Campaign launched this week has confused me a bit . I always thought that the stomach acid refluxing up into the oesphageous damaged the lining and made it susceptible to changes and the formation of cancerous cells .
But if heartburn is a SIGN of cancer ( as I now read in the papers ) how does that work ? The cancer weakens the sphincter and allows reflux ? So the cancer is present before the reflux ?
I entirely sympathise. The Be Clear on Cancer campaigns have a theme about going to the doctor with blood in poo, coughs etc that have lasted for three weeks or more, so it does not particularly fit well with persistent heartburn, which is not a sign of cancer itself, as many doctors have pointed out; it is a symptom that needs investigating because one of the underlying conditions may be Barrett's Oesophagus, where the cells begin to change and become more like stomach cells in columns within the oesophagus. Barrett's is not cancer. But there is a risk of dysplasia developing with Barrett's, and of dysplasia (more changes in cells) develops, this creates the adenocarcinoma risk - about 1% per year per patient, or 5% in 1 - years for low grade dysplasia; or 6% per patient year, (or 50% in 1 - 8 years) for high grade dysplasia. It is very often a long term thing, with many people with Barrett's not developing adenocarcinoma at all - but for some, the development is suddenly triggered off for reasons we don't know.
So I do not think the cancer is there before the reflux; but many who have the cancer diagnosed have unwittingly had Barrett's undiagnosed beforehand. The lower oesophageal sphincter does not work properly (sometimes because of being overweight; or sometimes a hiatus hernia) and the acid then comes into the oesophagus where the lining cannot cope with the strong acid in the way that stomach cells can.
So to diagnose more people with adenocarcinoma at an early, treatable stage, we have to find more Barrett's cases from the population suffering heartburn. But all that is a bit too complex to go into an advertising slogan!
Well ,I'm really sorry to say this but I think it's a a bad idea for the media to be stating that heartburn is a sign of cancer .
It will damage the credibilty of the campaign .Not to mention causing distress and anxiety .
I think these campaigns always run a risk of causing anxiety to the 'worried well' and what you are saying reflects the debates that took place in Public Health England before the campaign was launched. Many women get worried by lumps in their breast that turn out not to be cancer, some people have blood in their poo that turns out to be haemorrhoids, and so on. But the UK is well behind the best practice in Europe on our outcomes for cancer, and this tends to relate to lack of early diagnosis. If oesophageal cancer is caught in the very early stages the 5 year survival rate is around 90%; overall it is 15%; later stages 3%. For the earliest-stage cancers only 3.6% are referred by GPs (which cannot be regarded as a good thing).
Persistent heartburn is not normal, and it is quite justified to go to your GP to have it investigated. There can of course be a number of different reasons for it, and some really good health-related consultations may well come from those GP visits. There is a protocol that has just been developed, and I believe that what will happen over time is that GPs may put patients on to a course of PPIs for 6 - 8 weeks, and then review it, with a non-urgent endoscopy if then warranted. In Belgium, for instance, patients cannot be prescribed PPIs long term without an authoritative diagnosis from an endoscopy; having a proper diagnosis is a good thing.
A landmark Swedish study quantified the link between heartburn and oesophageal adenocarcinoma (OAC), with an odds ratio (OR) of 8 for a patient experiencing heartburn once weekly in developing OAC, through to an OR of 44 for those with severe, long-standing heartburn.
The UK incidence of OAC has increased eightfold over the past thirty years, shifting the oesophageal cancer balance dramatically from 90% squamous to 70% adenocarcinoma. OAC in the UK is now the highest in the world. The reason is the increase of gastro-oesophageal reflux disease (GORD), a common symptom of which is heartburn, and its principal complication, Barrett’s Oesophagus.
The experience in the North-East regional pilot was that GPs saw an increase of 0.6 extra visits per week because of the campaign, and there was an extra endoscopy list per week per Trust to investigate the extra referrals.
So, overall, it is, I believe, better for people to become worried by persistent heartburn (and the word persistent is very important) and to have it investigated, rather than ignoring it. If we simply concentrated on difficulty in swallowing, something that occurs when a tumour has spread about two-thirds around the circumference of the oesophagus and is much more likely to be beyond curative treatment, we will detect cancer earlier, but we won't be saving any more lives.
I understand the point you are making, but I hope that some of the above will reassure you that the campaign message headline might be simplistic, but it was not done thoughtlessly.
Alan - those stats don't look quite right. But overall you are right. The reflux, the acid, is the root cause of the adenocarcinoma, the cancer. And the reflux doesn't stop when the cancer develops so it can be both the cause of cancer and a sign of possible cancer. Or it could be a sign of a precursor, Barrett's and, therefore, it could enable a diagnosis that allows early preventative treatment.
I agree. In the pilot trial of the campaign last yera, the wording was. "If you've had heartburn most days for three weeks or more, your doctor wants to know."
As Alan points out, it seems that Health England, in trying to provide consistency with previous campaigns they have run, decided to change the message to the not so accurate, "Having heartburn, most days, for three weeks or more, could be a sign of cancer." It would have been better to have said, "... could lead to cancer."
However, if it makes people think more seriously about heartburn, it may not be such a bad thing. we'll see whether GPs are inundated with patients thinking they have cancer already.
I see what you're saying .But personally speaking I think I would have reacted to a message of long term heart burn being something that could cause damage and should be treated .
Heartburn possibly being a syptom of cancer I would have filed under the heading of any number of aches and pains could be cancer and ignored .
Until I was diagnosed with oesophageal cancer in 2011 my knowledge of cancer, in it's many forms, was more or less limited to it being a smoking related illness - my knowledge was that poor.
Prior to stopping in 2010 I'd smoked since the age of around 15 (at one time reaching a 70 a day habit), so I figured if I was going to get cancer, smoking would be the reason. Imagine my surprise when the doctor explained that the lump in my oesophagus, which he said would kill me in two years if not treated, was instead caused by Barrett's and acid.
Although my cancer was found fairly early, it wasn't soon enough to mean that it could be removed endoscopically. As chemo didn't work, it was left to surgery to try and solve things. Due to complications this lead to the loss of my entire stomach and oesophagus, and personal and medical issues that will be with myself and my family for as long as I'm here, and probably after too.
Whatever their issues regarding over-simplification, or lack of detail, I would have been happy to have seen these type of messages which, I believe, would have broadened my knowledge about the subject of cancer, and some of it's symptoms. Just possibly, it may have lead me to go to the doctors even earlier, and at a time when surgery might not have been required.
I personally think the campaign is excellent! I personally had heartburn so bad when I was pregnant with my daughter whom will be 21 in april. I had to eat before 5:00p.m. otherwise I would lose all the nutrients that I put into my body! One of my favorite foods was Chinese and the waiter at the restaurant called my unborn child the heartburn baby! My tumor was very slow growing and I had always had a sensitive stomach before giving birth at 30. I was just in contact with a mutual friend that asked me to talk to a friend of hers that was diagnosed with the same cancer. Esophageal Cancer Adenocarcinoma. I asked her if she had heartburn with her pregnancies and she stated so bad that she actually had heartburn so bad that it caused asthma. She had three children I stopped after the first because I had such a hard time that I thought I would not risk going through it again and had a beautiful healthy daughter. I use to pick the colors of Tums that I would eat next. I had always been very sensitive to different foods but just ignored it. I have no doubt as my surgeon told me that my cancer was caused from Acid Reflux and it had been going on for years. I am tough and continue to be tough! Since I was very little had always had a sensitive stomach! It is up to us to notice what is going on with our bodies and to acknowledge it and the more people I can tell that heartburn may be dangerous I will! As a matter of fact my husband yesterday for the first time had acid reflux and experienced how painful it was. He stated oh my gosh is this what Lisa (me his wife) experiences it's painful. I allowed myself to be tough for too many years with heartburn and a sensitive stomach. Literally to where I would throw up because of the food I ate. I will warn anybody now with acid reflux and heartburn. This is so not scientific just a layman's term. I am grateful that you have a campaign because a very good friend of mine whom is a radiologist oncologist just told me that it is on the rise here in our small little county of San Luis Obispo California! It does not mean that one needs to become paranoid, but aware of the damage that acid reflux can do. I hope that we will adapt the same campaign here in the U.S. to make people more aware of the effects of Acid Reflux or Heartburn! I thank the professionals and the people that have shared on this website more than will ever shall know! Had my last Herception appt. on Monday get my port out next week. Got my blood test back and I was Vitamin D deficient. A red head and stay out of the sun also got a Vitamin B shot at the infusion center on Monday. If I had not found this site I would not have been aware of the vitamin deficiencies and would not have asked my doctors about them and insisted that I get the proper prescriptions for the medical journey that I have been through. I Thank everyone on this site for your cares, concerns and help. It has been invaluable!
Acid can cause cancer in the long-term because it is corrosive and damages the lining of the oesophagus. The stomach is able to protect itself from acid damage but the oesophagus is not. Damage to tissue causes inflammation. Inflammation is very useful if tissue damage is being caused by bacteria, but if there is no infection you have a lot of strong immune-system chemicals in the area. It's a bit like firing up a battalion of soldiers to a point where they are all ready to go into battle and kill the enemy and then letting them loose for a night on the town. There might be collateral damage. For this reason long-term inflammation can, in the long term, damage cells and bring about cancerous changes. The same kind of things seems to happen with some cancers of the stomach lining - but in that example the long-term inflammation is caused by bacteria known as Helicobacter pylori.
The topic of "heartburn," especially in esophageal patients, is complicated as has been mentioned. Here is a great paper: The Integrity of the Esophageal Mucosa. Balance Between Offensive and Defensive Mechanisms ncbi.nlm.nih.gov/pmc/articl.... Terminology is key here:
GERD or GORD (Gastroesophageal Reflux Disease): “a condition which develops when the re- flux of stomach contents causes troublesome symptoms and/or complications.”
NERD (Non-erosive esophageal Reflux Disease): “the presence of classic GERD symptoms in the absence of esophageal mucosal injury during upper endoscopy.”
ERD (Erosive Reflux Disease): “GERD symptoms with erosions present (ERD).
FH (Functional Heartburn): “burning retrosternal discomfort, excluding GERD and esophageal motility disorders as a cause of the symptom.”
Here is another great paper: Endoscopic assessment and management of early esophageal adenocarcinoma ncbi.nlm.nih.gov/pmc/articl...
The damage to the esophagus may come from acid reflux, bile acid, and the fermentation of food sitting in the esophagus (Achalasia).
What is typically not discussed by allopathic medicine are nutrient deficiencies caused both by poor absorption due to disease and lack of absorption due to PPI use. These nutrient deficiencies are quite significant and affect one's overall health and state of inflammation. Food sensitivities, environmental toxins, mindset, stress are all very important factors as well.
I have written a book about Achalasia and review allopathic and functional approaches to Achalasia called LivingWithAchalasia.org. It is available for free as an E-book.
I hope this helps - there are many worthwhile suggestions in the book!
Well I don't think this campaign emphasisis that it is about oesophageal cancer. It only says if you have heartburn for more than 3 weeks see your doctor but I didn't have heartburn or indigestion so it wouldn't have rung alarm bells for me. My symptoms were loss of weight and a pain behind my sternum when I ate certain foods. I am only here because my gp was on the ball.
I checked with my mate who is a retired gastro-oesphageal surgeon and he said that in a few cases reflux can be a symptom of cancer at the bottom of the oesophagus/top of the stomach. Reflux is caused by a weak or damaged valve at the junction and if there was a tumour in the area, it could stop the valve functioning properly. But that is why GP will ask other questions e.g. swallowing, weight loss if you present with acid reflux.
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