RECENT INCREASES in the number of people with cancer of the oesophagus (gullet) are linked to rising obesity levels and the already high incidence of the disease in the Republic is likely to increase further, a leading expert has said.
Speaking in advance of this week’s fundraising Lollipop Days for the charity Oesophageal Cancer Fund, John Reynolds, professor of surgery at Trinity College Dublin (TCD) and consultant surgeon at St James’s Hospital, Dublin, said there were almost 450 new cases of the cancer here every year. Ireland has one of the highest rates of oesophageal cancer in Europe.
Researchers at TCD have established that obesity is associated with an 11-fold increase in cancer of the oesophagus. Central abdominal fat promotes the reflux of acid from the stomach to the gullet. This acid scars the tissue at the lower end of the swallowing tube leading to pre-cancerous changes called Barrett’s oesophagus.
“In approximately 10 per cent of patients who have tests for severe or chronic heartburn, Barrett’s oesophagus is identified and this confers an approximate 0.5-1 per cent risk per year of progression to cancer,” Prof Reynolds said.
Noting that the same metabolic changes that cause diabetes and heart disease in people who are obese may also directly promote oesophageal cancer, he said: “The TCD research group reported recently in the Annals of Surgery that 62 per cent of patients with Barrett’s oesophagus had metabolic syndrome [a combination of high lipid levels, high blood pressure and resistance to the effects of insulin], compared with 21 per cent in the non-affected population, and 92 per cent were centrally obese, and that that this correlated with the extent of the Barrett’s oesophagus.”
On a positive note, the number of people “cured” of the disease has improved significantly over the last decade, especially in those patients who present with cancer that has not spread beyond the oesophagus.
An increasing number of patients are treated with chemotherapy alone or in combination with radiation therapy before they undergo surgery. International research suggests that people who are looked after in dedicated centres have up to five times less risk of dying from surgery than those treated in hospitals with a low throughput of patients with oesophageal cancer.
But Prof Reynolds said there was a need to move beyond volume alone when assessing quality of care: “We need to move from volume alone as a surrogate of quality, and actually measure outcomes . . . including survival, treatment complications and quality of life.”
He also warned of the need to ensure that care of the cancer patient is immune from pressure for beds, especially from AE departments. “From a public health perspective, we have to assume an added risk of oesophageal cancer in the large demographic of young obese people in Ireland,” he said.
Oesophageal Cancer Fundraising Lollipop Days take place next Friday and Saturday, February 27th and 28th. See lollipopday.com or contact (01) 289 7457