What do Humphrey Bogart and Robert Kardashian Sr. have in common? By: Dr. Mark Fusco
Humphrey Bogart was an actor who became an icon of American film. Even to this day, nearly 60 years since his last film, his roles are recognizable to the point that there is virtually no one that can’t do a serviceable “Boggie” impression. Robert Kardashian was a lawyer and businessman that was part of O.J. Simpson’s “dream defense team”. Oh, and he is also responsible for all those other Kardashian’s that are always on cable TV. What they have in common is that they both died of esophageal cancer before they turned 60.
The esophagus is a muscular tube that brings food from the throat to the stomach. Unlike some cancers such as lung and stomach, esophageal cancer is rapidly becoming more common. (400% increase in the last 20 years!) Most of the increased frequency is occurring in middle age white males like Bogart, Kardashian…. and me. There are two types of esophageal cancer. The first type is called squamous cancer which is associated with tobacco, alcohol, and injury to the esophagus from ingesting chemical irritants. (Ingesting drain cleaner tragically is a not uncommon method of attempting suicide). A very high incidence of this cancer was also found in the Calvados region of France. It is thought that this is potentially linked to the ingestion of a very strong type of apple brandy of the same name which has lead some to believe that there may also be dietary factors involved. The second type, and the type that is most significantly increasing, is Adenocarcinoma.
Adenocarcinoma occurs mostly at the bottom of the esophagus. It occurs when the normal esophageal cells transform into cells that look more like glandular intestinal cells. This transformation is called Metaplasia. Intestinal Metaplasia of the esophagus is also called Barrett’s Esophagus. Adenocarcinoma of the esophagus is more common in people with Barrett’s esophagus, acid reflux, and obesity. Over one third of the US population have chronic Acid Reflux Disease. In this group about 16% have Intestinal Metaplasia (Barrett’s Esophagus). Of those patients with Barrett’s the have a 25 to 130 fold increased likelihood of developing esophageal cancer.
Unlike the tremendous strides the medical community is making curing many cancers, the cure rate for esophageal cancer has not increase significantly since Humphrey Bogart had his surgery in 1957. (Open thoracotomy, removal of the esophagus, removal of a rib). The five year survival rate for esophageal cancer is only approximately 17%. Additionally, obese patients have twice the risk of recurrent cancer than those not afflicted with obesity.
The poor prospects for patients with esophageal cancer make the prevention of the disease of paramount importance. Follow this link to read a very personal account from the wife of an esophageal cancer victim.
April is Esophageal Cancer Awareness Month. Save the date for this important event.
In support of esophageal cancer awareness I will be writing additional blog posts on subjects related to this topic. I also will be hosting an patient awareness event on Saturday, April 14th from 9:30-11:30 am. Call 321-728-7553 to sign up.