Opportunities for esophageal cancer screening

In a case-control study using the Veterans Health Administration (VHA) Central Cancer Registry, the authors investigated opportunites to undergo screening for esophageal adenocarcinoma (EAC). They found that more than 80% of individuals diagnosed with EAC or EGJAC had not undergone prior upper endoscopy, and the vast majority of those individuals had potential opportunities at which screening could have been offered prior to their cancer diagnosis. They also observed that cancer cases with prior BE who were overdue for surveillance made up only 3.3% of EAC cases.

Gastroenterology. 2021 Dec 20;S0016-5085(21)04091-9. doi: 10.1053/j.gastro.2021.12.255. Online ahead of print.

Patients with Adenocarcinoma of the Esophagus or Esophagogastric Junction Frequently Have Potential Screening Opportunities

Joel H Rubenstein 1, Richard R Evans 2, Jennifer A Burns 2, Maria E Arasim 2, Ji Zhu 3, Akbar K Waljee 4, Harnessing Opportunities to Screen for Esophageal Adenocarcinoma Group; Peter W Macdonald 3, Megan A Adams 4, Joy W Chang 5, Elizabeth M Firsht 2, Sarah T Hawley 6, Sameer D Saini 4, Lauren P Wallner 7

PMID: 34942170 DOI: 10.1053/j.gastro.2021.12.255


Symptoms of gastroesophageal reflux disease (GERD) are risk factors for Barrett’s esophagus (BE) and esophageal adenocarcinoma (EAC). Guidelines recommend considering endoscopic  screening for patients with GERD and additional risk factors.1 Screening programs can fail due  to failure of uptake of initial screening or of surveillance among those with known BE. Prior studies have demonstrated that fewer than 20% of patients with EAC had an  esophagogastroduodenoscopy (EGD) before diagnosis of cancer, but were typically defined as an  EGD within just a few years before. 2-5  Those studies also did not address whether there were  potential opportunities to undergo screening. Such opportunities could include encounters for GERD, prescription of acid-reducing medications, or for colorectal cancer screening. We  quantified the proportion and types of potential opportunities for screening and surveillance  among individuals who later developed EAC. Because esophagogastric junction  adenocarcinoma (EGJAC) shares many risk factors with EAC we also explored the same  opportunities for EGJAC.

This website contains a curated and opinionated look at recent literature regarding the epidemiology and prevention of esophageal cancer, with an emphasis on esophageal adenocarcinoma. It is developed by Thomas L Vaughan MD, MPH ©2021
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