Barrett's esophagus and cancer risk: a more realistic estimate.

The cancer risk in patients with Barrett's esophagus is important because it determines screening, surveillance, and treatment considerations. Previously, the risk of progression to esophageal adenocarcinoma in patients with Barrett's esophagus was thought to be approximately 1%. Recently, 2 very large population-based studies have significantly reduced this risk estimate of cancer. Paradoxically, esophageal adenocarcinoma continues to rise exponentially in the United States. Screening and surveillance programs based on endoscopic, histopathological, and molecular criteria need to be improved to identify a high-risk population of progressors.