Tamara Thomas

Urban Health Today

A study published in the journal Gastroenterology found that targeted screening of people with a 5% risk of developing Barrett’s esophagus (BE) or esophageal cancer (EC) reduced the screening population by about 45% but still detected more than 70% of cases of BE/EC.
Studies show that patients with esophageal cancer had a 5-year survival of less than 20%, but a previous diagnosis of Barrett’s esophagus was associated with detecting the cancer at an earlier stage and improved survival.
For this study, Dr. Keith Tan of the Department of Oncology, University of Cambridge, United Kingdom, and colleagues used large clinical trial data (Barrett’s Esophagus Screening Trial 3 [BEST3]) to identify the optimal target population to screen for BE and stage-1 EC (BE/EC) to maximize diagnostic yield and minimize harm from overdiagnosis.
The BEST3 trial compared the use of the capsule sponge Trefoil Factor 3 (TFF3) test, a minimally invasive test to usual care for detecting BE and early EC. The usual care group had about 6,300 patients aged 50 years and older with gastroesophageal reflux disease (GERD).
The researchers estimated the number of missed BE/EC cases. The TFF3-negative patients were also randomly invited for further testing and diagnosed with BE/EC. Dr. Tan and colleagues then calculated the expected number of diagnoses.
The results revealed that only 0.3 % of BE/ECs were detected in usual care, which fell short of the expected 10.6%, suggesting that about 98% of cases go undetected. From the findings, the researchers projected that if all 6388 participants in the usual care group took the TFF3 test at the same rate as those in the intervention group, they would detect up to 74% of undiagnosed cases of BE/EC.
Following this, Dr. Tan and colleagues evaluated the best way to enrich the screening population. They invited a certain percentage of individuals at risk for screening using factors like age, sex, and family history. The researchers selected representative groups for individuals with more than a 5% risk of developing BE or EC, such as women and men of a certain age.
“To target individuals with a 3% probability of harboring BE/EC, women aged ≥60 and men aged ≥50 could be invited for screening. For ≥5% probability, women aged ≥65 years and men aged ≥55 years could be invited. For a 10% threshold, only men aged ≥65 should be invited because women never reach 10% probability,” the researchers wrote.
The researchers observed that screening participants with a 5% risk of having BE/EC using a targeted strategy could substantially decrease the population to screen while still detecting &gt;70% of BE/ECs.
In addition, the study revealed that screening only men with a 10% risk of BE/EC significantly reduces the number of individuals screened by 84%. However, this approach only identified about 27 % of prevalent cases.
“Ultimately, the value of screening will also be reliant on uptake. In the BEST3 trial, 39% of invitees expressed interest, but only 25% attended their appointment once exclusion criteria and availability were considered,” the researchers concluded.
Sources:<a href="https://www.healio.com/news/gastroenterology/20240702/probabilitybased-screening-for-be-esophageal-cancer-could-reduce-screening-needs-by-45"> Healio </a>
Journal: <a href="https://www.gastrojournal.org/article/S0016-5085(24)00495-5/fulltext">Gastroenterology </a>

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Researchers selected representative groups for individuals with more than a 5% risk of developing BE or EC

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