The prediction and prevention of esophageal-cancer risk

Aspirin significantly reduces esophageal-cancer risk in people with most-aggressive form of Barrett's esophagus

Photo by Stephanie Cartier "This is the first prospective, longitudinal study in patients with Barrett's esophagus — or any other pre-malignant condition, for that matter — to link somatic genetic biomarkers for cancer-risk prediction with candidate interventions such as NSAIDs to prevent cancer," said Patricia Galipeau, a lead author for the study and research technician in the Reid Lab. Galipeau is pictured with co-author Dr. Xiaohong Li, a scientist in the Public Health Sciences Division's Statistical Center for HIV/AIDS Research and Prevention.

Researchers in the Human Biology Division have found that people with the most-aggressive form of Barrett's esophagus, a precancerous condition that can lead to esophageal cancer, may benefit the most from preventive therapy with aspirin, ibuprofen and other nonsteroidal anti-inflammatory drugs, or NSAIDs. The researchers also identified a cluster of four known cancer biomarkers, or genetic abnormalities, in people with Barrett's that significantly increases their risk of developing esophageal cancer.

Dr. Brian Reid Human Biology Division

The findings, by lead authors Patricia Galipeau and Dr. Xiaohong Li, senior author Dr. Brian Reid, and colleagues in the Hutchinson Center-based Seattle Barrett's Esophagus Program, were published in the Feb. 27 issue of PLoS Medicine, a freely available online journal. The National Institutes of Health and Hutchinson Center-funded study involved collaborators from Virginia Mason Medical Center, Harvard Medical School and The Wistar Institute.

The researchers found that those with three or more of the cancer biomarkers upon enrollment in the study who also used aspirin or other NSAIDs had a 30 percent risk of esophageal cancer after 10 years, while those with the same biomarkers who did not use NSAIDs had a 79 percent risk of developing cancer within a decade of joining the study.

The researchers also found that Barrett's patients whose esophageal tissue had no such genetic abnormalities, or biomarkers, upon joining the study had a 12 percent risk of developing esophageal cancer after 10 years, whereas those with three or more of the abnormalities at baseline had a nearly 80 percent risk of developing such cancer within a decade.

"Several studies have suggested that individual genetic abnormalities may identify Barrett's patients who are at increased risk of progression toward esophageal cancer, but this is the first study to evaluate the combined contribution of genetic abnormalities for esophageal cancer-risk prediction," said Reid, director of the Seattle Barrett's Esophagus Program.

Ultimately, the researchers hope, these biomarkers one day could be used in a clinical setting to identify which Barrett's patients are most likely to develop esophageal cancer and therefore benefit from aggressive cancer surveillance via endoscopy and chemoprevention with aspirin and other NSAIDs.

To read the full paper, visit www.plos.org/press/plme-04-02-galipeau.pdf.

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