Esophageal cancer, while relatively uncommon, has risen dramatically over the past several decades. Currently it is the sixth most common cause of cancer deaths worldwide and its frequency continues to grow rapidly. As its established precursor, actively diagnosing Barrett’s esophagus – often found in people who have long-term gastroesophageal reflux disease or GERD – has taken on greater importance among gastroenterologists and pathologists. And, yet, despite its historically poor prognosis, with four out of five patients dying within 5 years of diagnosis, the risk that Barrett’s will turn into cancer five in 10,000 for women and 15 in 10,000 for men.
A key clinical question is which of the 3-4 million people living with Barrett’s esophagus in the US will progress to esophageal adenocarcinoma. It is an important question given the accepted limitations and lack of uniform consensus of endoscopic definitions in Barrett’s esophagus diagnosis. In fact, it is surprising that there has not been more consideration of the impact of incorrect and/or overdiagnosis of the condition. The inability to determine that risk leaves doctors and their patients without complete information to determine the most clinically and cost-effective treatment. This may lead to unnecessary surveillance and needless worry on the part of patients and families.
In response to both the uncertainty and overdiagnosis of Barrett’s esophagus, medical experts approach this topic using a series of FAQs to focus pathologists on the presence and absence of goblet cells and clues for confirmation tubular esophagus. Knowing how likely that all endoscopists and gastroenterologists will encounter Barrett’s esophagus in their clinical practice, we believe the prudent approach in surveillance and diagnosis is for practicing pathologist to have a thorough understanding of this disease and its diagnostic pitfalls.