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Assessing the feasibility of targeted screening for oesophageal adenocarcinoma based on individual risk assessment in a population-based cohort study in Norway (The HUNT Study)

Research output: Contribution to journalArticle

Xie SH, Ness-Jensen E, Medefelt N, Jesper Lagergren

Original languageEnglish
Pages (from-to)829-835
Number of pages7
JournalAmerican Journal of Gastroenterology
Volume113
Issue number6
Early online date11 May 2018
DOIs
Accepted/In press20 Feb 2018
E-pub ahead of print11 May 2018
Published1 Jun 2018

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Abstract

Objectives: Unselected screening for oesophageal adenocarcinoma (OAC) is not justifed due to the low absoluterisk in the general population. This study aimed to evaluate a risk prediction model in identifyinghigh-risk individuals who might be considered for targeted screening.Methods: A population-based cohort of 62,576 participants was recruited in 1995–1997 in Nord-TrøndelagCounty, Norway (HUNT) and followed up until 31 December 2015. A model for predictingindividuals’ absolute risk of OAC was developed using competing-risk regression. The Lorenz curvewas used to assess the concentration of OAC patients in high-risk individuals and the feasibility oftargeted screening based on individual risk assessment.Results: During 1,085,137 person-years of follow-up, 29 incident cases of OAC occurred. The modelincluded risk factors for OAC, in which male sex, older age, gastro-oesophageal refux symptoms,obesity, and tobacco smoking predicted higher risk of OAC. The area under the receiver operatingcharacteristic curve for 10-year risk of OAC was 0.71 (95% confdence interval 0.57–0.85) and for15-year risk was 0.84 (95% confdence interval 0.76–0.91) after 10-fold cross-validation, with goodagreements between observed and predicted risks. The Lorenz curve indicated that 33% of all OACcases would have occurred in the 5% of the population with the highest risks within 15 years, and61% of all cases in the top 10% of the population.Conclusions: Individual risk assessment based on known risk factors for OAC has the potential to identify aselected high-risk group of individuals who may beneft from screening for early detection.

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