The earlier esophageal cancer is detected, the better the treatment effect. The 5-year survival rate after surgical resection of early-stage esophageal squamous carcinoma has been reported to be 85% to 90%, compared with 6% to 20% for patients with advanced disease. Therefore, high-risk groups should be screened for esophageal cancer.
So, who should be screened? What is the best way to screen?
Who should be screened?
Who should be screened?
Who should be screened?
The vast majority of patients with esophageal cancer in China are squamous, and our experts have made appropriate screening recommendations for people at different risks.
1. High-risk groups: Those who meet any of the following:
1.
①Long-term residence in areas with high incidence of esophageal squamous carcinoma (including the Taihang Mountains in North China, including Linzhou in Henan, Magxian in Hebei, and Yangcheng in Shanxi, as well as the Qinling Mountains region in Shaanxi, Henan and Anhui, and the Dabie Mountains in EYU);
②History of first-degree relatives with esophageal squamous carcinoma;
③History of previous esophageal lesions (e.g., chronic GERD, esophageal mucosal atypical hyperplasia, Barrett’s esophagus, etc.);
④Personal history of cancer;
⑤Long-term history of smoking;
⑥History of long-term alcohol consumption;
⑦People who have bad eating habits, such as fast eating, love of hot and scalding diet, high salt diet, and love of pickles.
2. General risk group: those who do not have any of the above.
3. People whose family history is unknown.
Screening recommendations for the above three groups are:
For those at high risk and with an unknown family history, screening for esophageal squamous cancer should be considered from age 40 years until age 74 years;
For those at average risk, consider esophageal cancer screening beginning at age 55 years until age 74 years.
In addition, patients who present with symptoms such as acid reflux and heartburn will be considered for esophageal cancer screening at the discretion of the physician.
What is the method used? What is the frequency of screening?
Gastroscopy is currently recommended for esophageal cancer screening both nationally and internationally. Instead, barium meal of the upper gastrointestinal tract, pull-down cytology, pathological histological markers, and tumor proteomics are not recommended.
Because gastroscopic screening is an invasive procedure and is not risk-free, it is generally recommended for people with a high suspicion of esophageal cancer, or who have precancerous esophageal lesions.
There is no consensus on the timing and frequency of gastroscopic screening. The exact timing and frequency of screening has not yet been defined by our expert consensus.
In clinical practice, our screening recommendations for people at high risk for esophageal cancer are generally given separately for squamous and adenocarcinoma.
1. Atypical mucosal hyperplasia of the esophagus, but not Barrett’s esophagus (BE)
Mild hyperplasia is reviewed every 6 months, followed by 1 year or consultation with the relevant specialist if there is no progression on 2 consecutive occasions;
Patients with severe atypical hyperplasia should have a gastroscopy every 3 months or consult with a specialist.
2. Barrett’s esophagus
Patients with BE without atypical hyperplasia should be reviewed every 2 years; if no heterogeneous hyperplasia or early cancer is detected after 2 reviews, the review interval can be relaxed to 3 years;
Patients with BE with mild atypical hyperplasia should be reviewed every 6 months for the first year; if the heterogeneous hyperplasia does not progress, subsequent reviews can be performed annually.
Patients with BE with severe atypical hyperplasia have 2 options: 1) endoscopic or surgical treatment; and 2) close follow-up with gastroscopy every 3 months.