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Nat Rev Gastroenterol Hepatol. 2015 Apr;12(4):243-8. doi: 10.1038/nrgastro.2015.24. Epub 2015 Feb 10.

Precision prevention of oesophageal adenocarcinoma.

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Program in Cancer Epidemiology, Fred Hutchinson Cancer Research Center, Department of Epidemiology, University of Washington, 1100 Fairview Avenue North, Seattle, WA 98109, USA.
Medical Research Council (MRC) Cancer Unit, Hutchison-MRC Research Centre, University of Cambridge, Hills Road, Cambridge CB2 0XZ, UK.


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.

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