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Esophageal & Gastric Cancer Screening and Prevention  

1. Guidelines for Screening

Risk factors for esophageal cancer:

Age 45 to 70 years

Gastroesophageal reflux disease (GERD)

Barrett’s esophagus



Asian Flush Syndrome (in response to alcohol)

Bile reflux

Chewing tobacco


Drinking very hot liquids


Prior radiation therapy to the chest or upper abdomen

Eating insufficient fruits and vegetables

Eating foods preserved in lye, such as lutefisk, a Nordic recipe for whitefish and some olive recipes

Being male


Plummer-Vinson syndrome

Caustic esophageal injury


Risk factors for gastric cancer:


H. Pylori

Atrophic gastritis

Intestinal metaplasia on endoscopic gastric biopsy

First generation Japanese living in the United States

Pernicious anemia

Prior distal gastrectomy

Lack of fresh fruits and vegetables

Eating foods prepared in salt such as pickled vegetables

Family history of gastric cancer




Esophageal cancer


Screening endoscopy is not appropriate for all patients with GERD


There is no level I evidence that screening for esophageal cancer will lower the very high mortality of the disease but cancers diagnosed in patients with Barrett’ s Esophagus who have been screened with esophagogastroscopy, tend to be at earlier stages than cancer patients who have not been screened


Screening patients with GERD, of whom about 10 percent are associated with Barrett’s esophagus with annual esophagoscopy. About 10% of these patients will develop esophageal cancer in their lifetime

Smoking is a strong risk factor for squamous cancers of the esophagus and to a lesser degree adenocarcinomas


Gastric cancer


There is no level 1 evidence that screening for gastric cancer will lower the very high mortality of the disease


Gastric cancer patients who are under the age under the age of 50 should be screened for HNPCC or Familial gastric cancer


2. Cancer Prevention


Patients with Barrett’s esophagus, and dysplasia on biopsy, may reduce their chances of esophageal cancer with treatment of their GERD and local ablative therapy to the Barrett’s disease


Not smoking

Quitting smoking preferably by joining a smoking cessation program

Eating more fruits and vegetables

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