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Screening for oesophageal cancer

Nature Reviews Clinical Oncology volume 9, pages 278–287 (2012)Cite this article

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Abstract

Oesophageal cancer is a global health problem with high mortality due to the advanced nature of the disease at presentation; therefore, detection at an early stage significantly improves outcome. Oesophageal squamous-cell cancer is preceded by dysplasia and oesophageal adenocarcinoma is preceded by Barrett's oesophagus, which progresses to cancer via intermediate dysplastic stages. Screening to detect these preneoplastic lesions has the potential to substantially reduce mortality and morbidity. However, the risks and benefits of such programmes to individuals and to society need to be carefully weighed. Endoscopic screening is invasive, costly and error prone owing to sampling bias and the subjective diagnosis of dysplasia. Non-endoscopic cell-sampling methods are less invasive and more cost effective than endoscopy, but the sensitivity and specificity of cytological assessment of atypia has been disappointing. The use of biomarkers to analyse samples collected using pan-oesophageal cell-collection devices may improve diagnostic accuracy; however, further work is required to confirm this. The psychological and economic implications of screening as well as the feasibility of implementing such programmes must also be considered.

Key Points

  • Oesophageal cancer is a public health concern worldwide

  • With the abysmal outcome for oesophageal cancer (5-year survival <20%) pursuit of a screening strategy is essential

  • Increased public awareness coupled with early diagnosis is likely to have the biggest impact on reducing population mortality from oesophageal cancer

  • Advances in diagnostic technologies and minimally invasive treatments mean that the time is ripe to consider a formalized screening programme for this disease

  • Screening tests should be of low cost and easily administered from the perspective of the patient and the health-care provider

  • Further research in quality of life, economics, biomarkers and device technologies is required to allow screening to be adopted into clinical practice

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Figure 1: Oesophageal cancer incidence and mortality worldwide—2008 estimates.
Figure 2: Pathological sequence of oesophageal cancer progression.
Figure 3: Endoscopic photographs of oesophageal lesions.
Figure 4: Oesophageal cell collection using non-endoscopic devices.

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  1. MRC Cancer Cell Unit, Hutchison-MRC Research Centre, Hills Road, Cambridge, CB2 0XZ, UK

    Pierre Lao-Sirieix & Rebecca C. Fitzgerald

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Both authors researched the data for the article, provided substantial contributions to discussions of its content, wrote the article and undertook review and/or editing of the manuscript before submission.

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Correspondence to Rebecca C. Fitzgerald.

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The authors declare grant or research support and patents held with the Medical Research Council (Cell sampling device patent n# PCT/GB2010/002077; Biomarker for Barrett's oesophagus patent n# 12/833,548) and grant support from Cancer Research UK.

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Lao-Sirieix, P., Fitzgerald, R. Screening for oesophageal cancer. Nat Rev Clin Oncol 9, 278–287 (2012). https://doi.org/10.1038/nrclinonc.2012.35

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