Esophageal cancer is the fastest increasing cancer among American men — and the incidence in Ohio is higher than the national average — but doctors aren't certain why, according to Esophageal Cancer Action Network (ECAN).
Nationally, diagnosis rates in men are six times higher than in women, according to Dr. Amitabh Chak, who specializes in gastroenterology at University Hospitals. Esophageal cancer is the sixth leading cause of cancer death in men, he said.
"Forty years ago, we did not see very many esophageal cancer cases and it's incidence has been growing dramatically, almost exponentially," Chak said. "We don't know why it's growing so rapidly."
But there are precursors to esophageal cancer that can be detected with screening. The first stage is Barrett's Esophagus, or a change in the lining of the esophagus spurred by acid reflux. That stage is followed by finding abnormal cells in the esophagus, followed by cancer.
Chak said there are methods to prevent the cancer from developing. The problem is people aren't being screened, he said. Barrett’s Esophagus causes no symptoms, and many patients experience a reduction in their heartburn symptoms when they develop the condition, according to ECAN.
"We're not affecting the disease because even though we have a method for preventing the cancer or catching it early and avoiding the morbidity and mortality, unless we can identify patients with Barrett's, we're not going to make a difference," Chak said.
But not everyone can have an endoscopy, he noted. That's why his research team at Case Western Reserve University and University Hospitals created a small capsule about the size of a vitamin that gets swallowed by the patient.
Once the capsule reaches the stomach, a balloon-like device inflates and swabs a cell sample from the lower esophagus. The balloon inverts back inside the capsule to protect the sample before it's pulled from the esophagus via string and sent to a lab for a DNA test.
A five-year clinical study for Chak to continue his research by evaluating its effectiveness in detecting esophageal precancer was announced in February.
Who is at risk?
Chak said the most significant risk factor for esophageal cancer is chronic reflux, even if it isn't severe or frequent.
Not only is esophageal cancer more common in men, it's also more common in white people, Chak added. He recommended that people over the age of 50 get screened, adding that obesity is also a risk factor.
"Men tend to have fat cells around their abdominal girth, and those fat cells are more metabolically active," Chak said. "So that may explain some of it, but doesn't explain the whole difference."
There are also regional differences in esophageal cancer numbers. The rate of esophageal cancer in Ohio is 5.6 per 100,000 population, which is higher than the national average of 4.2. Locally, Cuyahoga County's rate is 4.7.
But Chak pointed to the region's mortality rate of esophageal cancer as an indicator of the area's health problems.
"What we find is that in rural counties, the death rate is much higher than it is in areas where there's probably better access to health care," he explained. "And so there is a marked disparity in areas where you may not have endoscopies in areas where access to care is more limited."
Columbiana County leads Northeast Ohio in esophageal cancer mortality rate at 7.0 per 100,000 population, compared to the state average of 4.8. For comparison, Cuyahoga County's mortality rate is 3.9, according to National Cancer Institute data.
Estimates from the American Cancer Society say there are expected to be 22,070 new cases of esophageal cancer diagnosed this year, with 17,430 in men.
