Screening for Barrettʼs Esophagus in the Population: Results from a Population Based Survey

Abstract

Purpose: Knowledge and attitudes regarding BE and esophageal adenocarcinoma (EAC) screening in the community are unknown. Screening for BE has been hampered by the lack of an acceptable and widely applicable tool. The acceptability of screening using novel non-invasive techniques in the general population compared to sedated endoscopy (sEGD) is unknown. We AIMED to assess attitudes towards these issues using a survey administered to the population in south-eastern Minnesota. Methods: A population-based, mixed-mode (mail and telephone) survey approach focused on a random community sample of adults aged 50 and older in the seven county area in Southeastern Minnesota was used. The core variables for this survey consisted of items assessing awareness regarding BE and its premalignant potential, willingness to participate in screening for BE/esophageal adenocarcinoma, preferences regarding optimal method of screening for BE: Sedated endoscopy (sEGD), unsedated transnasal endoscopy (uTNE) and capsule endoscopy (CE) were described in the survey, potential barriers to participation in population based screening for BE/esophageal adenocarcinoma, and selected demographics. Results: 114 of 413 (28%) of surveys have been returned. 58 (51%) of the respondents were females, with a mean age of 63 years (SD10.2) compared to non-responders who had a mean age of 65 years (SD 11.4) and similar gender distribution (females 147 (49%). 30 (27%) subjects had heard of BE before the survey, however 72% of subjects were moderately to extremely interested in a screening test for BE/EAC after reading the educational section of the survey. 64 (66%)were aware of sEGD (22% had undergone sEGD), while only 18 (16%) and 15 (13%) were aware of uTNE and CE (5.5% had undergone uTNE and 1% had undergone CE before). 72 (67%) preferred unsedated techniques (CE: 56% or uTNE: 11%) while the rest (33%) preferred sEGD. 18 (16%) had been diagnosed with cancer before (5 breast, 3 prostate, 2 colon, 6 skin, 6 others). 99 (87%) had undergone colonoscopy, 51 (86%) mammography and 45 (82%) prostate cancer screening. 99 (87%) were interested in being invited to undergo screening using one of the three techniques described in the survey. Conclusion: Though only a minority of residents in south eastern Minnesota were initially aware of BE, following education about BE, a majority of subjects expressed willingness to undergo screening. Respondents appear to be more willing to undergo screening by unsedated techniques with Esophageal capsule endoscopy being the most acceptable technique. Responders appear to be willing to undergo non-invasive screening tests for BE. Predictors of participation in screening need to be identified.