Researchers say heartburn behind surge in cancer
The Associate Press
WASHINGTON (AP) -- Chronic heartburn appears to be fueling the nation's fastest-growing cancer, esophageal cancer. Some 3 million Americans are thought to have a type of esophagus damage from severe acid reflux that puts them at increased risk for the deadly cancer - and new research is exploring whether it's possible to zap away that damage and block the cancer from ever forming.
"The million-dollar question is can we prevent cancer," says Dr. V.K. Sharma of the Mayo Clinic in Scottsdale, Ariz., who is leading one of the newest studies, using radiofrequency energy to burn away the damage. "That has not been answered."
But it's a question taking on new urgency as doctors chart a six-fold increase in the last two decades in the main type of esophageal cancer.
About 14,550 Americans will be diagnosed with esophageal cancer this year, the American Cancer Society estimates. Most won't be diagnosed until they feel such symptoms as trouble swallowing and loss of appetite. The prognosis is grim: Just 16 percent of esophageal cancer patients survive five years, and 13,770 are predicted to die this year.
Most have esophageal adenocarcinoma, the type linked to severe chronic heartburn.
With this "gastroesophageal reflux disease," or GERD, a loose valve allows stomach acid to regularly back up into the delicate esophagus. In a fraction of heartburn sufferers, most over age 50, severe GERD over many years actually changes the lining of the esophagus: When the stomach acid kills cells in that lining, the esophagus eventually starts healing itself with more acid-resistant cells - which happen to be cancer-prone.
Here's the rub: Esophageal cancer is slow-growing and doesn't appear overnight. Just one in 200 Barrett's patients develops cancer every year, cautions Dr. Stuart Spechler, a gastroenterologist at the Dallas Veterans Affairs Medical Center. Those who go on to develop precancerous spots called "high-grade dysplasia" are at greater risk - one in five will get full-blown cancer in the next five years.
Current guidelines call for doctors to watch for these step-by-step changes by giving Barrett's patients regular down-the-throat exams, so they can operate at the first sign of cancer when survival is around 80 percent, he says.
The debate is whether to just monitor - or to try to get rid of Barrett's tissue.
Last year, the Food and Drug Administration approved a device that snakes a balloon inside the esophagus and beams RF energy through it to burn away the Barrett's tissue. Maker Barrx Medical Inc. this month began funding a study of 120 patients at Mayo and 15 other medical centers to see how well RF ablation treats Barrett's patients with precancerous dysplasia.
Other options: Freezing away Barrett's tissue; photodynamic therapy, where a combination of a light-sensitizing drug and a laser burn it away; or endoscopically cutting out dysplasia.
The problem: The only treatment completely proven to prevent esophageal cancer is to cut out that part of the esophagus, a high-risk operation, conclude Spechler and colleague Dr. Rhonda Souza, who recently reviewed the evidence in an American Cancer Society journal.
The less invasive Barrett's treatments haven't been studied long enough to know if they'll really eliminate the cancer risk, or if it will just return - and they, too, cause some side effects, the pair caution.
Still, the treatments do offer an option for patients too old or ill for major esophagus surgery, says Dr. Prateek Sharma of the University of Kansas School of Medicine, a spokesman for the American Gastroenterological Association. And for those with those precancerous dysplasia spots, they're a potential middle ground.
One thing all agree on: Every Barrett's patient needs high-powered medication to control their acid reflux, even those who don't complain of heartburn symptoms. The esophagus may simply be too scarred to feel the pain anymore.
Promising research is under way that suggests a genetic marker may soon be able to tell which Barrett's patients are at highest risk for cancer, and which can relax, Souza adds.
What about heartburn sufferers today? Studies show only a fraction will develop Barrett's, but Souza worries about people who never see a doctor about frequent reflux. Her advice: Anyone over 50 who has used over-the-counter heartburn medicines regularly for six months to a year should probably see a gastroenterologist.
Cherry Industry Chafes at FDA Warnings
Is cherry a health food or drug?
FDA tries to stem the industry�s health benefit claims
TRAVERSE CITY, Mich (AP). - Olivene Robbins swears a daily glass of concentrated tart cherry juice cured her painful gout. "It's almost like a miracle to me," says the 69-year-old resident of Hickory, N.C.
Customers like Robbins are now caught in the middle of a fight between federal health officials and the cherry industry.
The industry is marketing cherries as health food, trumpeting research showing they contain helpful antioxidants, along with testimonials from buyers like Robbins. At the same time, the
Food and Drug Administration has ordered 29 companies to stop making unproven claims that their cherry products treat or prevent disease.
"We have the government telling people to eat more fruits and vegetables, and we have the U.S.
Department of Agriculture funding some of these fruit studies, and now we have another arm of the federal government that says you can't use the research," said Bob Underwood, whose Traverse City company sells capsules containing cherry and blueberry paste.
Since receiving FDA letters last fall, some cherry product producers have removed � or at least reworded � their health benefit statements. But others still make the connection, and an industry group is continuing a promotional campaign telling consumers that cherries are good for them.
"We've always tried to report the science, to stick with the facts, to report things as they are and not exaggerate," said Jane DePriest, marketing director for the Lansing-based Cherry Marketing Institute.
Some producers complain the government is picking on a small industry whose products are harmless.
"Nobody ever claimed they had adverse side effects from eating cherries, which is more than you can say for a lot of drugs," said Steve de Tar, president of Brownwood Acres Foods in Eastport, where Robbins orders her juice concentrate.
His business, once a roadside farm market in northern Michigan orchard country, boomed so dramatically after it started Internet juice sales that it made Inc. magazine's 2004 list of the nation's 500 fastest growing privately held companies.
The cherry industry isn't alone on the antioxidant bandwagon. Foods as varied as blueberries, green tea and chocolate have been touted as antioxidant-rich. Antioxidants are believed to neutralize free radicals � compounds that damage cells in the body and are implicated in disorders such as cancers and Alzheimer's disease.
The FDA told the 29 companies that by claiming their products could prevent, treat or cure disease, they were in effect calling them drugs, which are covered by the Food, Drug and Cosmetic Act. New drugs require FDA approval and testing to confirm safety and effectiveness.
"If somebody is using a product that is unproven for health benefits, they may be forgoing other treatments that they would need," said Jennifer Thomas, consumer safety officer with the agency's Center for Food Safety and Applied Nutrition. "We're concerned that consumers not get the wrong message and use products that may not have the benefits they believe they would have."
The FDA cited one vendor's Web site that proclaimed "Breakthrough News: Cherries Prevent Cancer!"
Cherries, that ad said, "are packed with perillyl alcohol � a natural chemical that not only flushes cancer-causing substances out of the body, but also helps stunt the growth of cancerous cells." It also said cherries contain anthocyanins, "anti-inflammatory pain relievers 10 times stronger than aspirin or ibuprofen."
The FDA could seek a court order or seize their products to enforce its order to stop the claims, Thomas said.
Studies funded partly by the industry and the USDA detected antioxidants in cherries, including anthocyanins, the compounds responsible for a fruit's color. University of Iowa scientists documented the presence of perillyl alcohol.
Russel J. Reiter, who found that cherries have high levels of melatonin, an antioxidant believed to improve sleep patterns, thinks it's fair to tell consumers that cherries contain antioxidants. But he says explicitly linking any food to a specific disease is going too far without clinical proof.
"No one has given cherry products to a group of individuals with gout in a controlled, clinical study and showed it can be used to treat or cure gout," said Reiter, of the University of Texas Health Science Center.
Robbins insists she doesn't need clinical trials.
She says that for two years her gout was so painful she could hardly wear shoes. It got better after she began eating cherries daily and cleared up almost overnight when she switched to concentrated juice, she says.
"I don't care what the FDA says," Robbins said. "They want you to pop a bunch of pills and I'm not a pill taker."
