Barrett’s Oesophagus and Oesophageal Adenocarcinoma
OAC is preceded by an inflammatory condition called Barrett’s oesophagus (BO), although this is now thought to only be diagnosed in approximately 7% of individuals affected by BO, with many cases remaining undiagnosed. Research from the Northern Ireland BO register has shown worrying trends of increasing incidence of BO from the 1990s to 2005 of 150%, which could not be attributed to detection bias, and was particularly evident in younger males.
Our population-based research in Northern Ireland has shown that OAC patients who have had a prior diagnosis of BO, had significantly better survival outcomes than OAC patients who were unaware of their BO. While the majority of BO patients do not develop OAC, risk stratification measures to identify those at highest risk of developing cancer are not available.
Our population-based and multi-centre research on the island of Ireland has shown that risk of cancer progression BO patients is relatively low (approximately 0.2-0.3% per year). There is a desperate need for objective biomarkers to prioritise BO patients at greatest risk of progression to cancer. Therefore, major research gaps remain in determining how best to stratify BO patients into low or high-risk groups to avoid unnecessary burden on limited healthcare resources and to provide reassurance to BO patients at lower risk. This will improve surveillance strategies for higher-risk patients. In addition, current practice over-diagnoses low-risk non-progressive disease, while under-diagnosing high-risk life-threatening lesions. Studies assessing the impact of physical activity, nutrition and medication use also require further study in these cohorts of low and high-risk patients.
AllCaN Oesophageal's Role
AllCaN Oesophageal will establish for the first time an All-Ireland Oesophageal consortium, bringing together experienced scientific, clinical and industry teams with international recognised experience in BO and OAC research and will work across the different work packages addressing these major public health problems outlined above. AllCaN Oesophageal is uniquely positioned to identify prevention strategies through enhanced understanding of the BO-OAC progression model. Importantly, early detection and control of high-risk BO will lead to better survival outcomes for patients. Upon the establishment of AllCaN Oesophageal, we will extend affiliate membership to those wishing to join from academia, industry, charities and patient groups and organisations both nationally and internationally, working on any aspect of oesophageal cancer.
One primary focus of AllCaN Oesophageal is to create a training network of postgraduate research students, enabling vital capacity-building in oesophageal cancer research on the island of Ireland. Network interactions will be driven by secondments of researchers across institutions nationally and on site and virtual research network meetings to discuss findings, interpretations of data and the impact of the work. Evaluation of the programme outputs and impact will be assessed by external boards and a PPI panel. The overall aim is for contributing members and early career researchers to be nurtured within this network, gain knowledge of different methodology and approaches, and conduct collaborative cross-disciplinary research. Importantly, by training a network of public health researchers, epidemiologists, translational biologists, interventionists, PPI representatives etc together, we will create a world-class network dedicated to improving outcomes for oesophageal cancer patients.
AllCaN Oesophageal’s Overall Aim
The overall aim of AllCaN Oesophageal is to improve outcomes for BO and OAC patients on the island of Ireland and globally, by bringing together internationally recognised leaders in cancer prevention, diagnosis, treatment, and survivorship. The research-led innovation will address key gaps in knowledge across the cancer patient’s journey. We will provide excellent opportunities for early career trainees within a structured programme, linked with industry partners, mobility research secondments and patient involvement. The outputs of AllCaN Oesophageal will significantly improve the management and outcomes for BO and OAC patients.
AllCaN Oesophageal’s Overall Objectives and Deliverables
Objective 1: All-Ireland comparisons of OAC and BO intelligence.
Deliverables:
- Report on why OAC is a male predominant disease and are there sex disparities in incidence or risk of progression of BO and OAC.
- Report on our All-Ireland BO incidence trends & OAC survival comparisons.
- Report on the production of an All-Ireland OAC atlas by histological subtypes.
Objective 2: Aetiology Research: will include pharmacoepidemiology and environmental research to determine modifiable risk factors associated with BO risk and its progression to OAC.
Deliverables:
- Report on medication exposures in BO and OAC risk and progression
- Report on environmental exposures in BO and OAC risk
Objective 3: Health services research related to BO and OAC screening, risk prediction tools and Endo therapy treatments.
Deliverables:
- Report on comparison of EMR/RFA treatments and intervals between population-based data in NI (where healthcare provision is free as part of the UK National Health Service), with Barrett’s Registry data in the Republic of Ireland.
- Report on the evaluation of potential barriers and acceptability to use of risk prediction tools and screening for oesophageal neoplasms in primary care on the island of Ireland.
