Heartburn and cancer: an interview with Mindy Mintz Mordecai

Mindy Mintz Mordecai ARTICLE IMAGE

Please could you give us a brief introduction to heartburn, who it affects and how frequently it occurs?

What most of us think of as heartburn is a symptom of Reflux Disease or GERD (Gastroesophageal Reflux Disease). It’s that burning discomfort an individual experiences when stomach acids and other fluids come back up into their esophagus.

We use the phrase “Heartburn can cause Cancer” because heartburn is the symptom of Reflux Disease with which people are most familiar. Many also correctly connect Reflux Disease with a host of symptoms like nausea after eating, regurgitation, and a sour taste the mouth. But some people aren’t aware that GERD can also cause a chronic cough, hoarse voice or sore throat, chest pain, even a choking sensation upon lying down.

Reflux Disease can affect just about anybody and it is very common. In the United States, it’s estimated that 25 million adults will suffer from Heartburn each day and 40 percent of the entire adult population will experience it at least once each month.

What causes heartburn?

What causes the burning sensation of Heartburn is the irritation caused by the splashing of fluids from the stomach back up into the esophagus. Those fluids also cause the irritation that produces the other symptoms of Reflux Disease.

What types of cancer can heartburn cause?

Persistent Heartburn and Reflux Disease can cause Esophageal Cancer, a particularly deadly type of cancer that will kill four out five patients diagnosed with the disease. The poor survival rate is due in large part to the fact that the Esophageal Cancer is usually detected in late stages, when it is very hard to treat.

There are two types of Esophageal Cancer. The type caused by Heartburn and Reflux Disease is Esophageal Adenocarcinoma. This type of Esophageal Cancer is most prevalent in the United States and it’s increasing rapidly throughout the Western World.

The other type of Esophageal Cancer, squamous cell carcinoma, is more often associated with smoking and drinking and was once the most prevalent type of Esophageal Cancer in the U.S. But, in recent years, squamous cell carcinoma has declined dramatically in the US and the Western World, but the bad news is that Adenocarcinoma has increased just as rapidly as the other type has declined. Squamous cell carcinoma remains the most prevalent type of Esophageal Cancer in the world and it is one of the top cancer killers in many Asian nations.

By what mechanism does heartburn cause cancer?

The esophageal lining can respond with cellular change to the irritation caused by the fluids brought back up when someone experiences Reflux Disease. The lining of the esophagus can react in response to the caustic fluids from the stomach by becoming more like the lining of the stomach. When this occurs, patients have a condition called Barrett’s Esophagus. Barrett’s Esophagus can become dysplastic – pre-cancerous – and, if this condition is not treated, it can become malignant.

New, outpatient procedures are now available to treat Barrett’s Esophagus. Some of those methods of addressing the condition have produced impressive results – curing the condition in 97 percent of cases and potentially eliminating the risk of developing Esophageal Cancer.

Does heartburn always lead to cancer, or does it only occur in some people?

Thankfully, Esophageal Cancer is fairly rare. Most people with Heartburn or Reflux Disease will never go on to develop Esophageal Cancer. But the devastating truth is that, if you are one of the unlucky few, your chances for survival are very slim if your disease is not caught at an early stage. Some studies show that individuals with Barrett’s Esophagus are 50 times more likely to develop Esophageal Cancer than the average individual. And yet, most people who have Barrett’s Esophagus have no idea that they have the condition.

Barrett’s Esophagus has no symptoms. The changes in the esophageal lining don’t cause patients any problems. The only symptoms they may notice arise from the GERD that causes the condition.

In fact, patients who experience symptoms of Reflux Disease like Heartburn and then notice that their symptoms went away may actually be at a greater risk for the disease than those who continue to feel the symptoms. This can create a false sense of security. In some cases what is really happening is that the patient’s esophageal lining has changed so completely in response to the stomach fluids that they no longer cause irritation the patient can feel. Too often, those changes result in malignancy.

Today, we don’t have the research to predict who will go on to develop Esophageal Cancer after Barrett’s Esophagus is present, or what makes one more likely to develop Barrett’s Esophagus in the first place. But, these are exactly the type of research findings we are hoping to see in the near future to help us detect this disease at earlier, treatable stages.

Why do you think that a lot of people don’t know that heartburn can cause cancer?

The increase in Esophageal Adenocarcinoma over the past few decades has been explosive – up more than 600 percent in the past 30 years by some measures. That means that some primary care physicians trained even 20 years ago don’t think of Esophageal Cancer when they see cases of persistent Heartburn.

At least in the US, until ECAN, the Esophageal Cancer Action Network, began its public awareness efforts three years ago, there were no large scale efforts to educate the general public about the link between Heartburn and Cancer.

Most people believe the Heartburn they experience is a nuisance and an annoyance, but too many also believe it is benign. So, they often look for a quick remedy to end the symptoms without seeking to find out the cause or the impact Reflux Disease may be having on their long-term health.

A recent study found that GERD patients who were effectively medicated for their symptoms were more likely to develop Esophageal Cancer. The result was not because the medications caused the disease, but because the medication worked well enough that these patients didn’t have any symptoms that prompted them to go to their doctor to address the problem until it was too late.

Usually patients with Esophageal Cancer don’t discover their disease until they’ve developed an Esophageal tumor so large that they have difficulty swallowing.

What are you doing to try to inform more people that heartburn can cause cancer?

ECAN, the Esophageal Cancer Action Network, has undertaken several strategies to increase public awareness about the link between Heartburn and Cancer. We do everything we can to share our message, using the internet, events, publications and media outreach to spread our message.

We have just released our Guide for Patients to provide individuals with valuable information to help them be effective advocates for their own healthcare. The Guide is available for free as a download from the ECAN website at www.ecan.org.

Because there are currently no screening guidelines for Esophageal Cancer or Barrett’s Esophagus, ECAN brought together doctors from many different pertinent specialties who practice all over the U.S., and in other nations as well, to collaborate on creating this easy-to-understand guide. Using cutting-edge internet technology developed by Qmarkets.net, ECAN provided physicians with an online platform to share ideas and decide collaboratively what information should be included in the Guide and how it should be presented.

Not only was ECAN’s Guide created with input from about 100 doctors, but many doctors who didn’t participate in creating the Guide have formally endorsed the publication, some saying that it will save lives. We are providing materials for physicians’ offices and any other location where small displays can be made available to the public. We provide cards with the Guide’s checklist of issues to discuss with a physician and the link to download the complete Guide for Patients.

In addition to the Guide for Patients, ECAN is in the early stages of developing a national public awareness campaign in conjunction with the estate of film legend Humphrey Bogart, who lost his life to Esophageal Cancer in 1957.

Three years ago, ECAN initiated Esophageal Cancer Awareness Month, which is in April. Every year since then, we have expanded our programming activities in April. In addition to obtaining government proclamations, hosting events and publicizing observation of the month, each year ECAN sends out hundreds of free Reach Out Kits with posters, brochures and periwinkle blue wristbands, all bearing our life-saving message, “Heartburn can cause Cancer.” (Periwinkle Blue is the color assigned for Esophageal Cancer Awareness.)

ECAN also provides support to individuals and groups who want to undertake awareness activities in their own communities. Our goal is to make understanding about the link between Heartburn and Cancer as well known as the need to wear sunscreen when outdoors. We look forward to the day when nobody has to die from Esophageal Cancer.

How should people know when to go to their doctors about heartburn symptoms?

Our Guide for Patients includes a checklist with eight situations that should prompt a patient to discuss their symptoms with their physician:

  1. You have more than occasional heartburn symptoms
  2. You have experienced heartburn in the past, but the symptoms have gone away
  3. You have any pain or difficulty swallowing
  4. You have a family history of Barrett’s Esophagus or Esophageal Cancer
  5. You have an ongoing, unexplained cough
  6. You have been speaking with a hoarse voice over several weeks
  7. You have a long lasting, unexplained sore throat
  8. You cough or choke when you lie down

Our goal is that patients will be prepared to have a meaningful conversation with their primary care physicians so that every patient who is at risk for Esophageal Cancer will receive proper screening.

The Esophageal Cancer Action Network (ECAN) online patient guide mentions that you should speak to your doctor if you experience more than occasional heartburn symptoms. How often do you classify as “occasional”?

If you experience heartburn a few times a week for a period of two or three weeks, you should speak to your doctor.

How can people minimise their symptoms of heartburn?

We are less concerned about people minimizing their heartburn symptoms than we are about them paying attention to the symptoms and what they may be telling them. Of course, one is less likely to experience Heartburn if they eat smaller meals and don’t lie down after meals. But, for individuals who have more than occasional heartburn symptoms, ECAN’s top priority is to make sure that they speak with their physician about whether they should be screened for Barrett’s Esophagus and Esophageal Cancer.

Would you like to make any further comments?

Esophageal Cancer is one of the fastest increasing cancer diagnoses in the U.S. – and one of the deadliest. ECAN believes that until medical breakthroughs are discovered that can identify those who are most at risk to develop Esophageal Cancer, anyone who may be at risk for this disease should be screened.

Early detection is the only effective method we have available today to effectively fight Esophageal Cancer. And, because this is a cancer that has the distinction of having a clearly recognizable precursor in Barrett’s Esophagus, it really allows for a much better chance to save lives through early detection. That’s why we believe it is so important for people to understand the risk. If they wait until they have trouble swallowing, it is often too late.

Where can readers find more information?

www.ecan.org

About Mindy Mintz Mordecai

Mandy Mintz Mordecai BIGECAN’s founder, President and Chief Executive Officer Mindy Mintz Mordecai is an experienced, award-winning media professional and attorney with a proven track record for leadership of nonprofit organizations that achieve positive change on issues of public importance.  Ms. Mordecai is passionate about the work of ECAN in large part because she lost her husband of 14 years to Esophageal Cancer in 2008. She sits on the Disease Working Group of the Esophageal Cancer pilot project of the Cancer Genome Atlas of the National Cancer Institute and is part of the Deadly Cancer Coalition.

Prior to launching ECAN, she was an award-winning television reporter and anchor for two decades, working for both commercial and public television news operations in the Midwest and Baltimore. She also worked in public radio for several years, selected in 1998 as Baltimore City Paper’s Best Radio Talk Show Host. Ms. Mordecai graduated with honor from the University of Maryland, School of Law in 1989. Thereafter, she worked as a litigator with a large Baltimore law firm before moving into advocacy work, first with Advocates for Children and Youth addressing education issues and later with the Greater Baltimore Committee working on matters of public safety. Ms. Mordecai is the mother of two teenaged daughters.

April Cashin-Garbutt

Written by

April Cashin-Garbutt

April graduated with a first-class honours degree in Natural Sciences from Pembroke College, University of Cambridge. During her time as Editor-in-Chief, News-Medical (2012-2017), she kickstarted the content production process and helped to grow the website readership to over 60 million visitors per year. Through interviewing global thought leaders in medicine and life sciences, including Nobel laureates, April developed a passion for neuroscience and now works at the Sainsbury Wellcome Centre for Neural Circuits and Behaviour, located within UCL.

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Comments

  1. Roy Roy United States says:

    Never thought heartburn could cause cancer.  Very informative. What if you have persistent heartburn and you tell your primary care doctor and he/she doesn't think it's a problem and doesn't think you need an endoscopy? What should you do?

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