While not exactly a streetfight, Drs. Spechler and El-Serag briefly discuss in this "point/counterpoint" possible reasons that current screening approaches for esophageal adenocarcinoma and Barrett's esophagus have had only modest success in affecting incidence and mortality for this cancer. I note that neither author mentions
This review nicely updates the status of screening programs for Barrett's esophagus and esophageal adenocarcinoma, with and emphasis on established and newer non-invasive methods. The Horizon of Screening for Barrett's Esophagus and Esophageal Cancer Techniques and Innovations in Gastrointestinal Endoscopy, 2023 https://doi.org/10.1016/
There are a few recent reports that the incidence of EA has increased in young adults, and that they are being diagnosed at a later stage. In an analysis of nine SEER population-based cancer registries from 1975-2015, Codipilly, et al. reported an approximate tripling of incidence in persons less than
Evidence continues to mount from observational epidemiologic studies and animal experiments supporting the notion that statins may be effective chemopreventive agents for esophageal adenocarcinoma, and possibly useful in esophageal cancer treatment as well. In this large (over 1M persons) records-based cohort study in Korea, investigators observed a 45% reduction in
Last week I posted figures summarizing changes in age-adjusted incidence rates of esophageal adenocarcinoma (EA) over the past 20 years according to demographic characteristics, using the latest data from 14 population-based registries in NCI's SEER program (https://www.esocan.org/ea-rates-increasing/). This post focuses on changes in incidence
The habitual intake of very hot beverages has long been implicated in increasing risk of ESCC in higher-incidence areas in China, Iran and other countries, but is less well studied in high-incidence countries of East Africa. In this carefully-conducted case-control study in Malawi and Tanzania, investigators observed consistently elevated risk
A number of observers have noted that the incidence of esophageal adenocarcinoma (EA) appeared to plateau beginning in the early years of the millennium (e.g., Pohl, 2010; Cook, 2021.) To see whether this leveling off has continued, I examined the incidence of EA over the last 20 years (2000-2019)
IARC's GLOBOCAN database was used to estimate the worldwide esophageal cancer burden in 2020, and to project to 2040 under various assumptions. In 2020 over 600,000 cases were estimated to have occurred, rising to almost 1 million in 2040 unless more effective prevention programs are implemented. Gastroenterology.
Since approximately 40% of esophageal adenocarcinoma cases arise in persons without significant gastroesophageal reflux (Nat Rev Cancer 2015), it has long been clear that screening guidelines that require GERD symptoms will miss a significant proportion of prevalent cases. Current guidelines are also inefficient with low specificity (Clin Gastroenterol Hepatol 2019.
This thoughtful and thorough analysis of food frequency dietary data from the Melbourne Cohort Study supports previous research indicating that regular intake of leafy vegetables and fruit may independently decrease risk of Barrett's esophagus, in this instance by approximately 40%. Br J Nutr. 2022 Jul 15;1-28. doi:
Given that the incidence of esophageal adenocarcinoma in the U.S. varies dramatically by sex and race, it seems likely that optimal screening programs might vary as well. CISNET investigators used comparative cost-effectiveness analysis to identify optimal ages for screening by sex and race. Among white men, they found that
Important guideline updates include the recommendations for nonendoscopic screening methods, longer intervals for short-segment BE surveillance, and specific suggestions for post-ablation surveillance. Am J Gastroenterol. 2022 Apr 1;117(4):559-587. doi: 10.14309/ajg.0000000000001680. Diagnosis and Management of Barrett's Esophagus: An Updated ACG Guideline Nicholas J