Prevention - AllCaN Oesophageal Project Title

  • All-Ireland comparisons of Oesophageal cancer (OC) and Barrett’s oesophagus (BO) intelligence.

Specific Project Team

Prof. Helen Coleman

AllCaN Oesophageal Co-Lead & Principal Investigator

Dr. Victoria Child

AllCaN Oesophageal Postdoctoral Research Fellow

Project Start Date and Duration

  • August 2024 (19 months)

Project Collaborators

  • Scientific Collaborators

Dr Damien Bennett (NICR)

Prof. Jacintha O'Sullivan

Northern Ireland Cancer Registry

National Cancer Registry of Ireland

Oesophageal Cancer Fund

Project Collaborators

  • Clinical Collaborators

Dr Richard Turkington

Prof. John Reynolds

Prof. Brian Johnston

Dr Damian McManus

VC Project

Project Lay Summary

This project will be part of work package 1 (prevention).

Barrett’s oesophagus is a premalignant condition which offers opportunities for early detection, diagnosis and treatment of dysplasia (characterised by abnormal (but not yet malignant) cell growth/development) and oesophageal cancer as following a Barrett’s oesophagus diagnosis, patients are followed up to monitor further changes in the oesophagus.

Our population-based and multi-centre research on the island of Ireland has shown that the majority patients living with Barrett’s oesophagus did not progress to dysplasia or cancer but risk of progression is not uniform across all patients. Work is ongoing to determine how best to identify groups of Barrett’s oesophagus patients at lower or higher risk of progression to avoid unnecessary healthcare burden and provide reassurance for low-risk patients whilst ensuring that patients at higher risk are followed-up more frequently. For those who do progress, there are now treatments available via the flexible tube used during an endoscopy (camera test) making them less invasive than previous treatment options. This work aims to bring together two unique large-scale Barrett’s registry data sources to:

  1. Explore trends in the number and characteristics of people being diagnosed with Barrett’s oesophagus and dysplasia across the island of Ireland, and
  2. Compare endoscopic treatment access and outcomes between the different healthcare structures North and South.

The findings will inform future service planning and the development of clinical guidelines for the management of Barrett’s oesophagus such as through identifying groups of patients at higher risk of progression. Evidence-based patient information resources will be co-designed with our patient representatives, to communicate the current results in an easily accessible format.

Scientific Overview

Barrett’s oesophagus is a premalignant condition for a type of oesophageal cancer called oesophageal adenocarcinoma. Oesophageal adenocarcinoma often has poor survival outcomes due to diagnosis occurring at late-stage disease. Following a diagnosis of Barrett’s oesophagus, patients are entered onto a surveillance programme to monitor any further cell changes such as dysplasia or cancer. Our population-based and multi-centre research on the island of Ireland has shown that most patients living with Barrett’s oesophagus will not progress to dysplasia or cancer. However, for those who do there are now minimally invasive endoscopic treatments (endoscopic mucosal resection and radiofrequency ablation) available. Therefore, Barrett’s oesophagus offers an opportunity for early detection, diagnosis and treatment of dysplasia and cancer.

This work aims to:
1. Combine the diagnostic information for >34,000 Barrett’s oesophagus patients from Northern Ireland Barrett’s register and the National Barrett’s registry to explore trends in the number of people being diagnosed with Barrett’s oesophagus and dysplasia across the Island of Ireland, and
2. Combine endoscopic treatment information for approximately 1,000 patients with dysplasia and early cancer to quantitatively compare the number of endoscopic treatments, the time intervals between diagnosis and treatment and outcomes for patients between the different health service structures in Northern Ireland and the Republic of Ireland.

Short-term impacts:

This work will quantify Barrett’s oesophagus disease burdens across the island of Ireland using data from the 2010s and 2020s for the first time, which is important given the introduction of endo-therapies in this timeframe.

As one of the largest registers of Barrett’s oesophagus globally, this work will inform high-impact scientific journal articles, allowing distribution of findings across the world.

We also aim to co-design patient-orientated information on the results, in conjunction with our PPI members (via leaflets or website content development distributed through the different charities linked with AllCaN).

  • Long-term impacts:

Barrett’s oesophagus intelligence including the number and characteristics of patients diagnosed is vital in informing where appropriate healthcare services (for example Barrett’s surveillance recommendations) or interventional prevention research should be targeted in future.

Findings related to endotherapy practices and outcomes will have direct implications for patient management and importantly, will inform clinical guidelines from Gastroenterology societies.  

AllCaN Oesophageal

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