Cytologic screening for esophageal cancer: Results from 12,877 subjects from a high-risk population in China

Linxian, China, has one of the highest esophageal-cancer mortality rates in the world. In 1983, esophageal balloon-cytology screening was performed to identify subjects eligible for 2 nutrition-intervention trials in Linxian; 12,877 subjects had cytology slides which were satisfactory for diagnosis. Of the 12,649 subjects with squamous-cell diagnoses, 31% were normal by Chinese cytologic criteria; 38% showed hyperplasia; 21% showed dysplasia 1; 6% showed dysplasia 2; 2% showed near-cancer; and 2% showed cancer. Of the 1,471 subjects with columnar-cell diagnoses, 31 % were normal; 44% showed hyperplasia; 16% showed dysplasia 1; 4% showed dysplasia 2; 2% showed near-cancer; and 3% showed cancer. Squamous dysplasia and cancer were more common among females than males, while columnar dysplasia and cancer showed male predominance. The prevalence of dysplasia and cancer of both cell types increased with age. The prevalence of squamous dysplasia was significantly higher than in earlier balloon-cytology screenings in Linxian, probably reflecting changes in cytologic classification.     

The effect of vitamin and mineral supplementation on esophageal cytology: Results from the linxian dysplasia trial

The population of Linxian in China has one of the world's highest rates for esophageal/gastric cardia cancer, as well as documented nutritional deficiencies. To determine whether dietary supplementation with a multi-vitamin multi-mineral preparation could reduce the risk of esophageal cancer and favorably influence precursor lesions, 3,318 individuals age 40-69 with cytologically determined grade I or grade 2 esophageal dysplasia were randomly assigned to receive either an active multi-vitamin multi-mineral supplement or a placebo. Pills were distributed at monthly visits and incident cancers or deaths were recorded. At 30 and 72 months subsequent to randomization all living participants without a known incident cancer were asked to undergo repeat cytological examination of their esophagus. Based on these procedures participants were classified as having no dysplasia, dysplasia grade I, dysplasia grade 2 or near cancer dysplasia. Diagnoses of cancer were based on the cytology findings plus available histologic, radio-logic and clinical materials. At the end of the study there was little overall difference in cumulative risk of esophageal cancer between those receiving vitamin/mineral supplementation and those receiving placebo. There was, however, a significant increase in reversion to non-dysplastic cytology among the group receiving the active treatment. The odds of not having any dysplasia at the two post-randomization screens was 1.23 times higher in the active treatment group than in the placebo group. Within each treatment group higher categories of dysplasia were associated with higher rates of cancer. © 1994 Wiley-Liss, Inc.     

Secondary prevention of esophageal cancer--intervention on precancerous lesions of the esophagus

In 1983, intervention of precancerous lesion of esophagus was undertaken in the high risk area of esophageal cancer, Heshun Village, Linxian County. It had been expected that cancerous degeneration rate of esophageal dysplasia should be reduced by 50% so as the prevention of esophageal cancer could become possible. 6758 subjects of the general population aging from 40 to 65 were examined by esophageal exfoliative cytology, 1729 had marked dysplasia and 2411 had mild dysplasia of esophageal epithelium. Those with marked dysplasia were randomized into 3 groups to take their respective medication: antitumor B (Chinese herbs); retinamide (4-Ethoxycarbophenylretinamide) and placebo. The subjects with mild dysplasia were divided randomly into 2 groups for treatment by riboflavin and placebo. 95% of the subjects had taken 90% or more of the total medication for 3 years, at the end of which they were reexamined by esophageal exfoliative cytology. The reexamination rate was 94.1%. The incidence of esophageal cancer in the antitumor B group (3.9%) was reduced by 53% as compared with that of the placebo group (8.3%). This difference had statistical significant (means 2 = 7.672, P less than 0.05). The incidence of esophageal cancer in retinamide and riboflavin groups were reduced by 33.7% and 19% as compared with those of the control groups. The regression rate of dysplasia in the treatment groups were increased than that of the control groups. The above results showed that our hypothesis about the secondary prevention of esophageal cancer is correct. The intervention of precancerous lesion of the esophagus is effective in the prevention of esophageal cancer.(ABSTRACT TRUNCATED AT 250 WORDS)     

No association between HPV infection and the neoplastic progression of esophageal squamous cell carcinoma: result from a cross-sectional study in a high-risk region of China

Esophageal cancer is a leading cause of cancer death, especially in developing countries. In high-risk regions, squamous cell carcinoma is the most common type of esophageal cancer, and its etiology remains poorly understood. The purpose of this study was to evaluate the association between human papillomavirus (HPV) infection and esophageal squamous cell carcinoma (ESCC) and related precursor lesions in a high-risk area of China. We conducted a cross-sectional study among adult inhabitants of Linxian, China. All subjects were interviewed about potential risk factors, had the length of their esophagus sampled by a balloon cytology examination and underwent endoscopy with mucosal iodine staining and biopsy of all unstained lesions. A multivalent HPV hybridization probe, Digene Hybrid Capture II (Gaithersburg, MD), which recognizes high-risk types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 68, was used to determine the HPV infection status of the cytologic specimens, and the endoscopic biopsies were used to classify each subject's esophageal disease. 740 subjects completed the cytologic and endoscopic exams, and 702 had adequate cytologic and biopsy specimens. Using a cutpoint of > or =3.0 pg/ml of HPV DNA to define a positive test, HPV positivity was identified in 13% (61/475) of subjects without squamous dysplasia, 8% (8/102) with mild dysplasia, 7% (6/83) with moderate dysplasia, 16% (6/38) with severe dysplasia and zero (0/4) with invasive ESCC. Changing the cutpoint defining a positive test did not change the association of HPV infection and dysplasia grade. In this high-risk population, infection of esophageal cells with high-risk HPV types occurs in 13% of asymptomatic adults with no evidence of squamous dysplasia and a similar proportion of individuals with mild, moderate or severe dysplasia. This suggests that HPV infection is not a major risk factor for ESCC in this high-risk Chinese population. Further studies are warranted to determine if infection with this agent is associated with neoplastic progression in a subset of cases.     

A Survey of Esophageal Cancer in Cixian County of Hebei Province

OBJECTIVE To characterize the histologic types of esophageal cardiac mucosa by endoscopic survey in a high-risk cancer area of China. METHODS An endoscopic survey with Lugol,s staining was carried out in Cixian County, Hebei Province from December 2001 to May 2002. The data were processed using computer SPSS 10.0 software. RESULTS The incidences of mild esophagitis, moderate esophagitis, and severe esophagitis were for 2013 cases, 34.9%(703), 1.6%(33) and 0.1% (2)respectively; those with mild dysplasia, moderate dysplasia, severe dysplasia of the esophagus were 8.6% (172), 7.8% (157) and 2.6% (53) respectively; those with carcinoma in situ, intramucosal carcinoma, invasive squamous carcinoma of the esophagus were 2.5%(50), 0.2% (4) and 0.7%(14) respectively. The histologic-detecting rates of non-atrophic gastritis, and atrophic gastritis of the cardia were 36.3%(730), 11.5% (232) respectively; those with mild dysplasia, severe dysplasia of the cardia were 2.5%(51), 0.8%(17) respectively; those with intramucosal adenocarcinoma, invasive adenocarcinoma of the cardia were 0.1% (3), 0.8%(17) respectively. The early-detection rate of esophageal cancer was 79.4%(54/68). The survey rate(examined population to covered population) was 73.8% (2013/2725). CONCLUSIONS Esophageal endoscopic screening with Lugol‘s solution staining has an advantage over esophageal balloon cytology, in that the histological diagnoses of esophageal cardiac diseases can be obtained, thus contributing to the prevention of subsequent disease. In using the staining method the detection rate of early esophageal cancer is higher than that revealed by balloon cytology.     

Association between GSTM1*0 and squamous dysplasia of the esophagus in the high risk region of Linxian, China

Individuals with specific phase I and phase II enzyme polymorphisms may be at increased risk for squamous cell carcinoma of the esophagus. However, to our knowledge there has been only one previous report that evaluates a potential role for these polymorphisms in increasing risk for preneoplastic squamous lesions of the esophagus. To explore this further, we examined polymorphisms in CYP1A1, CYP2E1, GSTM1 and GSTT1, both independently and in combination, for potential associations with the risk of biopsy-proven squamous dysplasia of the esophagus in asymptomatic adults from Linxian, a high risk region in China. Cases consisted of 56 individuals from an esophageal cancer screening study with an endoscopic biopsy diagnosis of mild or moderate squamous dysplasia. Each case was matched on age (+/- 1 year) and gender to a control. Controls were defined as screening study participants with an endoscopic biopsy diagnosis of normal mucosa or esophagitis. DNA was extracted from frozen cell samples obtained by cytologic balloon examination and genotyped using standard methods. Individuals who were GSTM1 null (homozygous for GSTM1*0) were found to have a tendency for an increased risk of esophageal squamous dysplasia (odds ratio=2.6, 95% CI, 0.9-7.4). No excess risks were observed for inheritance of other putative at risk genotypes CYP1A1*2B, CYP2E1*6 or GSTT1*0. The risk associated with the inheritance of combined genotypes was not significantly different than the risk estimates from the univariate analysis. These results are consistent with the notion that exposure to environmental carcinogens that are detoxified by GSTM1, such as polycyclic aromatic hydrocarbons, may contribute to the etiology of esophageal cancer in Linxian.     

河北省磁县食管癌普查

[目的]通过内镜普查了解食管癌高发区人群食管及贲门癌和其他各种病变的患病情况，达到早诊早治的目的。[方法]河北省肿瘤研究所于2002年在磁县台城乡进行了电子纤维胃镜辅以碘染色普查，结果采用SPSSl0．0软件进行统计学处理。[结果]食管癌高发区人群中轻度食管炎、中度食管炎、重度食管炎的组织学检出率分别是34．9％、1．6％、0．2％；轻度不典型增生、中度不典型增生、重度不典型增生的组织学检出率分别是8．6％、7．8％、2．6％；食管原位癌、黏膜内癌、浸润性鳞癌的组织学检出率分别是2．5％、0．2％、0．7％。贲门炎的组织学检出率是47．8％；轻度不典型增生、重度不典型增生的组织学检出率分别是2．5％、0．8％；黏膜内腺癌、浸润性腺癌的组织学检出率分别是0．1％、0．8％。内镜普查食管癌的早期发现率为79．4％。普查率达73．8%。[结论]电子纤维胃镜辅以碘染色直接普查较拉网普查的优点是可以得到食管和贲门各种病变的组织学诊断，早期食管癌的检出率高于拉网普查．为二级预防打下基础。     

A case-control study of cancer of the esophagus and gastric cardia in Linxian

A case-control study involving interviews with 1,244 patients (758 males and 486 females) with cancer of the esophagus or gastric cardia and 1,314 population-based controls (789 males, 525 females) was carried out in Linxian, a rural county in North Central China with one of the world's highest mortality rates for these tumors. Cancer risks tended to rise with increasing intake of wheat and corn, but no association was found with adult intake of pickled vegetables, the leading a priori suspect, and risks were not elevated among those consuming low quantities of fresh vegetables or fruits. Few differences in preparation or storage of food or water were detected, although cancer patients reported less fluid intake than controls. Few persons reported drinking alcoholic beverages. Smoking was reported by 61% of the male cases and was a mild risk factor, related more to cancer of the cardia than of the esophagus. The risk was increased by 70% among those whose parents had esophageal or stomach cancer, but only slightly among those whose spouses had such cancers, suggesting that exposure early in life and/or genetic effects may be involved.     

牙齿缺失与上消化道肿瘤关系前瞻性研究

[目的]探讨牙齿缺失与食管癌、贲门癌、胃癌发病的关系.[方法]采用前瞻性队列的研究方法.研究对象为1986～1991年林州市营养干预试验研究中的普通人群组,随访11年,观察牙齿缺失与食管癌、贲门癌、胃癌发生的关系,资料采用SPPSSl0.0多因素非条件Logistic回归分析.[结果]男性牙齿缺失与食管癌、贲门癌发病有统计学关联,相对危险度(RR)分别为1.265(95%CI=1.115～1.435,P=0.000);1.170(95%CI=1.009～1.356),P=0.037.女性牙齿缺失与胃癌发病有统计学关联,RR值为1.470(95%CI=1.042～2.074),P=0.027.经调整年龄、吸烟、体质指数、家族史等混杂因素后,男性牙齿缺失增加食管癌发病、女性牙齿缺失增加胃癌发病的危险性.牙齿缺失与上消化道肿瘤发病存在剂量-反应关系.[结论]在林州市男性牙齿缺失增加食管癌、贲门癌发病的危险,女性牙齿缺失增加胃癌发病的危险.     

Prospective study of serum selenium levels and incident esophageal and gastric cancers

BACKGROUND: From March 1986 through May 1991, we conducted a randomized nutritional intervention trial, the General Population Trial, in Linxian, China, a region with epidemic rates of squamous esophageal and adenomatous gastric cardia cancers. We found that participants who received selenium, beta-carotene, and vitamin E had significantly lower cancer mortality rates than those who did not. In the current study, we examined the relationship between selenium levels measured in pretrial (1985) sera from participants and the subsequent risk of developing squamous esophageal, gastric cardia, and gastric non-cardia cancers during the trial. METHODS: This study was designed and analyzed in accord with a stratified case-cohort sampling scheme, with the six strata defined by sex and three age categories. We measured serum selenium levels in 590 case subjects with esophageal cancer, 402 with gastric cardia cancers, and 87 with gastric non-cardia cancers as well as in 1062 control subjects. Relative risks (RRs), absolute risks, and population attributable risk for cancers were estimated on the basis of the Cox proportional hazards models. All statistical tests are two-sided. RESULTS: We found highly significant inverse associations of serum selenium levels with the incidence of esophageal (P: for trend <10(-4)) and gastric cardia (P: for trend <10(-6)) cancers. The RR and 95% confidence interval (CI) for comparison of highest to lowest quartile of serum selenium was 0.56 (95% CI = 0.44-0.71) for esophageal cancer and 0.47 (95% CI = 0.33-0.65) for gastric cardia cancer. The population proportion of these cancers that is attributable to low selenium levels was 26.4% (95% CI = 14.45-38.36). We found no evidence for a gradient of serum selenium associated with incidence of gastric non-cardia cancer (P: for trend =.96), with an RR of 1.07 (95% CI = 0.55-2.08) for the highest to lowest quartile of serum selenium. CONCLUSIONS: Our study supports findings from previous prospective studies and randomized trials that variations in selenium levels affect the incidence of certain cancers. In the United States, where intervention trials of selenium are in the planning stages, consideration should be given to including populations at high risk for squamous esophageal and gastric cardia cancers.     

Prospective study of serum vitamin E levels and esophageal and gastric cancers

Participants in the General Population Trial, a randomized nutrition intervention trial in Linxian, China, who received a combination of selenium, beta-carotene, and vitamin E supplements, had statistically significantly lower cancer mortality rates than those who did not receive the supplements. In the current study, we used a case-cohort design to examine the association between pre-trial serum vitamin E levels and the risks of developing esophageal and gastric cancers during the trial. We measured serum alpha- and gamma-tocopherol and cholesterol levels in 1072 case patients with incident esophageal squamous cell carcinoma (ESCC), gastric cardia cancer (GCC), or gastric noncardia cancer (GNCC) and in 1053 control subjects. The relative risks for comparisons of the highest to the lowest quartiles of serum alpha-tocopherol were 0.63 (95% confidence interval [CI] = 0.44 to 0.91) for ESCC, 0.84 (95% CI = 0.55 to 1.26) for GCC, and 2.05 (95% CI = 0.89 to 4.75) for GNCC. Serum gamma-tocopherol level was not associated with the incidence of any of these cancers. Our findings provide support for the role of alpha-tocopherol in the etiology of upper gastrointestinal cancers.     

Role of Helicobacter pylori cagA(+) strains and specific host immune responses on the development of premalignant and malignant lesions in the gastric cardia.

The incidence rates of gastric cardia and esophageal adenocarcinomas are increasing, but data suggest that carriage of cagA(+) Helicobacter pylori strains may protect against development of Barrett's esophagus and esophageal adenocarcinoma. Our aims were to examine the relationship between pre-malignant and malignant lesions in the gastric cardia and serum antibodies to H. pylori antigens in patients with and without complications of Barrett's esophagus. The prevalence of carditis was 40% in controls compared with 13% in patients with complicated or uncomplicated Barrett's esophagus and cardia adenocarcinoma (p < 0.001). Cardia intestinal metaplasia (IM) and atrophy were present and concordant in 28% of controls but less frequent in patients with Barrett's alone or with dysplasia/adenocarcinoma (0% for each, p < 0.001). Carriage of cagA(+) strains was present in 34% of patients with carditis and significantly associated with increased frequency and severity of cardia inflammation, IM, and atrophy but not with adenocarcinoma. IgA and HspA seropositivity were significantly increased in H. pylori-colonized patients with carditis compared to persons with normal cardia histology (p 相似文献   

Mortality and incidence trends from esophagus cancer in selected geographic areas of China circa 1970-90

China was one of the countries with the highest esophagus cancer risk in the world during the 1970s. This report provides data on time trends of esophagus cancer incidence and mortality during the 1970s-90s in selected geographic areas of China. Information on newly diagnosed cancer cases and cancer deaths is based on data collected by local population-based registries and Disease Surveillance Points (DSP). For the whole country, esophagus cancer mortality decreased slightly, 17.4 per 10(5) populations during 1990-92 in contrast to 18.8 per 10(5) populations in 1973-75. In the Linxian area, trends in the incidence and mortality rates for esophagus+gastric cardia cancer reversed over time; incidence rates increased significantly during 1959-72 but were decreased significantly on average -2.26% (95% Confidence Interval [CI]: -1.74, -2.77) and -1.10% (95% CI = -0.58, -1.62) per year for males and females, respectively, during 1972-97. In urban Shanghai, incidence trend for esophagus cancer decreased monotonically and significantly on average by -4.99% (95% CI = -4.28, -5.70) and -5.18% (95% CI = -4.99, -5.70) per year for males and females, respectively. In Nanao islet, esophagus+gastric cardia cancer mortality rates increased during 1970-82 but decreased slowly from 1982-99 (-0.96% per year; 95% CI = -0.14, -1.78). Our study indicates that incidence and mortality rates for esophagus or esophagus+gastric cardia cancer are now decreasing in China. The declines may be due to an unplanned success of prevention, such as changes in population dietary patterns and food preservation methods.     

Prospective study of risk factors for esophageal and gastric cancers in the Linxian general population trial cohort in China

Esophageal cancer incidence and mortality rates in Linxian, China are among the highest in the world. We examined risk factors for esophageal squamous cell carcinoma (ESCC), gastric cardia cancer (GCC), and gastric noncardia cancer (GNCC) in a population-based, prospective study of 29,584 adults who participated in the Linxian General Population Trial. All study participants completed a baseline questionnaire that included questions on demographic characteristics, personal and family history of disease, and lifestyle factors. After 15 years of follow-up, a total of 3,410 incident upper gastrointestinal cancers were identified, including 1,958 ESCC, 1,089 GCC and 363 GNCC. Cox proportional hazard models were used to estimate risks. Increased age and a positive family history of esophageal cancer (including ESCC or GCC) were significantly associated with risk at all 3 cancer sites. Additional risk factors for ESCC included being born in Linxian, increased height, cigarette smoking and pipe smoking; for GCC, male gender, consumption of moldy breads and pipe smoking; and for GNCC, male gender and cigarette smoking. Protective factors for ESCC included formal education, water piped into the home, increased consumption of meat, eggs and fresh fruits and increased BMI; for GCC, formal education, water piped into the home, increased consumption of eggs and fresh fruits and alcohol consumption; and for GNCC, increased weight and BMI. General socioeconomic status (SES) is a common denominator in many of these factors and improving SES is a promising approach for reducing the tremendous burden of upper gastrointestinal cancers in Linxian.     

食管癌高发区贲门癌、胃癌流行强度分析及其对内镜筛查的启示

 目的 分析涉县等食管癌高发区贲门癌、胃癌的流行强度，明确其防治任务，探讨具体控制途径。方法 对比分析涉县、林县、磁县全人群肿瘤登记的食管癌、贲门癌、胃癌发病率与死亡率以及内镜筛查6233例40-69岁人群三种癌及癌前病变的检出率。结果 太行山南麓食管癌高发区食管癌、贲门癌和胃癌发病率或死亡率的合计占到全身恶性肿瘤的70％～80％。涉县2000-2004年贲门癌发病率男女性分别为69．9／10万和41．5／10万，死亡率男女性分别为54．3／10万和33．2／10万。高发区运用内镜碘染色指导活检技术筛查，食管鳞状上皮癌前病变及早期癌的检出率高，但贲门和胃腺上皮癌前病变及早期癌的检出率相对较低。结论 太行山南部食管癌高发区存在贲门癌和胃癌共同高发的现象，要想通过旱诊早治从整体上降低该地区上消化道癌的死亡率，必须加强内镜对贲门和胃腺上皮癌前病变及早期癌检出的研究。     

食管拉网细胞学对食管癌前病变和危险因素的探讨

 1995年7月-1995年10月在泰国南部食管癌高发区宋卡省进行的食管拉网细胞学检查是将我国的拉网细胞学诊断方法第一次用于国外。泰南559例受检者细胞学结果显示与中国食管癌高发区林县相同的三大特点：1．高的不正常细胞发生率；2．高的过度角化细胞出现率；3．大量的霉菌和炎性细胞。再一次证明在癌的高发区存在高比率的癌前病变；并提示存在的可能的危险因素：霉菌感染和维生素缺乏。同时，拉网细胞学结合对受检者审查发现吸烟、饮酒、嚼烟草也是与食管上皮改变有关的因素。     

EPIDEMIC STRENGTH OF CARDIA AND DISTANT STOMACH CANCER IN THE HIGH RISK REGION OF ESOPHAGEAL CANCER AND THEIR IMPLICATION TO EDOSCOPIC SCREENING

Objective： To discuss the epidemic strength of cardia and distant stomach cancers in the high risk region of esophageal cancer along the south Taihang mountain such as in Shexian, Linxian, and Cixian Counties, and to clarify the tasks for the control of upper gastrointestinal tract cancer as a whole in the region. Methods： Comparisons of incidence and mortality rates of esophageal, cardia and stomach cancers were made between Cixian, Linxian and Shexian Counties with reference to detection rates of cancer in situ and precancerous lesions of the three upper gastrointestinal cancers by endoscopic screening. The screening was performed from 1999 through 2004 in the three adjacent counties including a total of 6233 local residents aged 40 to 69 years old. Results： The incidence rates for cardia cancer for the male and female from 2000 through 2004 were 69.9 and 41.5, and the mortality rates were 54.3 and 33.2 respectively in Shexian County. Esophageal, cardia, and stomach cancers constitute about 70～80 percent of all malignant disease by incidence or mortality rates. Endoscopic survey with iodine staining can effectively detect squamous cell precancerous lesions in the esophagus, but the method is inadequate for the detection of adeno precancerous lesions of the cardia and stomach. Conclusion： The south Taihang mountain region is a high risk area not only for esophagus cancer, but also for cardia and stomach cancers. To control upper gastrointestinal tract cancers as a whole in the region, special attention should be paid to the control of cardia and stomach cancers. Presently, to find effective screening methods for detecting cardia and stomach precancerous lesions is especially important.     

DIAGNOSIS AND SURGICAL TREATMENT OF 103 PATIENTS WITH EARLY ESOPHAGEAL CANCER AND CARDIAC CANCER OF STOMACH

ＤＩＡＧＮＯＳＩＳＡＮＤＳＵＲＧＩＣＡＬＴＲＥＡＴＭＥＮＴＯＦ１０３ＰＡＴＩＥＮＴＳＷＩＴＨＥＡＲＬＹＥＳＯＰＨＡＧＥＡＬＣＡＮＣＥＲＡＮＤＣＡＲＤＩＡＣＣＡＮＣＥＲＯＦＳＴＯＭＡＣＨＷｕＣｈａｎｇｒｏｎｇ；ＺｈａｎｇＺｈｅｎｂｉｎ；ＺｈｕＺｏｎｇｈ...     

Heredity and risk of cancer of the esophagus and gastric cardia.

The importance of genetic factors in the etiology of esophageal cancer is uncertain. We addressed the question of heredity in a population-based, nationwide case-control study conducted in Sweden during 1995 through 1997. The study involved 189 patients with esophageal adenocarcinoma, 262 with cardia adenocarcinoma, 167 with esophageal squamous cell carcinoma, and, for comparison, 820 control subjects. Familial occurrence of cancer was explored at face-to-face interviews. Logistic regression, with multivariate adjustment for potential confounders, was used to calculate odds ratios (ORs), which estimated relative risk. Occurrence of esophageal cancer among first-degree relatives did not increase the risk of adenocarcinoma or squamous cell carcinoma of the esophagus. Neither were there any significant associations with familial occurrence of gastric cancer or other gastrointestinal tumors. The risk of cardia adenocarcinoma was moderately increased among persons with first-degree relatives with gastric cancer (OR, 1.6; 95% confidence interval, 1.0-2.6). Familial occurrence of any cancer was not associated with increased risks of any of the three studied tumors. In conclusion, heredity does not seem to contribute importantly to the occurrence of esophageal cancer of any histological type. A weak association between familial gastric cancer and the risk of cardia cancer may represent a genetic link.     

A comparative cytopathologic and histologic study of atypia, dysplasia, and adenocarcinoma in Barrett's esophagus.

As a potentially premalignant condition, Barrett's esophagus has stimulated controversy over the need for surveillance of glandular dysplasia and early carcinoma. This prompted the authors to review their experience with endoscopic cytologic brushings and biopsies from patients with Barrett's esophagus. The authors reviewed 65 consecutive specimens from 42 patients with Barrett's esophagus in which both the concurrently obtained esophageal cytologic brushings and companion biopsy specimens were available. In addition, esophagogastrectomy specimens from 9 nine these patients were reviewed. Cytologic and histologic specimens were assigned to one of four diagnostic categories, based on specifically defined criteria: simple Barrett's esophagus with or without inflammatory atypia; dysplasia; adenocarcinoma; or suspicious for dysplasia or carcinoma. Simple Barrett's esophagus was diagnosed in 38 cytologic brushings and 44 biopsy specimens, dysplasia in 4 brushings and 7 biopsy specimens, and carcinoma in 14 brushings and 10 biopsy specimens. Nine brushings and three biopsy specimens were suspicious. In 13 cases, brushings revealed a higher grade lesion than did histology; in 5 cases, biopsy specimens showed a higher grade lesion. Agreement between the two occurred in 72% (47/65) of all specimens. Accuracy was confirmed in the histologic examinations of the resection specimens. The authors conclude that specific criteria, when consistently applied, allow accurate cytologic diagnoses of epithelial changes in Barrett's esophagus. The use of esophageal brush cytology and biopsy specimens provides two complementary techniques, which detect a greater number of serious lesions than either technique alone.