Gastro-oesophageal cancer: death at the junction

Understanding changes at molecular level could lead to screening opportunities

The death rates from cancers of the oesophagus and gastro-oesophageal junction, adjusted for age, have risen steadily since the early 1970s (from 3 to 6 per 100 000 and from 1.5 to 3 per 100 000 population in the United Kingdom respectively).1 These figures are comparable to those in northern Europe and the United States. The incidence of Barrett's adenocarcinoma in the United States has increased from 0.3 per 100 000 to 2.3 per 100 000 over the past three decades.

Despite improvements in multimodality therapy, especially chemotherapy regimens of combined epirubicin, cisplatin, and fluorouracil combined with surgery, survival has not improved significantly, suggesting that alternative strategies for identifying and treating these conditions are needed.

The incidence of intestinal metaplasia of both the oesophagus (Barrett's oesophagus) and the gastro-oesophageal junction are also increasing. This metaplastic tissue is believed to have a premalignant potential, and Barrett's oesophagus is related to bile and acid reflux disease.2 About 8% of patients undergoing routine endoscopy and 3% of …