Monitoring strategies for reflux patients diagnosed with Barrett’s esophagus are based on the flawed concept that there is a gradual and linear transition to esophageal adenocarcinoma. New research shows that esophageal cancer only develops in a very small minority of patients, and occurs over a 4-year period as a dynamic, stochastic process of punctuated equilibrium followed by catastrophic genomic doubling. The vast majority of patients with Barrett’s experience a pattern of small mutations with little diversity and die of other causes. The new model of cancer evolution explains why screening for Barrett’s is a failed strategy – 95% of those with Barrett’s never develop cancer and die of other causes, while 95% of those who do develop cancer do so outside of surveillance measures. The solution? A Barrett’s screening test that addresses the specific mutations known to occur over the critical 4-year diagnostic window. Changing the way physicians and physician organizations view and do things is a slow process, however, and in the meantime doctors need to stop scaring patients with the word cancer. Although reflux is common, only 5% of those undergoing endoscopy are diagnosed with Barrett’s, and of those, only a minuscule proportion — 0.3% to 0.7% — progress to cancer.
