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

Abstract

Unselected screening for oesophageal adenocarcinoma (OAC) is not justified due to the low absolute risk in the general population. This study aimed to evaluate a risk prediction model in identifying high-risk individuals who might be considered for targeted screening. A population-based cohort of 62,576 participants was recruited in 1995-1997 in Nord-Trøndelag County, Norway (HUNT) and followed up until 31 December 2015. A model for predicting individuals' absolute risk of OAC was developed using competing-risk regression. The Lorenz curve was used to assess the concentration of OAC patients in high-risk individuals and the feasibility of targeted screening based on individual risk assessment. During 1,085,137 person-years of follow-up, 29 incident cases of OAC occurred. The model included risk factors for OAC, in which male sex, older age, gastro-oesophageal reflux symptoms, obesity, and tobacco smoking predicted higher risk of OAC. The area under the receiver operating characteristic curve for 10-year risk of OAC was 0.71 (95% confidence interval 0.57-0.85) and for 15-year risk was 0.84 (95% confidence interval 0.76-0.91) after 10-fold cross-validation, with good agreements between observed and predicted risks. The Lorenz curve indicated that 33% of all OAC cases would have occurred in the 5% of the population with the highest risks within 15 years, and 61% of all cases in the top 10% of the population. Individual risk assessment based on known risk factors for OAC has the potential to identify a selected high-risk group of individuals who may benefit from screening for early detection.