Risk of progression depends on several factors
Patients with high-grade dysplasia can immediately be flagged for treatment because they have a clear elevated risk of progression to cancer. However, the decision to treat Barrett’s esophagus, or to monitor the condition for future risk, becomes more nuanced for individuals with less advanced dysplasia or no dysplasia at all. Many people are either at much higher or lower risk of progression than their dysplasia grading suggests. For example, one patient with non-dysplastic Barrett’s esophagus develops cancer within a year of diagnosis, while another non-dysplastic patient remains cancer-free for decades. This variability in outcomes makes determining appropriate patient care very challenging.
For patients with low-grade dysplasia, or who are negative for dysplasia, accounting for additional factors that contribute to an individual’s risk of progression can help to determine appropriate treatment and management. Just as sleeping well and studying before an exam are more powerful in combination, Barrett’s esophagus risk factors are additive, and are considered in conjunction with dysplasia grading to predict an individual’s risk of progression.
Many of the risk factors for developing Barrett’s esophagus – such as age, weight, gender, hiatal hernia and family history – are also risk factors for developing cancer. Other risk factors of cancer progression, such as the presence of lesions, are identified during the endoscopic screening or biopsy analysis.
