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To the Editor: The incidence of esophageal and gastric cardia adenocarcinoma is increasing in Western Europe and the United States.¹ Survival rates² are substantially improved by early tumor detection.³ Therefore, it seems important to identify high-risk persons in whom endoscopic surveillance might be warranted. Recently, symptomatic reflux⁴ and obesity⁵ were found to be strong independent risk factors for these tumors, particularly for esophageal adenocarcinoma.^4-5 Endoscopic surveillance of persons with reflux has been suggested,⁶ but the benefits and efforts are unknown.

Methods

In this reanalysis of Swedish nationwide case-control data collected in 1995-1997, we estimated the number of endoscopies needed to identify 1 esophageal or gastric cardia adenocarcinoma in persons with various combinations of obesity and reflux, including collaboration with all 195 relevant Swedish hospital departments and all cancer registries in Sweden. Our population-based study encompassed a comprehensive organization with rapid and prospective case ascertainment, uniform tumor classification, and face-to-face interviews.⁴ We . . . [Full Text of this Article]

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