Endoscopic screening for precancerous lesions of the esophagus in a high risk area in Northern Iran

Outcomes of upper gastrointestinal cancer screening in high-risk individuals: a population-based prospective study in Northeast China

OBJECTIVES

The strategy for upper gastrointestinal cancer (UGC) screening has not yet been determined, especially in northeast China.

DESIGN

The sample was from an ongoing prospective population-based cohort for cancer screening.

PARTICIPANTS

This study belonged to the Chinese Urban Cancer Screening Program. The analysis was based on the recruitment of participants aged 40-74 in Northeast China from 2016 to 2017. Totally, 39 369 eligible participants were recruited, 8772 were evaluated to be at high risk for UGC, 1957 underwent endoscopy.

OUTCOMES

χ² test and multifactor logistic regression model was performed to analyse influencing factors of participation rate. Receiver operating characteristic curve analysis was applied to evaluate the diagnostic power of the high-risk assessment. The Cox regression model was used to estimate hazard ratio (HR) for the potential value.

RESULTS

The high-risk rate was 22.28% and the participation rate of endoscopy screening was 22.31%. Factors such as age at 45-59 years, female sex, high level of education, occupation for professional and technical personnel, former drinking, secondary smoking, less physical activity, history of trauma or mental depression, history of upper gastrointestinal system disease and family history of UGC were associated with increased participation in endoscopy screening (all the p<0.05). There were five UGCs, 86 oesophageal precancerous lesions and 145 gastric precancerous lesions, and the detection rates were 0.26%, 4.39% and 7.41%, respectively. The detection rate for both oesophageal and gastric lesions increased with age and was higher for men than for women (all the p<0.05). After a 3-year follow-up, 30 UGCs had been diagnosed and the high risk of UGC increased the mortality risk ratio (HR: 1.90, 95% confidence interval (CI) 1.41 to 2.56).

CONCLUSION

The participation rate and outcomes of UGC screening were promising in our study and will provide important reference for evaluating value of UGC screening in China.

Investigations concerning the impact of consumption of hot beverages on acute cytotoxic and genotoxic effects in oral mucosa cells

Consumption of very hot beverages and foods increases the incidence of oral and esophageal cancer but the mechanisms are not known and the critical temperature is not well defined. We realized a study with exfoliated cells from the oral cavity of individuals (n = 73) that live in an area in Iran which has the highest incidence of EC worldwide. Consumption of beverages at very high temperatures is a characteristic feature of this population. We analyzed biomarkers which are (i) indicative for genetic instability (micronuclei that are formed as a consequence of chromosomal damage, nuclear buds which are a consequence of gene amplifications and binucleated cells which reflect mitotic disturbances), (ii) markers that reflect cytotoxic effects (condensed chromatin, karyorrhectic, karyolitic and pyknotic cells), (iii) furthermore, we determined the number of basal cells which is indicative for the regenerative capacity of the buccal mucosa. The impact of the drinking temperature on the frequencies of these parameters was monitored with thermometers. We found no evidence for induction of genetic damage but an increase of the cytotoxic effects with the temperature was evident. This effect was paralleled by an increase of the cell division rate of the mucosa which was observed when the temperature exceeded 60 °C. Our findings indicate that cancer in the upper digestive tract in drinkers of very hot beverages is not caused by damage of the genetic material but by an increase of the cell division rate as a consequence of cytotoxic effects which take place at temperatures over 60 °C. It is known from earlier experiments with rodents that increased cell divisions lead to tumor promotion in the esophagus. Our findings provide a mechanistic explanation and indicate that increased cancer risks can be expected when the drinking temperature of beverages exceeds 60 °C.

Determinants of participation and detection rate of upper gastrointestinal cancer from population-based screening program in China

Upper gastrointestinal cancer (UGC) screening has been widely implemented in many Asian countries. However, there is little evidence of participation and diagnostic yields in population-based UGC screening in China. The participation rate and detection of upper gastrointestinal lesions in this program were reported and related factors were explored. The analysis was conducted in the context of the Cancer Screening Program in Urban China, which recruited 179 002 eligible participants aged 40-74 years from three cities in Henan province from 2013 to 2017. A total of 43 423 participants were evaluated to be high risk for esophageal cancer or gastric cancer by an established risk score system and were subsequently recommended for endoscopy. Of 43 423 with high risk for UGC, 7996 subjects undertook endoscopy (participation rate of 18.4%). We found that male sex, high level of education, marriage, smoking, current alcohol drinking, lack of physical activity, history of upper gastrointestinal system disease, and family history of UGC were associated with increased participation of endoscopy screening. Overall, 15 UGC (0.19%), 275 squamous epithelial dysplasia (3.44%), and 33 intraepithelial neoplasm (0.41%) cases were detected. Several factors including age, sex, smoking, current alcohol drinking, lack of physical activity, and dietary intake of processed meat were identified to be associated with the presence of upper gastrointestinal lesions. Health promotion campaigns targeting the specific group of individuals identified in our study will be helpful for improvement of the adherence of UGC screening in population-based cancer screening programs. Participant rate and yield of UGC screening will provide important references for evaluating the effectiveness and cost-effectiveness of cancer screening in China.

Association between coffee or tea drinking and Barrett's esophagus or esophagitis: an Italian study

BACKGROUND/OBJECTIVES

Only a few papers have treated of the relationship between Barrett's esophagus (BE) or erosive esophagitis (E) and coffee or tea intake. We evaluated the role of these beverages in BE and E occurrence.

SUBJECTS/METHODS

Patients with BE (339), E (462) and controls (619) were recruited. Data on coffee and tea and other individual characteristics were collected using a structured questionnaire.

RESULTS

BE risk was higher in former coffee drinkers, irrespective of levels of exposure (cup per day; ⩽1: OR=3.76, 95% CI 1.33-10.6; >1: OR=3.79, 95% CI 1.31-11.0; test for linear trend (TLT) P=0.006) and was higher with duration (>30 years: OR=4.18, 95% CI 1.43-12.3; TLT P=0.004) and for late quitters, respectively (⩽3 years from cessation: OR=5.95, 95% CI 2.19-16.2; TLT P<0.001). The risk of BE was also higher in subjects who started drinking coffee later (age >18 years: OR=6.10, 95% CI 2.15-17.3). No association was found in current drinkers, but for an increased risk of E in light drinkers (<1 cup per day OR =1.85, 95% CI 1.00-3.43).A discernible risk reduction of E (about 20%, not significant) and BE (about 30%, P<0.05) was observed in tea drinkers.

CONCLUSIONS

Our data were suggestive of a reduced risk of BE and E with tea intake. An adverse effect of coffee was found among BE patients who had stopped drinking coffee. Coffee or tea intakes could be indicative of other lifestyle habits with protective or adverse impact on esophageal mucosa.

The Discovery and Validation of Biomarkers for the Diagnosis of Esophageal Squamous Dysplasia and Squamous Cell Carcinoma

The 5-year survival rate of esophageal cancer is less than 10% in developing countries, where more than 90% of these cancers are esophageal squamous cell carcinomas (ESCC). Endoscopic screening is undertaken in high incidence areas. Biomarker analysis could reduce the subjectivity associated with histologic assessment of dysplasia and thus improve diagnostic accuracy. The aims of this study were therefore to identify biomarkers for esophageal squamous dysplasia and carcinoma. A publicly available dataset was used to identify genes with differential expression in ESCC compared with normal esophagus. Each gene was ranked by a support vector machine separation score. Expression profiles were examined, before validation by qPCR and IHC. We found that 800 genes were overexpressed in ESCC compared with normal esophagus (P < 10(-5)). Of the top 50 genes, 33 were expressed in ESCC epithelium and not in normal esophagus epithelium or stroma using the Protein Atlas website. These were taken to qPCR validation, and 20 genes were significantly overexpressed in ESCC compared with normal esophagus (P < 0.05). TNFAIP3 and CHN1 showed differential expression with IHC. TNFAIP3 expression increased gradually through normal esophagus, mild, moderate and severe dysplasia, and SCC (P < 0.0001). CHN1 staining was rarely present in the top third of normal esophagus epithelium and extended progressively towards the surface in mild, moderate, and severe dysplasia, and SCC (P < 0.0001). Two novel promising biomarkers for ESCC were identified, TNFAIP3 and CHN1. CHN1 and TNFAIP3 may improve diagnostic accuracy of screening methods for ESCC. Cancer Prev Res; 9(7); 558-66. ©2016 AACR.

Pilot study of cytological testing for oesophageal squamous cell dysplasia in a high-risk area in Northern Iran

Background:

Oesophageal squamous cell carcinoma (ESCC) is a fatal disease with 5-year survival rates of <5% in Northern Iran. Oesophageal squamous dysplasia (ESD) is the precursor histologic lesion of ESCC. This pilot study was conducted to assess the feasibility, safety, and acceptability of non-endoscopic cytological examination of the oesophagus and to provide initial data on the accuracy of cytological atypia for identifying patients with ESD in this very-high-risk area.

Methods:

Randomly selected asymptomatic participants of the Golestan Cohort Study were recruited. A cytological specimen was taken using a capsule sponge device and evaluated for atypical cells. Sections of the cytological specimen were also stained for p53 protein. Patient acceptability was assessed using a visual analogue scale. The cytological diagnosis was compared with a chromoendoscopic examination using Lugol's solution.

Results:

Three hundred and forty-four subjects (43% male, mean (s.d.) age 55.6 (7.9) years) were referred to the study clinic. Three hundred and twelve met eligibility criteria and consented, of which 301 subjects (96.5%) completed both cytological and endoscopic examinations. There were no complications. Most of the participants (279; 92.7%) were satisfied with the examination. The sensitivity and specificity of the cytological examination for identifying subjects with high-grade ESD were 100 and 97%, respectively. We found an accuracy of 100% (95% CI=99–100%) for a combination of cytological examination and p53 staining to detect high-grade ESD.

Conclusions:

The capsule sponge methodology seems to be a feasible, safe, and acceptable method for diagnosing precancerous lesions of the oesophagus in this population, with promising initial accuracy data for the detection of high-grade ESD.