Our research

The scale of the problem

Rates of oesophageal adenocarcinoma have been rising faster than any other cancer in Australia, USA, UK and other industrialised nations. Approximately 1,000 Australians will be newly diagnosed with oesophageal cancer this year, and most of these patients will die from their disease. We and others have shown that the main causes of oesophageal adenocarcinomas are acid reflux (heartburn), obesity and smoking. Given the rising trends of obesity and reflux in Australia, we expect that more and more people will develop this lethal cancer in the years ahead.

Barrett’s oesophagus is a precursor of oesophageal adenocarcinoma

Oesophageal cancers often arise within an area of change in the lining of the oesophagus known as Barrett’s oesophagus. In Barrett’s oesophagus the normal smooth lining of the oesophagus becomes ‘velvety’ and changes colour. We and others have shown that Barrett’s oesophagus appears to have become much more common during the past few decades, with as many as 1 in 50 people having this condition. Most of these people will not be aware that they have Barrett’s oesophagus. Because patients with Barrett’s oesophagus have cancer risks up to 30-fold higher than people without Barrett’s, they are typically placed on surveillance programs requiring regular endoscopies. However, despite their increased risk, most people with Barrett’s oesophagus never develop cancer, and are therefore subjected to unnecessary risks and substantial costs associated with these investigations. A reliable screening test would allow doctors and patients to focus efforts on those at highest risk of developing cancer, while sparing the great majority who are at very low risk from unnecessary and costly investigations.

The prognosis for patients with oesophageal cancer is poor

Unfortunately, patients with oesophageal adenocarcinoma have survival rates that are among the lowest of all cancers, similar to cancers of the liver, lung and pancreas. Only 25% of patients with oesophageal adenocarcinoma undergo surgery however, because more than half of all patients have inoperable cancers at the time of diagnosis. Many other patients are too sick to have surgery. However, in the small group of patients diagnosed with very early stage oesophageal cancer, the long-term survival exceeds 90%.

How can we reduce the burden of oesophageal adenocarcinoma?

There are three main ways in which the health system approaches the control of diseases such as cancer, and these are broadly defined as follows:

1. Primary prevention: preventing the onset of cancer by identifying its causes, and then trying to reduce the number of people who are exposed to the causes. Examples include reducing the number of people who smoke to prevent lung cancer, or encouraging people to use sunscreen to prevent skin cancer, or immunising against human papillomavirus (HPV) to prevent cervical cancer.

2. Secondary prevention: preventing the onset of illness from cancers by finding them early, and then treating them effectively. For example, in Australia, we have a breast screening program to identify breast cancers at a very early stage. We also have a Pap smear program to pick up early changes in the cervix before they lead to cancer.

3. Tertiary prevention: preventing death from cancer by finding new and better treatments, including better surgical approaches and new anti-cancer drugs.