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turbo
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Quote turbo Replybullet Topic: What are the odds?
    Posted: 05 Dec 2019 at 1:21am
Hey guys I am 23 years old and i have a question...but first a little summary...i was diagnosed with gerd and barrett oesophagus at 19...specifically is a gastric metaplasia (no dysplasia) about 0.5 cm or less (confirmed by more than one endoscopies)...i had nissen fundoplication on 2015.I will soon go for another endoscopy because i feel like my wrap might have loosen but i will check it very soon.My last endoscopy was 12 months ago and it showed that barrett has no change.So no change in these 5 years which is good BUT considering the 0.5% chance of progress per year,and doing the maths,that means that in the next 20 years I have 0.5x20=10% chance of progress (and so on as I age...)and by that time i will be (hopefully) 43 which is not an old age.So now I am pretty anxious now but maybe I am doing something wrong in maths and propabilities.Any ideas?
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truthfreesall
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Quote truthfreesall Replybullet Posted: 05 Dec 2019 at 2:32am
Hey Turbo. Sorry to hear about your diagnosis. If it makes you feel better I was diagnosed at 35 but felt like i probably had it much younger possibly in my teens. Also, to answer your question from what i've been told by a few doctors who are specialist in the field is that the .5% is not cumulative. They compared it to rolling a dice every year and your odds of progression is 0.5% every year and every year you get a new roll.

I would double check with a gentlemen by the name of ChrisRob on here. He's the yoda of this forum and his level of knowledge is second to none.   
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chrisrob
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Quote chrisrob Replybullet Posted: 05 Dec 2019 at 10:54am
Hi Turbo and welcome to the forum. "Yoda" here

Risks of cancerous mutation of Barrett's cells are small and not cumulative.
Annual risk can be roughly calculated by dividing the number with Barrett's by the number of oesophageal cancer deaths. However, the number with Barrett's can only be approximately estimated. I do not have figures for Austria but can illustrate with examples from UK and US.
The Mayo clinic suggests from its research that as many as 1 in 20 of the population may have Barrett's. Relating that to the US infers there could be 16 million with the disease with annual deaths of around 16 thousand giving an annual risk of 0.1%.
Applying the statistics to UK, which was identified by World Health Organisation as having the highest rate in the world, we may have 3 million with Barrett's but an annual oesophageal cancer mortality of around 7,500 meaning the risk is 0.25% p.a.

(Actually, your gastric metaplasia would not be diagnosed as Barrett's in US where it specifically has to be intestinal metaplasia (the two forms differentiated by the presence of "goblet cells) though we believe gastric metaplasia also has the ability to mutate.)

This Swedish study, Barrett’s esophagus: Cancer risk is highest in first year after diagnosis, reports, "recent studies in Europe and the U.S. have suggested that the risk is lower, with an estimated annual risk range of 0.12%-0.18%."

Barrett's cells are a protective construct by the body to defend against acid erosion. Because they are alien to the oesophagus, there is the chance they could mutate but are actually unlikely to and the longer you have had them, the less likely they are to do so - as the Swedish study found and as this study, Cancer Risk in Barrett's is Mainly Early also shows: "when patients had not progressed after two or more endoscopic exams several years apart, the risk of cancer fell sharply", "We can say that the more endoscopies you have (without progression) the less risk there is of cancer."

Since Barrett's itself is non-symptomatic, we can only estimate the numbers of those with it based upon random sampling. In UK, although we probably have between 2.5 and 3 million with it, fewer than 150,000 have been identified and it's those who have it but not identified who are most at risk of the mutation occurring. The Swedish study states, "97% were diagnosed in patients with previously unknown BE".

Assessing lifetime risk is a lot harder since it's obviously not possible to follow everyone with Barrett's for their lifetime. However, my friends at UK Barrett's Registry did attempt to calculate a figure in this paper, Lifetime risk of esophageal adenocarcinoma in patients with Barrett's esophagus "lifetime risk of development of adenocarcinoma of between 0.071 to 0.124 (between 1 in 8 and 1 in 14)"

So, takeaway points:
  1. Over 90% of us will never get the cancer.
  2. The longer you've had Barrett's the less likely it is to become cancer.
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turbo
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Quote turbo Replybullet Posted: 06 Dec 2019 at 12:30am
Thank you very much for your responses I appreciate it !Mr Chris I read your replies in other topics too,and you gave me much info so a special thank you for your time to do all these research for us (and for yourself).
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