title: Precision prevention of oesophageal adenocarcinoma.
abstract: The incidence of oesophageal adenocarcinoma has risen rapidly over the past four decades. Unfortunately, treatments have not kept pace; unless their cancer is identified at a very early stage, most patients will not survive a year after diagnosis. The beginnings of this widespread problem were first recognized over 25 years ago, yet rates have continued to rise against a backdrop of much improved understanding and management of oesophageal adenocarcinoma. We estimate that only ∼7% of the 10,000 cases of oesophageal adenocarcinoma diagnosed annually in the USA are identified through current approaches to cancer control, and trace pathways by which the remaining 93% are 'lost'. On the basis of emerging data on aetiology and predictive factors, together with new diagnostic tools, we suggest a five-tier strategy for prevention and control that begins with a wide population base and triages individuals into progressively higher risk strata, each with risk-appropriate prevention, screening and treatment options.
authors: Program in Cancer Epidemiology, Fred Hutchinson Cancer Research Center, Department of Epidemiology, University of Washington, 1100 Fairview Avenue North, Seattle, WA 98109, USA.
authors: Thomas L
authors: TL
authors: Vaughan
authors: Medical Research Council (MRC) Cancer Unit, Hutchison-MRC Research Centre, University of Cambridge, Hills Road, Cambridge CB2 0XZ, UK.
authors: Rebecca C
authors: RC
authors: Fitzgerald
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology / Q000517:prevention & control*; D001471:Barrett Esophagus / Q000175:diagnosis / Q000453:epidemiology; D004938:Esophageal Neoplasms / Q000453:epidemiology / Q000517:prevention & control*; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D012307:Risk Factors