July 31, 2019

Risk Calculator for Esophageal Adenocarcinoma

This paper describes the development of the IC-RISC™ calculator and provides examples of its application in the general population and among persons with Barrett’s esophagus. (See “What’s Your Risk” menu above for the actual calculator.)

Risk Calculator for Esophageal Adenocarcinoma

BMC Gastroenterol. 2019 Jun 27;19(1):109. doi: 10.1186/s12876-019-1022-0.

Interactive decision support for esophageal adenocarcinoma screening and surveillance.

Vaughan TL1,2, Onstad L3, Dai JY3.

Abstract

BACKGROUND:

A  key barrier to controlling esophageal adenocarcinoma (EAC) is  identifying those most likely to benefit from screening and  surveillance. We aimed to develop an online educational tool, termed  IC-RISC™, for providers and patients to estimate more precisely their  absolute risk of developing EAC, interpret this estimate in the context  of risk of dying from other causes, and aid in decision-making.

RESULTS:

U.S.  incidence and mortality data and published relative risk estimates from  observational studies and clinical trials were used to calculate  absolute risk of EAC over 10 years adjusting for competing risks. These  input parameters varied depending on presence of the key precursor,  Barrett’s esophagus. The open source application works across common  devices to gather risk factor data and graphically illustrate estimated  risk on a single page. Changes to input data are immediately reflected  in the colored graphs. We used the calculator to compare the risk  distribution between EAC cases and controls from six population-based  studies to gain insight into the discrimination metrics of current  practice guidelines for screening, observing that current guidelines  sacrifice a significant amount of specificity to identify 78-86% of  eventual cases in the US population.

CONCLUSIONS:

This  educational tool provides a simple and rapid means to graphically  communicate risk of EAC in the context of other health risks,  facilitates “what-if” scenarios regarding potential preventative  actions, and can inform discussions regarding screening, surveillance  and treatment options. Its generic architecture lends itself to being  easily extended to other cancers with distinct pathways and/or  intermediate stages, such as hepatocellular cancer. IC-RISC™ extends  current qualitative clinical practice guidelines into a quantitative  assessment, which brings the possibility of preventative actions being  offered to persons not currently targeted for screening and, conversely,  reducing unnecessary procedures in those at low risk. Prospective  validation and application to existing well-characterized cohort studies  are needed.