%) for short-segment (Barrett esophagus length <3 cm) Barrett esophagus vs 0.31% (95% CI, 0.21%-0.40%) for long-segment (Barrett esophagus length ≥3 cm) Barrett esophagus . In the retrospective, multicenter cohort study of 2145 patients with Barrett esophagus, after adjusting for body mass index, smoking, race, use of aspirin, nonsteroidal anti-inflammatory drugs, and other factors, women had a lower rate of progression to esophageal adenocarcinoma than men (12.7% vs 21.4%; P < .001) at a median of 5.7 years of follow-up …”

Higher risk of neoplastic progression of Barrett’s esophagus in patients with systemic sclerosis

“…We observed that SSc patients with BE are at high risk of neoplastic progression, with an incidence rate of HGD/EAC of 2.62% per year. This is significantly higher than the 0.48% per year reported in general NDBE patients [ 3 ] and 0.1% annual risk reported in women [ 4 ]. It is worthwhile to note that our patients were predominantly female non-smokers, which is markedly different from the classic BE patients, who are white males and obese.…”