This opinion piece quantifies limitations of current approaches to prevention of esophageal adenocarcinoma, comparing the lost cases to the lost army of Napoleon during the March on Moscow in 1812 – 1813. We suggest a more rigorous approach – precision prevention – in which the population is stratified by absolute risk and risk-appropriate prevention, screening and treatments are applied.

Nat Rev Gastroenterol Hepatol. 2015 Apr;12:243-248.

Precision prevention of oesophageal adenocarcinoma.

Vaughan TL, Fitzgerald RC


The incidence of oesophageal adenocarcinoma has risen rapidly over the past four decades. Unfortunately, treatments have not kept pace; unless their cancer is identified at a very early stage, most patients will not survive a year after diagnosis. The beginnings of this widespread problem were first recognized over 25 years ago, yet rates have continued to rise against a backdrop of much improved understanding and management of oesophageal adenocarcinoma. We estimate that only ~7% of the 10,000 cases of oesophageal adenocarcinoma diagnosed annually in the USA are identified through current approaches to cancer control, and trace pathways by which the remaining 93% are ‘lost’. On the basis of emerging data on aetiology and predictive factors, together with new diagnostic tools, we suggest a five-tier strategy for prevention and control that begins with a wide population base and triages individuals into progressively higher risk strata, each with risk-appropriate prevention, screening and treatment options.