More screening for esophageal cancer?

Former Texas Gov. Ann Richards's brief battle with esophageal cancer has raised new questions about whether more people should be screened for the deadly disease.

Esophageal cancer is one of the fastest-rising forms of cancer, but it is rarely detected early, when it is most curable. Most patients live less than a year after being diagnosed — just 15 percent survive for at least five years. Richards lived for just six months after her diagnosis.

The form of cancer that killed Richards — squamous cell — often is associated with a history of heavy alcohol and tobacco use. Richards was a recovering alcoholic and former smoker. The fastest-rising form of esophageal cancer — adenocarcinoma — is strongly linked with years of chronic heartburn and acid-reflux disease.

But whether people should be screened for the disease remains a matter of heated debate in the medical community because it isn't clear whether screening would be cost-effective or make a meaningful difference in long-term survival rates. The medical community routinely screens for a range of diseases in high-risk populations, but there's no routine screening for people at high risk for "one of the deadliest tumors known — esophageal cancer," says Scott Swanson, chief of thoracic surgery at Mount Sinai School of Medicine in New York. "We need to consider (screening) for high-risk groups."

The best way to screen for esophageal cancer is with an endoscopy. During an endoscopy, the patient is sedated while a lighted tube is put down the throat to look for changes in the esophagus that might signal cancer. The procedure costs about $1,000 and is typically covered by insurance. Although an endoscopy is considered a safe procedure, there are always risks associated with anesthesia and a slight risk of bleeding or infection. The main concern about screening endoscopy is cost and the fact that the vast majority of screening endoscopies wouldn't find cancer but would tax the resources of an already overburdened health-care system.

Currently there are more than 14,000 cases of esophageal cancer each year. Considering that there are 40 million current smokers, 100 million former smokers and an estimated 40 million people who suffer weekly bouts of heartburn, the question is who among these groups is at highest risk for esophageal cancer and should be screened.

There are no simple answers. But we do know risk for the squamous-cell esophageal cancer is dramatically higher with long-term use of both tobacco and alcohol. It's six times more likely to occur in African-American men than in whites.