The detection and management of pre-cancerous conditions is often controversial and Barrett’s oesophagus is no exception. Like cervical screening, it can raise anxiety in those who are told they have this abnormality. However detection of Barrett’s is not a cancer diagnosis. Somewhere between 1% and 5% of those with the abnormal cells go on to develop cancer of the oesophagus.
Barrett’s is a change in the cells lining the oesophagus, thought to result from long-term reflux of acidic fluid from the stomach. Medical opinion is divided about the best way to proceed once the abnormality has been detected. Do you opt for surgery to remove the affected area or is it better to wait and watch, monitoring the oesophagus with regular checkups? Cancer of the oesophagus is increasing in incidence, while some other cancers become less common. But is it a good idea to screen the whole population or maybe a particular sub-group? The current method of checking involves a doctor performing an endoscopic examination and taking a sample of cells.
A British team has recently completed a huge review of the evidence. They looked at over 20,000 academic studies by gastroenterologists around the world and then used a voting system to make conclusions. This highlights the challenges that clinicians face when trying to make decisions about evidence-based care. No one specialist could hope to keep up to date on all these studies
A large team shared the work and concluded that, in most cases, the wait and watch approach is better. With more advanced cases though, surgery seems to be the best option. They also conclude that for men over 50, who have suffered from reflux for more than 10 years, screening is a good idea.
A new method of screening is being looked at in a study funded by Cancer Research UK, which may make screening easier and cheaper. It involves the patient swallowing a sponge (a “cytosponge”), which is contained in a small, soluble capsule and attached to a string. A nurse can retrieve it to provide a cell sample. This is less invasive and presumably less expensive than a doctor taking a cell sample via an endoscope.