Over the past 40 years, the incidence of adenocarcinoma of the esophagus  among white males in the US has increased almost 10-fold. Rapid  increases among females and African American males also have been  observed. This rapidly fatal cancer is becoming increasingly common in  parts of western Europe as well.

Esophageal adenocarcinoma is thought to develop in a series of  potentially reversible steps, usually under conditions of chronic  reflux. A substantial proportion, perhaps 10 – 15%, of those with  chronic reflux develop a metaplastic epithelium (Barrett’s esophagus).  Those with metaplasia are at substantial risk, estimated at 0.2% per  year, of developing adenocarcinoma, a cancer with very high mortality.  Paralleling the histopathological changes are a number of cell cycle and genetic abnormalities, such as loss or mutation of tumor suppressor  genes, telomere shortening and aneuploidy, resulting in increased  genetic instability and eventually invasive cancer.

Reid BJ, Li X, Galipeau PC, et al. Barrett’s oesophagus and oesophageal adenocarcinoma: time for a new synthesis. Nature Reviews Cancer 2010;10:87–101.

The major focus of my research is the identification of environmental  and host factors that underlie this dramatic increase in incidence. This  is accomplished through population-based case-control studies of  cancer, community-based case-control studies of the key precancerous  lesion, Barrett’s esophagus, and a long-standing cohort study of persons  with Barrett’s. Determinants of genetic susceptibility are being  investigated in genome-wide association studies (GWAS) in collaboration  with the international BEACON consortium and others. I am also interested in identifying potential preventive measures for these  cancers, such as use of anti-inflammatory medications (e.g., aspirin).

Recently I have focused on translating findings from observational  studies and trials to the clinical and population settings. My  colleagues and I have advanced a detailed research roadmap to overcome  the limitations inherent in current approaches to controlling esophageal adenocarcinoma, and created a web-based risk calculator and information  resource (IC-RISC™) to inform shared decision-making between a health  provider and patient regarding screening, surveillance and treatment options.

Vaughan TL, Onstad L, Dai JY. Interactive decision support for esophageal adenocarcinoma screening and surveillance. BMC Gastroenterol 2019;19:109.