Why middle aged men should NEVER just dismiss heartburn
From the Radio 4 presenter killed by oesophageal cancer to the Chas & Dave singer who’s fighting it
FOR Chas Hodges, one half of ‘rockney’ duo Chas & Dave, the first sign something was wrong came last December when he suddenly found himself unable to finish a glass of water.
‘I was thirsty, so I drank it quickly, but it just wouldn’t go down — it was very strange,’ recalls the 73-year-old piano player.
Although it was a one-off, he knew he needed to see a doctor, but kept it to himself until after Christmas so he wouldn’t worry his family.
However, as soon as his wife Joan heard about it, she arranged an appointment with his doctor, which was quickly followed by an endoscopy — where a tube with a camera on the end was put down his throat.
But as Chas explains: ‘They couldn’t get the camera past the swelling.’
That swelling was a tumour. Chas has cancer of the oesophagus (or gullet). Fortunately, it hasn’t spread, says the musician, whose hits include Rabbit and Gertcha.
He’s now begun chemotherapy and is upbeat: ‘I don’t let the cancer weigh down on me like a burden and I don’t wake up thinking about it — as far as I’m concerned it’s being dealt with,’ says the father-of-three, who’s recently penned new lyrics for an old song, Sling Your Hook, turning it into a ‘cancer-banishing anthem’.
Chas is part of a worrying trend, with cases of oesophageal cancer rising sharply in the past 40 years — it’s up by more than 40 per cent. The UK now has the highest rate in the Western world.
There are two main types of oesophageal cancer and it’s the more common form — adenocarcinoma — where the ‘incidence is rising quite alarmingly’, explains Michael Griffin, a professor of gastro-intestinal surgery at the Royal Victoria Infirmary in Newcastle. ‘It’s the fastest rising solid cancer [in the organs rather than blood] in our society,’ he says.
And there’s one group particularly affected, says Professor Griffin: middle-aged and older men. ‘Women do get it, too, but it usually affects them at a later age — perhaps because they are protected by hormones,’ adds Rebecca Fitzgerald, a professor of cancer prevention at the University of Cambridge and a trustee of the charity Heartburn Cancer UK.
DON’T IGNORE CHRONIC HEARTBURN
UNFORTUNATELY survival rates lag behind many other cancers: 15 per cent of oesophageal patients survive for five years after diagnosis, compared with 90per cent of breast cancer patients and 98 per cent for testicular cancer.
Around 8,000 people died of the disease last year, a large proportion of them men; last week oesophageal cancer claimed the life of BBC journalist and broadcaster Steve Hewlett, 58, less than a year after it was diagnosed.
One of the main problems is that patients too often fail to recognise or act on the early warning signs such as chronic heartburn, which means that by the time they’re diagnosed — typically after they have constant difficulty swallowing — there’s no chance of a cure.
This was what happened to Michael McCord, who died from oesophageal cancer in 2002, at the age of 47, after being unaware of the risks of long-term persistent heartburn.
‘Had we known the dangers, he would still be alive today,’ says his widow Mimi, who founded Heartburn Cancer UK after he died. ‘Men in particular are more likely to comment that “it’s only heartburn,” and ignore it.’
So why is the UK’s rate of oesophageal cancer rising?
Lifestyle plays a major part. Adenocarcinoma is strongly associated with acid reflux, which causes symptoms such as heartburn and regurgitation. (The other main type of oesophageal cancer, squamous cell, is associated with smoking and drinking.)
Acid reflux may be linked to a weak valve at the bottom of the oesophagus, which allows the stomach contents to reflux up. This may be genetic.
But fatty diets are thought to play a key role because fat slows down the emptying of the stomach, making reflux more likely.
Being overweight also makes acid reflux much worse, because it puts ‘incredible pressure’ on the valve at the bottom of the oesophagus, says Professor Griffin.
‘The UK is at the top of the tree for obesity. We may not have the super-obese individuals they have in the U.S., but there are actually proportionally more people who are obese in this country.
‘And the North East of England and west coast of Scotland, where incidence of adenocarcinoma is highest, are the fat centres of Europe.’
How your body fat is distributed may also be a factor. While women often gain weight on their hips, men tend to put it on around the middle, increasing the risk of acid reflux as this can put pressure on the valve.
Another possible reason for the cancer’s sharp rise is our success at reducing Helicobacter pylori, the bacterium linked to stomach cancer, says Professor Fitzgerald.
Forty per cent of us carry this in our stomachs, but thanks to antibiotics and increased hygieene, this is less prevalent than it used to be.
And Professor Fitzgerald says: ‘If you get rid of that bacterium, the stomach can start making more acid again.’
She also points to an emerging theory that fertilisers are linked. ‘We know Scotland has one of the highest a incidences of oesophageal cancer, and there is some evidence that maybe the fertilisers stay on the food crop because the sunlight doesn’t get to them.’
But, she adds, this is ‘rather speculative and the truth is we just don’t know for sure’ — stressing that ‘acid reflux is still the strongest link
THE RISKS OF SELF-MEDICATING
ALTHOUGH occasional reflux is extremely common — affecting up to one in three people, and not usually a cause for concern — repeated reflux can damage the cells lining the oesophagus, giving them the potential to become cancerous, a condition known as Barrett’s oesophagus.
‘Virtually all cases of adenocarcinoma in the oesophagus begin with Barrett’s,’ says Professor Griffin.
Whatever the cause of acid reflux, a
key problem is that, too often, people see heartburn as a harmless inconvenience and fail to take it seriously.
And many people — particularly men — prefer to treat their symptoms with over-the-counter medication rather than seeing their gP, says laurence lovat, a professor of gastroenterology at university College, london.
‘the availability of self-medication is appalling,’ adds Mimi McCord.
‘Anyone can go into a supermarket and fill their basket with antacids, and nowadays there’s even a proton pump inhibitor (PPI) you can buy over the counter,’ she says, referring to a class of drug that works by reducing acid production. ‘Previously this was something that had to be prescribed by the gP. Self-medicating can be so dangerous.’
this masks symptoms, so patients don’t seek medical attention for chronic heartburn. Furthermore, while PPIs reduce the acid ‘they don’t stop the reflux of bile, which can also be very damaging to the oesophagus’, explains Professor griffin.
But problems can occur even once patients see a gP.
‘Doctors are prescribing long-term PPIs instead of trying to get patients to lose weight and have a healthier lifestyle so that they don’t reflux as much,’ adds Professor griffin.
Before prescribing long-term treatment, doctors should ideally refer patients for an endoscopy, he says. ‘But it’s very much patient-driven: patients go back to their gP and say they want more medication because it’s made them better.’ REFLUX ‘VANISHES’ IN YOUR 50s Another issue is that once Barrett’s oesophagus has developed, the cells lining the oesophagus become more resistant to acid, so symptoms such as heartburn reduce — and ironically, patients may then be less aware they have a problem.
‘I’ve lost count of the number of times patients with cancer have told me they had heartburn throughout their teens and 20s, but by their 50s it went away — when in fact that’s when they developed Barrett’s,’ says Professor griffin.
Chas hodges had been told in the past he had a ‘swollen oesophagus’, but hasn’t experienced heartburn since the late nineties.
‘I used to get it a lot when I was on the brandy, and would treat it with bicarbonate of soda — lovely stuff, one burp and you were rid of it. But I ended up in hospital in 1999 because I was overdoing the drinking and the doctors said: “If you don’t cut down, it will cut you down”. So I packed up drinking completely for six years.’
he also avoids foods or drinks with added sugar, eats no bread, and keeps active by riding his bike every day to his allotment.
the main symptom of the cancer is difficulty swallowing. ‘this suggests the cancer has developed to the extent it is blocking the lumen, the hole that allows food to come through, and has spread through the wall of the oesophagus,’ explains Professor griffin.
‘It doesn’t mean it’s not curable, but the chances are lessened. Ideally, we want to pick up the cancer when it’s still in the lining of the oesophagus.’ SHOULD YOU SEE A DOCTOR? For this reason, he urges anyone who has heartburn daily for three weeks to see their doctor for an investigation — as well as raising the risk of cancer developing, persistent heartburn may be a warning sign of the cancer itself.
‘the difficulty we have is that, unlike breast cancer, for example, where you can feel a lump at a very early stage, the oesophagus is tucked away behind the chest, so you have to wait for something else to alert you to an early symptom.
‘the only alert we have is indigestion or heartburn. these most often won’t be anything to worry about, but they do have to be checked out.
‘If you ever feel like some food is starting to stick, or have any trouble swallowing, you must see the doctor straight away,’ he adds, as these can also be signs of cancer.
though difficulty swallowing can have other causes (for instance, anxiety), ‘it’s an absolute indication for an endoscopy’, says Professor griffin.
Steve hewlett revealed his first signs were ‘a vague sensation of fullness after eating very little and a very occasional sensation of food getting stuck, but always very temporary, not in my throat but at the back of my chest’.
he said that he ‘hardly noticed and certainly didn’t pay any serious attention’ to the symptoms, which went on for three or four months before he saw his gP.
When caught at a very early stage, the cancer may be burned away (using radiofrequency waves) or removed surgically. If more advanced, the patient may have surgery to remove the affected section of the oesophagus.
But in some patients, like Steve hewlett (thought to have had adenocarcinoma), this was not an option. Chemotherapy may also be given to shrink the cancer ahead of surgery, and is sometimes used instead of surgery.
Chas has had the first of three cycles of chemotherapy. And apart from feeling ‘a bit weary’, he has found it surprisingly bearable. ‘It was actually quite a nice, relaxing afternoon,’ he says. I wrote a couple of songs — I was still writing when it was time to go home.’ GPs TRYING OUT NEW TEST the good news is that huge strides in the disease have been made in recent years. ‘When I started 30-odd years ago, oesophageal cancer was a death sentence,’ says Professor griffin.
‘We have moved on massively in our understanding and treatment of the disease. It’s been a huge success story. But we have to find a better way to treat the more advanced disease, and improve earlier diagnosis.’
to this end, Professor Fitzgerald has helped develop a five-minute test for Barrett’s oesophagus, where the patient swallows a dissolvable capsule with a string attached. When the capsule opens up it exposes a small sponge that gathers a tissue sample as it is pulled back by the doctor.
‘We are now launching a huge nationwide trial at gP surgeries where we will be testing 9,000 patients,’ explains Professor Fitzgerald. ‘We hope it will be the last step before we take it to nICe [the national Institute for health and Care excellence] for it to be made available on the nhS.’
Meanwhile, even though Professor lovat says chronic heartburn is ‘very common and the vast majority of people with it won’t get cancer’, he adds: ‘It’s still important to get it checked out.’ heartburncanceruk.org