Esophageal cancer screening

Screening for esophageal cancer has not been established. Screening may be effective in reducing the incidence of esophageal adenocarcinoma, especially in Barrett’s esophagus, but is left at the physician’s discretion.

• The predominant type of esophageal cancer in the United States is adenocarcinoma.^[1]
• Since there is a lack of data that records esophageal adenocarcinoma mortality rates, screening is not indicated and is left at the physician’s discretion.
• Patients diagnosed with Barrett’s esophagus have a higher risk for esophageal adenocarcinoma.
• Screening is therefore recommended for those diagnosed by endoscopy and biopsy for Barrett’s esophagus.
• Early screening can detect dysplasias and treatment can be implemented to prevent the incidence of esophageal cancer.
• It should also be noted that those who present with adenocarcinoma demonstrate no prior Barrett’s esophagus in 80 – 90% of the time.

• Screening for squamous cell carcinoma is discouraged in the US because esophageal squamous cell carcinoma carries a very low incidence.^[2]
• Squamous cell carcinoma of the esophagus is more prevalent in underdeveloped countries.
• Screening programs are not yet established worldwide.^[3]
  • A screening program in a high risk population was established in Hishun village, China.
  • Those with mild to moderate dysplasia were examined via endoscopy every 3 years, whilst those with severe dysplasia were screened once per year.
  • All the patients were concomitantly treated with monoclonal antibodies for the next three years.
  • At the end of three year monoclonal antibody trial, the incidence rate of esophageal squamous cell carcinoma had decreased by 57% in comparison to previous incidence rates.
  • These results demonstrated that screening for dysplastic changes in the esophagus is effective in the prevention of esophageal squamous cell carcinoma.

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