Screening for oesophageal cancer

Screening means testing people for early stages of a disease before they have any symptoms. Before screening for any type of cancer can be carried out, doctors must have an accurate test to use. The test must be reliable in picking up cancers that are there. And it must not give false positive results in people who do not have cancer. No tests have been shown to decrease the risk of dying from cancer of the oesophagus.

Not all screening tests are helpful and may have risks associated with them. At the moment, the only way to screen for oesophageal cancer is to have an endoscopy and a tissue sample (biopsy) taken from the lining of the food pipe. There is a risk of complications with these procedures, for example, tearing of the oesophagus.

A new screening test is being developed to pick up cell changes that may increase the risk of oesophageal cancer (Barrett's oesophagus). You swallow a capsule (pellet) that expands into a ball in the oesophagus. It is pulled back up the oesophagus using a string and takes samples of the lining as it goes. The ball is sent to the lab and the cells are tested to see if they have any changes that may increase the risk of oesophageal cancer. 

At the moment this screening test is being used in clinical trials in the UK in people with heartburn (who are more likely to have Barrett's oesophagus than people who do not have heartburn). In early trials that compared the capsule to endoscopy, patients preferred the capsule. If doctors can pick up Barrett's oesophagus in more people, they may be able to develop better ways of monitoring them for early signs of cancer. And hopefully develop ways of stopping Barrett's oesophagus becoming oesophageal cancer.

At the moment there is no screening programme for oesophageal cancer in the UK. Experts do not consider screening to be a reasonable approach to managing cancer of the oesophagus because of the

• High costs involved
• Low number of cancers that would be found and
• Risks of the tests that would have to be done

Some doctors recommend screening people who have been diagnosed with Barrett's oesophagus. But some specialists in the UK don't think that this helps, because at the moment we don't have a good way of knowing where to take tissue samples from and cancer could still be missed. Doctors also have to take into account the possible risks of damage to your throat from repeated endoscopies. Only a couple of people out of every 100 with Barrett's will go on to get cancer of the oesophagus. Results from the BOSS study will hopefully show whether it is better to monitor people with Barrett's oesophagus every 2 years or to wait until they have a change in their symptoms. 

A few people with Barrett's have very abnormal cells (high grade Barrett's oesophagus). These people should see a surgeon for treatment because they have a higher risk of developing cancer. They are not candidates for screening at the moment.

If you think you may be at higher than average risk (for example, if you have a medical condition that increases your risk of oesophageal cancer) talk to your doctor. You may be able to have regular check ups and endoscopies from time to time.