Does screening for Barrett's esophagus and adenocarcinoma of the esophagus prolong survival?
Despite the paucity of data supporting its use, screening upper endoscopy for patients with chronic gastroesophageal reflux disease symptoms to assess for Barrett's esophagus and esophageal adenocarcinoma has become a widely accepted practice. We apply the principles of screening to Barrett's esophagus and esophageal adenocarcinoma. Critical application of the key criteria of screening to this situation demonstrates that several criteria are unfulfilled. Key data are not available with which to judge other criteria. The major fault with screening for Barrett's esophagus is that the at-risk population is too broadly characterized and that too many cancers occur outside of this risk pool. Thus, recommendations for screening cannot be endorsed. Efforts may be better directed at further research identifying groups at risk for esophageal adenocarcinoma, developing more accurate and less-invasive methods of diagnosis, and discovering the underlying factors which continue to drive the increased incidence of this disease.
Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, NC 27599-7080, USA. nshaheen@med.unc.edu
Evan S
ES
Dellon
Nicholas J
NJ
Shaheen
D000230:Adenocarcinoma / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D001471:Barrett Esophagus / Q000150:complications / Q000175:diagnosis / Q000209:etiology; D003362:Cost-Benefit Analysis; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D005764:Gastroesophageal Reflux / Q000150:complications*; D006801:Humans; D008403:Mass Screening / Q000191:economics*