Symptoms of heartburn are all too familiar for many. A recent study looked at heartburn and its possible link to cancer.

Reporting in the Journal of the American Medical Association (Vol. 287: 1972-1981), researchers said it is still not known if routine screening for those with chronic heartburn problems, using a procedure called endoscopy, should be recommended.

Heartburn is also known as gastroesophageal reflux disease (GERD). Close to one-half of adults in the US have heartburn at least once a month, and one out of five adults have symptoms weekly, said Nicholas Shaheen, MD, MPH, and David Ransohoff, MD, from the University of North Carolina in Chapel Hill.

Of greater concern, they said, is whether this common symptom is related to cancer in the esophagus — the muscular tube in the chest where food passes through from the mouth to the stomach.

GERD may be a common problem, but cancer of the esophagus is not.

The American Cancer Society estimates there will be 13,100 new cases of esophageal cancer diagnosed in 2002, and 12,600 deaths. Although this cancer is rare, it is almost always fatal.

A related condition called Barrett's esophagus has been linked to adenocarcinoma (cancer of the gland cells) located in the esophagus.

The authors said several studies have shown an increased risk of cancer of the esophagus in people who have symptoms of GERD.

Based on their calculation, 10 million people older than age 50 have these symptoms weekly. Out of these 10 million, about 3,900 people will develop adenocarcinoma of the esophagus each year. So, the chance of any one person with GERD developing cancer in the esophagus is quite low.

And, the authors noted, many patients with adenocarcinoma of the esophagus did not have weekly symptoms of GERD.

After careful study, the authors concluded that symptoms of GERD probably are not a good reason to predict any one person will develop cancer.

And, newer treatments for GERD neither prevented cancer or caused greater improvement in Barrett's esophagus, the authors said.

In addition, even though new surgical treatments for GERD have improved symptoms, the surgery has not decreased the risk of cancer, they said.

The researchers emphasized that the symptoms of GERD are so common that it would not be practical to examine every patient.

Yet, the American College of Gastroenterology's guideline suggests that any patient with long-standing GERD symptoms, especially if age 50 or older, should have their esophagus and stomach examined with an endoscope.

Although using this scope may find a cancer early, the authors cautioned, "There are no randomized controlled trials demonstrating the prevention of cancer or an increased life expectancy" in patients who undergo the procedure on a regular, screening basis.

The authors concluded, "The guidelines may be too aggressive in their approach to the patient with uncomplicated GERD. The rate of cancer in those with reflux is low, and the overall incidence of this cancer is small."

In the future, methods to better target those at significantly increased risk may be developed, the authors pointed out. Also, newer types of procedures may be more effective in finding the cancer.

When this happens, the question of screening can be addressed once again, they said. Meanwhile, people who experience GERD, or those who have Barrett's esophagus, should discuss their symptoms with their physicians, the authors said.