James Revier of San Jose, Calif., had no idea his heartburn was anything more than a nuisance until six years ago, when a piece of beef became lodged in his esophagus and sent him to the emergency room.
The on-call internist removed the meat and suggested Revier see a gastroenterologist for the lingering redness. It's a good thing he did. Revier had developed Barrett's esophagus, a condition caused by prolonged acid reflux. Over time, it produces cellular changes that can lead to adenocarcinoma, a type of esophageal cancer.
"I'd had acid reflux for 15 years but never thought much about it," says Revier, now 64. "Everybody talks about having heartburn."
Scary, isn't it? A condition as common as the cold can cause cancer. An even scarier thought is that antacids such as Nexium, the No. 2 prescribed drug in 2010, according to health data firm IMS, won't prevent it. The obesity epidemic is only exacerbating the problem, making esophageal cancer the fastest-growing cancer diagnosis in the United States, up 300 to 400 percent since the 1970s, said Revier's physician, Dr. Ann Chen, director of endoscopic ultrasound at Stanford University School of Medicine.
If caught early, however, Barrett's esophagus is treatable. That's why Chen and other health advocates urge patients, especially white males older than 50 with persistent heartburn, to have an endoscopy, a procedure to examine the esophagus and gastrointestinal tract.
"Heartburn is a way of your body telling you there's something wrong," Chen said. "Unfortunately, enough physicians don't ask about it, and patients don't tell."
While there have been significant medical and surgical advances in the treatment of esophageal cancer, the survival rate is still grim. The National Cancer Institute estimates 17,500 new cases and 15,000 deaths in 2012. By comparison, of the 226,000 new cases of breast cancer projected for this year, 39,000 cases will likely end in death.
Only one in five people diagnosed with esophageal cancer will survive five years, said Mindy Mintz Mordechai of the Esophageal Cancer Action Network, a Baltimore-based nonprofit dedicated to raising awareness about the link between esophageal cancer and acid reflux.
"We want the link between heartburn and cancer to become as well known and understood as the need to wear sunscreen when outdoors," Mordechai said.
She lost her husband, Monte, to esophageal cancer in 2008. He lived with acid reflux for years, and, like most people, treated it with over-the-counter medications. By the time he was examined and diagnosed with Stage 3 adenocarcinoma, the acid was so persistent that he would choke when lying down, Mordechai says. He also had other advanced symptoms, such as a hoarse voice, chronic cough, choking on food and pain while swallowing.
Being overweight and drinking alcohol regularly can increase the chance of developing esophageal cancer, said Dr. Wilson Tsai, co-director of the thoracic surgery program at John Muir Hospital in Walnut Creek, Calif. Smoking and not eating vegetables are also thought to be culprits.
Tsai said patients with chronic acid reflux or hiatal hernia, which can cause acid reflux, should fix the problem with a minimally invasive surgery that strengthens the valve between the esophagus and stomach and stops acid from backing up into the esophagus.
While there is no guarantee against cancer, surgery might have prevented Revier from developing Barrett's esophagus.
"It's one of those things that quietly eats away at you and changes the cells over time," he said. "I'm just glad I did something about it."
