janusz jankowski - clokclok.uclan.ac.uk/16936/1/16936_jankowskibsg21.6.16final.pdf · janusz...
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Screening for Barrett’s Cancer: Who, How and Why?
Janusz Jankowski
Professor of Medicine
Pro Vice Chancellor Research
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Transdisciplinary/Holistic system needed where causality unclear
Reductionism strongly reflects a certain perspective on causality
Complex Genetic interplay versus unclear Environment
High Fat and Carbohydrate Diet
Brit Med J Jankowski et al, 2010
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Making sense of Barrett's oesophagus; doing more for the few
Bennett C et al, Am J Gastroenterol. 2015;110:662-682
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Who?
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Pre-Endoscopy - Screening
BOSS Trial (CI H Barr) awaited in 2021 for efficacy of surveillance
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How?
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GI Disease No. SNPs currently identifiedIBD ~ 165Colorectal Cancer ~ 30Coeliac Disease ~ 20
Barrett’s Oesophagus 16
Oesophageal Adenocarcinoma 16 + 1 (independent of BE)
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Environmental Component: High Sugar, Salt, Fat, Alcohol and Cigarettes
transcription factor 7-like 2 (TCF7L2)
APOE
NOD2
So how do we fix the clinical problems now?
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AspECT Trial (CI J Jankowski) will report 2017
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• Patients with Barrett's esophagus, approximately 2 percent will die of esophageal cancer.
• Patients with Barrett's esophagus died more frequently of other causes, such as ischemic heart disease and pneumonia.
• Therefore need for adequate weight, diet, smoking and alcohol modification strategies.
• Need for better quality endoscopy and perhaps FNE in select centers in the community.
Why?
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Summary• Who
60 years (men)ObeseSmokers/alcoholLong standing heartburn
• HowQuality endoscopyUnsedated TNE
• WhyIncrease global health benefits CVS and cancer deathsDecrease burden and cost of BE surveillance
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Cumbria recruiting now; contact [email protected]