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Letter
Overdiagnosis and Barrett’s oesophagus: a call for clarity
  1. Elspeth Davies
  1. Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  1. Correspondence to Elspeth Davies; elspeth.davies{at}phc.ox.ac.uk

https://doi.org/10.1136/bmjebm-2024-113260

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    This paper examines three varied ways in which the notion of overdiagnosis has been employed in literature on Barrett’s oesophagus (BO). It argues that the term has been poorly defined and calls for greater clarity in its usage in the future.

    BO is a metaplastic change in the lining of the oesophagus in which normal squamous epithelium is replaced by specialised or intestinalised columnar epithelium. It is often described as a precancer or risk factor for oesophageal adenocarcinoma—a type of cancer that has poor survival rates. In the UK's National Health Service (NHS), those diagnosed with BO are offered regular and sometimes lifelong endoscopic surveillance with the aim of detecting and treating dysplasia to prevent the development of cancer. As such, BO may potentially offer an opportunity to facilitate oesophageal cancer prevention and early detection.

    In the past decade, several medical societies have suggested screening high-risk populations for BO1–3, with risk factors including include long term GORD symptoms, being over 50, male, white ethnicity, and having a family history of oesophageal adenocarcinoma. In the UK, BO screening does not routinely occur at present. At least in this part, this is because doing so would require the use of endoscopies, which are expensive for healthcare services and can be uncomfortable for patients. Researchers …

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    Footnotes

    • Contributors ED is the sole author of this article. ED is also the guarantor and accepts full responsibility for the finished work and the conduct of the study, has access to the data and controls the decision to publish.

    • Funding This work was funded by International Alliance for Cancer Early Detection (C14478/A29331), a partnership between Cancer Research UK, Canary Center at Stanford University, the University of Cambridge, OHSU Knight Cancer Institute, University College London and the University of Manchester.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.