Data from cancer registries indicate that the incidence of esophageal adenocarcinoma (EAC) in the United States has increased nearly 6-fold during the past 3 decades. Our current strategy for prevention consists of endoscopic detection of Barrett's esophagus (BE). BE is a premalignant metaplastic condition and is the only known precursor of esophageal adenocarcinoma. BE is thought to be a metaplastic reparative response to injury and appears to progress from a metaplastic to dysplastic stage to invasive carcinoma. Upper endoscopy, when performed for evaluation of chronic gastroesophageal reflux symptoms, identifies BE in about 10% of patients. Non-randomized studies indicate that surveillance of BE may lead to improved survival. Unfortunately, only 5% of individuals who develop EAC are detected as part of a screening and surveillance program. Genomic investigations of BE and EAC are beginning to provide insights into the molecular changes underlying the metaplasia to dysplasia to carcinoma progression. This genomic discovery must be translated into more effective methods for screening, surveillance, prevention, and therapy.
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