Cyclin D1 and Esophageal Adenocarcinoma Risk: How Good Does a Marker Have to Be?

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Abstract
As a result of rapid and dramatic increases in incidence during the past 20–25 years, adenocarcinoma has eclipsed squamous cell carcinoma as the most frequent histopathologic esophageal cancer diagnosis in the United States and in other western countries ( 1). Adenocarcinoma and squamous cell carcinoma of the esophagus are epidemiologically distinct entities. Any coherent understanding of esophageal adenocarcinoma risk must explain the substantial associations with the male sex and the white race. Although obesity and some aspects of cigarette smoking history may contribute to risk, a growing body of evidence suggests that gastroesophageal reflux leads to a metaplastic change in the distal esophagus known as Barrett's esophagus, which is characterized by the replacement of the normal squamous epithelium with a columnar-lined epithelium of a specialized intestinal type ( 1, 2). In response to gastroesophageal reflux and perhaps other environmental factors, Barrett's esophagus, in some relatively small fraction of cases, appears to undergo dysplastic and ultimately malignant transformation.