• barrett's carcinoma
• barrett's metaplasia
• oesophageal disease
• oesophagus-gastric junction
• screening

Over the past several decades, while the incidence of oesophageal adenocarcinoma (OAC) in Western countries has risen dramatically, our primary strategy for preventing OAC deaths has been an endoscopic screening of individuals with gastro-oesophageal reflux disease (GORD) symptoms for Barrett’s oesophagus (BO) and regular endoscopic surveillance for those found to have BO. However, there is no definitive study establishing that endoscopic surveillance prevents OAC deaths, and observational studies on this issue have reached contradictory conclusions.

While there is no proof that surveillance for BO is effective, there is indisputable evidence that current screening practices are not. Only ~12% of patients diagnosed with OAC have a prior diagnosis of BO.1 Thus, our endoscopic screening policy has failed to identify the large majority of patients who develop this malignancy. The reasons for this failure are not clear, but one of several proposed explanation is that OACs might develop from a precursor other than the BO sought during endoscopic screening.2 An interesting study by Curtius et al in Gut suggests otherwise.3

Curtius et al used a sophisticated, multiscale computational model of OAC to determine whether all expected cases of BO in the US adult population could account for the incidence of OAC reported in the Surveillance, Epidemiology, and End Results Program (SEER) cancer registry.3 The model used published estimates of GORD prevalence and SEER-provided OAC incidence curves to calibrate the prevalence of BO and its rate of neoplastic progression. For the year 2010, the model predicted that 2.2 million adults in the USA had …