Influence of Malpractice History on the Practice of Screening and Surveillance for Barrett's Esophagus

Rubenstein, Joel H.; Saini, Sameer D.; Kuhn, Latoya; McMahon, Laurence F.; Sharma, Pratima; Pardi, Darrell S.; Schoenfeld, Philip

doi:10.1111/j.1572-0241.2007.01689.x

Cited by 31 publications

(29 citation statements)

References 26 publications

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“…These findings contrast with the results of a survey of practicing American gastroenterologists (16). In that survey, 73% reported they would recommend screening for a 35-year-old man with GERD, but the current study estimates that such a patient has a risk of colorectal cancer that is over fivefold greater than his risk of EAC, and yet the patient would be very unlikely to be offered colorectal cancer screening.…”

Section: Discussioncontrasting

confidence: 99%

“…The US Preventive Services Task Force has not published any guidelines for or against screening for EAC (15). Nonetheless, a recent survey of practicing American gastroenterologists found that 98 % would recommend screening a 55-year-old man with long-standing frequent GERD, and substantial proportions would screen other groups of patients with GERD (16). Recent advances in molecular and endoscopic markers predicting the risk of progression of Barrett's esophagus (17–19), and in the endoscopic treatment of neoplasia within Barrett's esophagus (20,21), will likely lead to greater enthusiasm for screening for EAC.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Esophageal Adenocarcinoma Incidence in Individuals With Gastroesophageal Reflux: Synthesis and Estimates From Population Studies

Rubenstein

Scheiman

Sadeghi

et al. 2011

American Journal of Gastroenterology

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Objectives Recent advances in the management of Barrett's esophagus may kindle enthusiasm for screening for esophageal adenocarcinoma (EAC). Symptoms of gastroesophageal reflux disease (GERD) are recognized as relative risks for EAC. However, the absolute incidence of EAC in specific populations with GERD is unknown. We aimed to estimate the symptom-, age-, and sex-specific incidences of EAC, and place these incidences in the perspective of other cancers for which screening is endorsed. Methods A Markov computer model utilizing published and publicly available data was created to estimate the age- and sex-specific incidences of EAC in American white non-Hispanics with GERD symptoms. Results The incidence of EAC in men younger than 50 years with GERD symptoms is very low (for instance, at the age of 35 years, incidence = 1.0/100,000), and their incidence of colorectal cancer is relatively much higher (for instance, at the age of 35 years, incidence of colorectal cancer is 6.7-fold greater). The incidence of EAC in older men with weekly GERD symptoms is substantial (for instance, at the age of 70 years, incidence = 60.8/100,000 person-years), but their incidence of colorectal cancer is at least threefold greater. The incidence of EAC in women with GERD is extremely low, and similar to that of breast cancer in men (for instance, 3.9/100,000 person-years at the age of 60 years). Conclusions Screening for EAC should not be performed in men younger than 50 years or in women because of very low incidences of cancer, regardless of the frequency of GERD symptoms. In white men with weekly GERD over the age of 60 years, the incidence of EAC is substantial, and might warrant screening if that practice is particularly accurate, safe, effective, and inexpensive.

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Section: Discussioncontrasting

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Esophageal Adenocarcinoma Incidence in Individuals With Gastroesophageal Reflux: Synthesis and Estimates From Population Studies

Rubenstein

Scheiman

Sadeghi

et al. 2011

American Journal of Gastroenterology

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“…Furthermore, despite the dearth of studies showing clinical benefit resulting from endoscopic screening for Barrett's esophagus, the practice remains widespread among clinicians in the United States. 70 Professional organizations are divided on whether to recommend endoscopic screening for Barrett's esophagus, however, with some suggesting that the practice may be appropriate 71 and others not endorsing it routinely. 72,73 …”

Section: Agai Procedures For Construction Of Technical Reviewsmentioning

confidence: 99%

American Gastroenterological Association Technical Review on the Management of Barrett's Esophagus

Spechler¹,

Sharma

Souza³

et al. 2011

Gastroenterology

1,025

676

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“…29,52 Given the additional information resources available in this setting, e.g., medical and family history, 53 physical examination, blood/urine measures (as effective biomarkers are identified), 54–57 and knowledge of their independent associations with cancer risk, a risk assessment tool, or risk calculator, can be used to educate and motivate, as well as to identify those at a higher level of risk who should be considered for additional investigation. 51,58 While no highly penetrant germline mutations for esophageal adenocarcinoma have been identified, there is evidence for a significant polygenic hereditary component, 59 and the list of common mutations conferring small differences in risk is growing.…”

Section: A Different Directionmentioning

confidence: 99%

Precision prevention of oesophageal adenocarcinoma

Vaughan

Fitzgerald

2015

Nat Rev Gastroenterol Hepatol

135

106

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Summary A rapid and continuous rise in incidence of esophageal adenocarcinoma over the past four decades has been well documented in many developed countries across three continents. Among white males, who are in the highest risk demographic, incidence has risen 10-fold in the U.S. since the early 1970s. Incidence among males in the U.K. are among the highest in the world, and 50% higher than in the U.S. Unfortunately, treatments have not kept pace; unless their cancer is identified at a very early stage, most individuals 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 including the introduction of medical and surgical treatments aimed at reducing acid reflux, one of the most important risk factors; the availability of screening and surveillance programs for the precursor lesion Barrett’s metaplasia; and the development of endoscopic therapies for prevention or treatment of early invasive cancer. We estimate that only about 7% of the 10,000 cases of esophageal adenocarcinoma diagnosed annually in the U.S. are identified through current approaches to cancer control, and trace pathways by which the remaining 93% are “lost.” Based on emerging data on etiology and predictive factors coupled 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.

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Influence of Malpractice History on the Practice of Screening and Surveillance for Barrett's Esophagus

Cited by 31 publications

References 26 publications

Esophageal Adenocarcinoma Incidence in Individuals With Gastroesophageal Reflux: Synthesis and Estimates From Population Studies

Esophageal Adenocarcinoma Incidence in Individuals With Gastroesophageal Reflux: Synthesis and Estimates From Population Studies

American Gastroenterological Association Technical Review on the Management of Barrett's Esophagus

Precision prevention of oesophageal adenocarcinoma

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