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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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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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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DOI: https://doi.org/10.1038/nrgastro.2015.24
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