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Precision prevention of oesophageal adenocarcinoma

Nature Reviews Gastroenterology & Hepatology volume 12, pages 243–248 (2015)Cite this article

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Abstract

The incidence of oesophageal adenocarcinoma has risen rapidly over the past four decades. Unfortunately, treatments have not kept pace; unless their cancer is identified at a very early stage, most patients will not survive a year after diagnosis. The beginnings of this widespread problem were first recognized over 25 years ago, yet rates have continued to rise against a backdrop of much improved understanding and management of oesophageal adenocarcinoma. We estimate that only ∼7% of the 10,000 cases of oesophageal adenocarcinoma diagnosed annually in the USA are identified through current approaches to cancer control, and trace pathways by which the remaining 93% are 'lost'. On the basis of emerging data on aetiology and predictive factors, together with new diagnostic tools, we suggest a five-tier strategy for prevention and control that begins with a wide population base and triages individuals into progressively higher risk strata, each with risk-appropriate prevention, screening and treatment options.

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Figure 1
Figure 2: The current approach to control of oesophageal adenocarcinoma identifies only about 7% of the cases via screening and surveillance, with most of the remainder diagnosed because of alarm symptoms, usually indicative of a late stage of disease.

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Acknowledgements

T.L.V. was supported in part by National Cancer Institute Established Investigator Award in Cancer Prevention and Control (K05 CA124911).

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  1. Department of Epidemiology, Program in Cancer Epidemiology, Fred Hutchinson Cancer Research Center, University of Washington, 1100 Fairview Avenue North, Seattle, 98109, WA, USA

    Thomas L. Vaughan

  2. Medical Research Council (MRC) Cancer Unit, Hutchison-MRC Research Centre, University of Cambridge, Hills Road, Cambridge, CB2 0XZ, UK

    Rebecca C. Fitzgerald

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Correspondence to Thomas L. Vaughan.

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Competing interests

R.C.F. developed the Cytosponge technology with MRC-Technology and is named on related patents. The technology has recently been licensed to Covidien GI Solutions; R.C.F. has no direct financial relationship with Covidien. T.L.V. declares no competing interests.

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Vaughan, T., Fitzgerald, R. Precision prevention of oesophageal adenocarcinoma. Nat Rev Gastroenterol Hepatol 12, 243–248 (2015). https://doi.org/10.1038/nrgastro.2015.24

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