Aspirin, weight loss may reduce risk of esophageal cancer
Local researchers have discovered lifestyle factors that may reduce a person's risk of developing esophageal cancer.
While 20 million Americans suffer from chronic heartburn, 2 million of these people also have Barrett's esophagus, an abnormal change in cells that can lead to esophageal cancer.
Of the 10,000 Americans diagnosed each year with Barrett's-related esophageal cancer, 80 percent die within five years of diagnosis.
Researchers aren't sure why, but the incidence of this cancer is rising faster than any other cancer in the country.
But researchers in the Seattle Barrett's Esophagus Program, part of the Fred Hutchinson Cancer Research Center, believe several lifestyle choices may prevent the progression of Barrett's, including taking aspirin.
A 2007 Fred Hutch study found that people with the most aggressive form of Barrett's may benefit the most from preventive therapy with aspirin, ibuprofen and other non-steroidal anti-inflammatory drugs (NSAIDs). The same study also identified four genetic abnormalities in people with Barrett's that significantly increased their risk of developing esophageal cancer.
Seattle Barrett's researchers have found patients with three or more of these genetic abnormalities who used aspirin or other NSAIDs had a 30 percent risk of developing esophageal cancer after 10 years a 49-percent improvement over those not using NSAIDs.
Researchers said that aspirin and other NSAIDs may fight cancer by reducing chronic inflammation, which is a driving force behind the development of many cancers and other diseases.
"Many Barrett's patients are subjected to over-diagnosis and over-treatment," said Dr. Brian Reid, director of the Seattle Barrett's Esophagus Program. "These findings ultimately may help us identify high-risk patients who truly require frequent surveillance and low-risk patients who need no or less-frequent surveillance."
The Seattle Barrett's investigators have not completed a clinical trial for aspirin therapy of Barrett's so they cannot recommend NSAIDs for people with Barrett's. The researchers recommend patients talk to a doctor before taking these medications.
Another Fred Hutch study published last year involving more than 400 patients with Barrett's found those who took cholesterol-lowering medications had a 32 percent lower risk of developing esophageal cancer.
The patients with especially advanced Barrett's who took these drugs had a 59 percent reduced risk of esophageal cancer as compared to those who did not take such drugs.
Smoking and obesity
Earlier this year Fred Hutch researchers looked at a variety of lifestyle factors - including smoking and obesity - to see whether they were associated with the progression to esophageal cancer in patients with Barrett's.
Researchers found that heavy smokers with Barrett's were more than twice as likely to develop esophageal cancer as non-smokers with Barrett's.
They also found belly fat was more associated with the progression from Barrett's to cancer than a high body-mass index. While this finding needs to be confirmed, researchers say the association between abdominal fat and cancer may be caused by the inflammatory effects of fatty tissue or an increase in chronic heartburn caused by intra-abdominal pressure exerted by extra belly fat.
Managing acid reflux
The Fred Hutch offers these tips for managing chronic acid reflux, which can lead to Barrett's esophagus:
- Don't smoke.
- Keep your weight down.
- Get regular exercise.
- Eat a diet rich in fruits and vegetables.
- Refrain from eating four hours before bedtime.
- If you're having heartburn, sleep with the head of your bed elevated (talk to your doctor about how to do this).
- Avoid foods and beverages that promote heartburn, including alcohol, caffeine, chocolate, peppermint, onions, green peppers and foods that are high in fat, all of which can relax the muscle that prevents stomach acid from washing up into the esophagus.
- Take antacids as needed for occasional heartburn. Talk to your doctor if you have frequent heartburn or if over-the-counter medications don't relieve your symptoms.