![]() more stringent thresholds that might be used. ![]() Using this calculator, we compared the risk distribution between EAC cases and population-based controls from six studies in the Barrett’s and Esophageal Adenocarcinoma Consortium (BEACON ) to contrast discrimination metrics of current guidelines vs. To address this barrier, an online Interactive and Contextual Risk Calculator (IC-RISC™ ) was developed to take advantage of existing knowledge from observational studies and clinical trials to estimate more precisely an individual’s absolute risk of developing EAC over a ten-year period, and to convey this estimate in the context of risk of dying from other cancers or from common causes such as injury, stroke or heart disease. However, this qualitative approach excludes the approximately 47% of all EAC that present in persons without significant sGERD, who may be at increased risk due to other factors, and does not take advantage of known quantitative relationships (i.e., strength of association and dose-response) between EAC incidence and sGERD, smoking and obesity, for example. ![]() For example, 2016 American College of Gastroenterology (ACG) guidelines suggest that screening may be considered among men with sGERD plus two or more other specified risk factors for BE or EAC. Furthermore, none consider the strong effect of age on EAC incidence except in defining a fixed age threshold, and all tend to treat the remaining risk factors as equally important. Clinical practice guidelines vary by country and professional society regarding criteria for initial screening for BE or EAC, as well as the definition of BE. Ī key barrier has been identifying those most likely to benefit from endoscopy or newer non-endoscopic tissue sampling methods. Nevertheless, the relative rarity of the cancer, combined with the cost and invasiveness of upper endoscopy for identifying early cancers and high-risk pre-cancers (e.g., Barrett’s esophagus (BE) with dysplasia or genomic abnormalities) make it challenging to define effective screening and surveillance strategies. Most cases can be attributed to known risk factors, such as symptomatic gastroesophageal reflux (sGERD), central obesity, cigarette smoking and family history. Incidence of esophageal adenocarcinoma (EAC) has risen markedly in many western countries.
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