Editorial: should women with heartburn undergo screening upper endoscopy for prevention of cancer?

Esophageal adenocarcinoma (EAC) is a rare disease which is much more common in men than in women. For any given age, women with gastroesophageal reflux disease (GERD) symptoms actually have a lower risk of EAC than men without GERD symptoms. The cause of the difference in incidence rates between men and women is unclear and not accounted for by differential distribution of known risk factors. Despite the long-recognized difference in incidence between men and women, neither societal guidelines nor physician practice take into account this difference, leading to illogical use of health-care resources. Given the epidemiology of EAC, the yield of endoscopic screening examinations in those under 50, and in women, regardless of age or GERD symptoms, is exceedingly low, and may approximate the low risk of the endoscopic procedure itself. Recommending organizations should consider the epidemiology of EAC when making screening recommendations.