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 17 January 2018

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News

New surveillance program needed for esophageal cancer

This month's Endoscopy finds that surveillance programs based on current concepts of risk cannot have an impact on mortality from esophageal adenocarcinoma, and more precise methods are needed to identify those most at risk.

News image

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The incidence of esophageal adenocarcinoma has increased significantly in recent years.

Surveillance of people with Barrett's esophagus has been advocated in order to detect dysplasia, and early cancer in those considered to be at greatest risk.

However, the impact of such a strategy on survival from esophageal adenocarcinoma is unclear.

Dr Quera and colleagues from Ireland determined the effect of surveillance on mortality from esophageal adenocarcinoma.

The research team performed a Medline search of the literature published between 1985 and 2004.

The team searched for studies on gastro-esophageal reflux disease, Barrett's esophagus and adenocarcinoma.

The analysis included 100 male patients considered to be at high risk of developing adenocarcinoma.

The patients were aged over 50 with Barrett's esophagus but without high-grade dysplasia at entry.

The researchers found that 4 patients in this high-risk group developed adenocarcinoma during surveillance, with survival rates of 79% at 2 years.

There was a 79% survival at 5 years.

Meanwhile, between 515 and 2060 patients with Barrett's esophagus were not detected or surveyed by this strategy.

Between 16 and 61 of these developed adenocarcinoma, with much lower survival rates of 37% at 2 years and 17% at 5 years.

The team noted that surveillance in the high-risk group resulted in the long-term survival of 3 patients who would not otherwise have survived.

This gain was dramatically offset by the 13 to 51 patients, excluded from surveillance by this strategy, who died from esophageal adenocarcinoma.

Dr Quera's team commented, “A surveillance program based on current concepts of risk cannot have an impact on mortality from esophageal adenocarcinoma.”

“To be effective, it will be necessary for surveillance programs to utilize more precise methods for the identification of those who are most at risk of progression to adenocarcinoma.”

Endoscopy 2006: 38: 162-9
23 February 2006

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