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GRAY MATTERS: Esophageal Cancer

Posted Jan 16 2010 2:30am

SaulFriedman75x75 Pulitzer Prize-winning journalist Saul Friedman (bio) writes the weekly Gray Matters column which appears here each Saturday. Links to past Gray Matters columns can be found here. Saul's Reflections column, in which he comments on news, politics and social issues from his perspective as one of the younger members of the greatest generation, also appears at Time Goes By twice each month.

This is how bad things got when the economy and Wall Street tanked: Sales of antacids topped $10 billion for the year. And the people who figure such things say that 100 million Americans suffered from heartburn once a month and 15 million battle it at least once a day.

That could strike you as amusing, but it’s not. For as a longtime chewer of Tums or Rolaids, I can tell you that what we call “heartburn,” or “acid indigestion” is not only a literal pain. It is also potentially dangerous, especially when the discomfort is relieved repeatedly with one of the many over-the-counter antacids that are heavily advertised — without including a warning.

Anyone remember that Alka-Seltzer commercial? “You ate the whole thing? I ate the whole thing!” The Alka-Seltzer provided relief from the indigestion, but the guy we laughed at may have been killing himself with each heavy meal and a burp.

One large reason for my concern right now is the approaching fifth anniversary next month of the thunderous, life-changing discovery – through a routine endoscopy – that I had cancer of the esophagus. The fifth anniversary means I have survived. Not cured, mind you, survived, as in so far, so good. For whether you know it or not, cancer can be arrested but there is no cure yet.

The other reason is a new website which caught my attention with this: “I want you to know that heartburn can cause cancer.” Based in Maryland, the website belongs to the new Esophageal Cancer Action Network founded by Mindy Mintz Mordecai who lost her husband, Monte, to the disease two years ago. And she has enlisted her two daughters to appeal to those of you who may be in danger without knowing it.

I understood their appeal, for I have two daughters and narrowly escaped this damned disease because of sheer luck. As Mindy Mordecai wrote, she discovered during her husband’s struggle, as I did during my ordeal, that

“...the cancer that was consuming my husband was caused by acid reflux, something we often call persistent heartburn. And I was angry that I had never been told that heartburn could cause cancer. Angry that, because we didn’t know, we never took any steps to try to catch my husband’s disease.”

When I began my research on the disease following that diagnosis – on St. Valentine’s Day, 2005 – what I learned was not encouraging. The incidence of esophageal cancer was rising faster than any other cancer, and the survival rate was (and is) only 15 percent.

It’s three or for times more common in men, especially if they smoke cigarettes, are overweight and eat too much or irregularly, all of which describe the lifestyles of busy men with stressful jobs. And that was me. Eating too much, chewing an antacid, getting relief and forgetting about until the next time – a potentially deadly cycle.

The incidence of esophageal cancer increases with age; eight of ten people diagnosed with this cancer are between 55 and 85. About 17,000 new cases are diagnosed each year. And most victims die because the cancer is usually caught at the too-late stage. Why? In large part because antacids mask what’s going on when your body is trying to warn you with heartburn or acid reflux.

The medical name for this condition is “gastroesophageal reflux disease,” or GERD. Heartburn, or acid reflux, occurs when digestive acids - that may accompany certain foods, over-eating, along with smoking – splash up from the stomach into the esophagus, the muscular tube that sends food to the stomach.

The cells in the walls of the stomach are tough and acid resistant. But the acid battering of the esophagus changes its cells into the type found in the stomach. That condition is called Barrett’s Esophagus which affects about ten percent of people with GERD and which increases the chance of developing a cancer by 30 to 125 times.

It’s good news when the cancer is spotted very early, when it’s confined to the esophagus. Even so, as it was with me and two friends, treatment involved weeks of chemotherapy, radiation and radical surgery in which most of the esophagus is removed and what remains is attached to the stomach.

Depending on the stage at which the cancer is discovered, there are other, less invasive treatments which can be found at the American Cancer Society site. Unfortunately there are few warning symptoms beyond persistent heartburn. By the time you have difficulty swallowing, as Mindy Mordecai’s husband’s learned, the cancer had spread beyond the esophagus. Even now, I’m subject to periodic checkups.

Despite the rapid growth in the incidence of esophageal cancer, it gets about only $23 million in research funds from the National Cancer Institute. That’s about ten percent or, $1,500 per death, compared to $14,000 per breast cancer death. Indeed, lung and esophageal cancers are shortchanged on research funds, I believe, because there are not too many survivors to lobby for more money and they are considered diseases in which the lifestyle of the victims – smoking and obesity – are blamed.

And it’s true that the increase in cancers of the esophagus seems to have coincided with the increase in obesity.

That suggests some obvious ways to prevent this cancer, according to the American Cancer Society, including cutting down on over-eating, especially spicy or fatty fast foods before bed time or before plunking yourself down on the couch, which increases the chance of acid reflux. If you tend to have acid reflux after meals, don’t lie down. Prop yourself up in bed. I shouldn’t need to tell you that smoking is also strongly linked to esophageal cancer as well as other nasty illnesses.

Beyond this, instead of chewing or swallowing those too-well advertised, over-the-counter remedies to relive the discomfort from GERD, which may mask the development of Barrett’s esophagus, take the antacid before the onset of reflux. Or better, ask your physician for the several prescription drugs available to prevent or control reflux.

And whether or not they work, if you have a history of heartburn, you should ask for an upper endoscopy – a probe of the esophagus and the upper stomach to determine if you’re one of an estimated 3 million Americans with Barrett’s Esophagus – which should be watched closely. Medicare and most insurance companies will cover an endoscopy if it’s prescribed by your primary care physician.

The Esophageal Cancer Action Network has on its board several distinguished physicians including the surgeon who operated on me. And Mindy Mordecai is selling for $2.50 blue wristbands, one of which says, “Heartburn can cause cancer.”

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