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Screening for oesophageal adenocarcinoma : an evaluation of a surveillance program for columnar metaplasia of the oesophagus

Nilsson, J LU ; Skobe, V ; Willén, R ; Johnsson, F LU and Johansson, Jan LU (2000) In Scandinavian Journal of Gastroenterology 35(1). p.6-10
Abstract

BACKGROUND: Screening patients with columnar metaplasia of the oesophagus for adenocarcinoma is controversial owing to the low cancer incidence and diverging opinions as to whether screening improves the prognosis of these patients. Our aim was to evaluate a screening program for adenocarcinoma in patients with columnar metaplasia in the oesophagus, with focus on cancer incidence and costs.

METHODS: One hundred and ninety-nine patients with columnar metaplasia of the oesophagus were identified through an endoscopy database, and the original patient records were reviewed.

RESULTS: The patients were followed up for 797 years in total and during this time were subjected to 1071 upper gastrointestinal endoscopies. During the... (More)

BACKGROUND: Screening patients with columnar metaplasia of the oesophagus for adenocarcinoma is controversial owing to the low cancer incidence and diverging opinions as to whether screening improves the prognosis of these patients. Our aim was to evaluate a screening program for adenocarcinoma in patients with columnar metaplasia in the oesophagus, with focus on cancer incidence and costs.

METHODS: One hundred and ninety-nine patients with columnar metaplasia of the oesophagus were identified through an endoscopy database, and the original patient records were reviewed.

RESULTS: The patients were followed up for 797 years in total and during this time were subjected to 1071 upper gastrointestinal endoscopies. During the screening period 5 patients presented with adenocarcinoma; thus the cancer-incidence was 1 in 159 patient-years. The cost of detecting one cancer was 294,950 SEK (US$ 37,815). However, only four of the five patients were suitable for oesophagectomy, and of these, one patient turned out to have an advanced cancer. All patients developing cancer had columnar metaplasia of the oesophagus longer than 3 cm and specialized columnar epithelium (intestinal metaplasia/Barrett oesophagus).

CONCLUSIONS: Low cancer incidence, high costs, and the doubtful prognosis for the patients with identified cancer question the benefits and cost-effectiveness of cancer screening among patients with columnar metaplasia in the oesophagus.

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author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Adenocarcinoma/diagnosis, Adolescent, Adult, Aged, Aged, 80 and over, Cost-Benefit Analysis, Endoscopy, Gastrointestinal/economics, Esophageal Neoplasms/diagnosis, Esophagus/pathology, Female, Humans, Male, Metaplasia, Middle Aged, Prognosis
in
Scandinavian Journal of Gastroenterology
volume
35
issue
1
pages
7 pages
publisher
Taylor & Francis
external identifiers
  • pmid:10672828
  • scopus:0033971581
ISSN
0036-5521
DOI
10.1080/003655200750024461
language
English
LU publication?
yes
id
17c4f2d1-d788-4b5e-bd8a-b15372da7499
date added to LUP
2019-05-26 19:07:15
date last changed
2021-02-17 01:04:22
@article{17c4f2d1-d788-4b5e-bd8a-b15372da7499,
  abstract     = {<p>BACKGROUND: Screening patients with columnar metaplasia of the oesophagus for adenocarcinoma is controversial owing to the low cancer incidence and diverging opinions as to whether screening improves the prognosis of these patients. Our aim was to evaluate a screening program for adenocarcinoma in patients with columnar metaplasia in the oesophagus, with focus on cancer incidence and costs.</p><p>METHODS: One hundred and ninety-nine patients with columnar metaplasia of the oesophagus were identified through an endoscopy database, and the original patient records were reviewed.</p><p>RESULTS: The patients were followed up for 797 years in total and during this time were subjected to 1071 upper gastrointestinal endoscopies. During the screening period 5 patients presented with adenocarcinoma; thus the cancer-incidence was 1 in 159 patient-years. The cost of detecting one cancer was 294,950 SEK (US$ 37,815). However, only four of the five patients were suitable for oesophagectomy, and of these, one patient turned out to have an advanced cancer. All patients developing cancer had columnar metaplasia of the oesophagus longer than 3 cm and specialized columnar epithelium (intestinal metaplasia/Barrett oesophagus).</p><p>CONCLUSIONS: Low cancer incidence, high costs, and the doubtful prognosis for the patients with identified cancer question the benefits and cost-effectiveness of cancer screening among patients with columnar metaplasia in the oesophagus.</p>},
  author       = {Nilsson, J and Skobe, V and Willén, R and Johnsson, F and Johansson, Jan},
  issn         = {0036-5521},
  language     = {eng},
  number       = {1},
  pages        = {6--10},
  publisher    = {Taylor & Francis},
  series       = {Scandinavian Journal of Gastroenterology},
  title        = {Screening for oesophageal adenocarcinoma : an evaluation of a surveillance program for columnar metaplasia of the oesophagus},
  url          = {http://dx.doi.org/10.1080/003655200750024461},
  doi          = {10.1080/003655200750024461},
  volume       = {35},
  year         = {2000},
}