Jankowski, Janusz

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Screening for Barrett’s Cancer: Who, How and Why?Janusz JankowskiProfessor of MedicinePro Vice Chancellor ResearchTransdisciplinary/Holistic system needed where causality unclearReductionism strongly reflects a certain perspective on causalityComplex Genetic interplay versus unclear Environment High Fat and Carbohydrate DietBrit Med J Jankowski et al, 2010 Making sense of Barrett's oesophagus; doing more for the fewBennett C et al,  Am J Gastroenterol. 2015;110:662-682Who?Pre-Endoscopy - ScreeningBOSS Trial (CI H Barr) awaited in 2021 for efficacy of surveillanceHow?GI Disease No. SNPs currently identifiedIBD ~ 165Colorectal Cancer ~ 30Coeliac Disease ~ 20Barrett’s Oesophagus 16Oesophageal Adenocarcinoma 16 + 1 (independent of BE)Environmental Component: High Sugar, Salt, Fat, Alcohol and Cigarettestranscription factor 7-like 2 (TCF7L2)APOENOD2So how do we fix the clinical problems now?AspECT Trial (CI J Jankowski) will report 2017• 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?Summary• Who60 years (men)ObeseSmokers/alcoholLong standing heartburn• HowQuality endoscopyUnsedated TNE• WhyIncrease global health benefits CVS and cancer deathsDecrease burden and cost of BE surveillanceCumbria recruiting now;  contact jjankowski@uclan.ac.uk

Screening for Barrett's Cancer: Who, How and Why?

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