What is the risk of cancer in patients with Barrett esophagus?
Janusz Jankowski, MD, PhD: This is perhaps the most important question. People with Barrett esophagus often go on to the website and get very scared by what they see.
For the average patient with Barrett esophagus with no dysplasia the risk is remarkably low. The lifetime risk of having cancer is no more than 2% or 3%. That means there is a 97% likelihood that patients with Barrett esophagus will die of something else. Because we tend to diagnose Barrett esophagus in mid-50s, patients have 30 years of Barrett [esophagus ahead of them], so essentially it works out at a conversion rate of about 0.2% per year that you will get cancer. That is approximately 1 in 500 patients who will get cancer each year with benign Barrett, which is very low.
If you have low-grade dysplastic change, it increases your risk 3-fold, so your conversion rate is 0.6% per year. It is approximately 1 in 150 patients.
If you have high-grade dysplasia, which is different altogether, your risk increases 30-fold, from 0.2% to 6%, which is approximately 1 in 16 patients.