Grant Number:	1R01CA140574-01A1 Interpret this number
Primary Investigator:	Hur, Chin
Organization:	Massachusetts General Hospital
Project Title:	Esophageal Adenocarcinoma Policy Model: Trends, Risk Factors and Screening
Fiscal Year:	2010

DESCRIPTION (provided by applicant): The incidence of esophageal adenocarcinoma (EAC) has been rising at an alarming rate over the past three decades. Although the absolute number of EAC cases per year remains too low to screen the general population, targeted screening may be appropriate. Heartburn, the primary symptom of gastroesophageal reflux disease (GERD), affects 60 million Americans and can lead to Barrett's esophagus (BE), a pre-malignant condition associated with the greatest risk (30-125x) of developing EAC. Because of the significant number of individuals affected with GERD and BE, the management of these patients has become a public health issue. However, an accepted screening or surveillance program for EAC has not been proposed. The broad, long-term objectives of the proposal are to identify an effective and affordable targeted screening strategy for EAC with early identification and an intervention program which will diminish the burden of this disease. These research goals will be accomplished developing and analyzing an Esophageal AdenoCarcinoma Policy Model (EACMo). A rich mix of complementary methodologies and state of the art simulation techniques will be necessary to achieve the numerous project objectives. Data from numerous sources including Surveillance Epidemiology and End Results (SEER), clinical trial data and the published literature will be used to develop a simulation model. Calibration methodology will be used to systematically fine tune model parameters to produce targeted endpoints (e.g. cancer incidence). Validation will be achieved by having the model reproduce other published data. The specific aims are: Aim 1: Develop and validate the EACMo. Aim 2: Estimate contributions of pivotal risk factors to the rise in EAC incidence in the U.S. Aim 3: Identify individuals at high risk for EAC: predictors of Barrett's esophagus. Aim 4: Estimate the effectiveness, cost and cost-effectiveness of plausible esophageal adenocarcinoma screening and management programs. The health relatedness of the project will be to use the results to design clinical trials, guide policy decisions and inform evidence-based practice guidelines. The multidisciplinary research team assembled for this project has expertise in all aspects of simulation disease modeling, clinical aspects of EAC, and a proven history of research and collaborations. PUBLIC HEALTH RELEVANCE: Esophageal adenocarcinoma is a concerning public health issue as this cancer is being diagnosed in an increasing number of Americans. The goal of the proposed research is to develop and evaluate a program to identify individuals at risk for this cancer and to intervene early to prevent cancer deaths.




Lorenz Curves and Gini Coefficient Analyses Indicate Inefficiencies in Esophageal Adenocarcinoma Screening.
Authors: Hur C. , Zhan T. , Thrift A.P. , Vaughan T.L. , Feuer E.J. .
Source: Clinical Gastroenterology And Hepatology : The Official Clinical Practice Journal Of The American Gastroenterological Association, 2019 Feb; 17(3), p. 560-562.e2.
EPub date: 2018-05-09 00:00:00.0.
PMID: 29753084
Related Citations

Low Prevalence of Suspected Barrett's Esophagus in Patients with Gastroesophageal Reflux Disease Without Alarm Symptoms.
Authors: Lin E.C. , Holub J. , Lieberman D. , Hur C. .
Source: Clinical Gastroenterology And Hepatology : The Official Clinical Practice Journal Of The American Gastroenterological Association, 2018-09-07 00:00:00.0; , .
EPub date: 2018-09-07 00:00:00.0.
PMID: 30196157
Related Citations

Hospice use and end-of-life care among older patients with esophageal cancer.
Authors: Tramontano A.C. , Nipp R. , Kong C.Y. , Yerramilli D. , Gainor J.F. , Hur C. .
Source: Health Science Reports, 2018 Sep; 1(9), p. e76.
EPub date: 2018-07-19 00:00:00.0.
PMID: 30623099
Related Citations

Survival Disparities by Race and Ethnicity in Early Esophageal Cancer.
Authors: Tramontano A.C. , Nipp R. , Mercaldo N.D. , Kong C.Y. , Schrag D. , Hur C. .
Source: Digestive Diseases And Sciences, 2018-08-14 00:00:00.0; , .
EPub date: 2018-08-14 00:00:00.0.
PMID: 30109578
Related Citations

Surgical vs Endoscopic Management of T1 Esophageal Adenocarcinoma: A Modeling Decision Analysis.
Authors: Chu J.N. , Choi J. , Tramontano A. , Morse C. , Forcione D. , Nishioka N.S. , Abrams J.A. , Rubenstein J.H. , Kong C.Y. , Inadomi J.M. , et al. .
Source: Clinical Gastroenterology And Hepatology : The Official Clinical Practice Journal Of The American Gastroenterological Association, 2018 Mar; 16(3), p. 392-400.e7.
EPub date: 2017-11-24 00:00:00.0.
PMID: 29079222
Related Citations

Patient decision-making and clinical outcomes following endoscopic therapy or esophagectomy for Barrett's neoplasia.
Authors: Lockwood R. , Ozanne E. , Hur C. , Yachimski P. .
Source: Endoscopy International Open, 2017 Nov; 5(11), p. E1128-E1135.
EPub date: 2017-11-08 00:00:00.0.
PMID: 29124122
Related Citations

The Impact of a Prior Diagnosis of Barrett's Esophagus on Esophageal Adenocarcinoma Survival.
Authors: Tramontano A.C. , Sheehan D.F. , Yeh J.M. , Kong C.Y. , Dowling E.C. , Rubenstein J.H. , Abrams J.A. , Inadomi J.M. , Schrag D. , Hur C. .
Source: The American Journal Of Gastroenterology, 2017-04-04 00:00:00.0; , .
EPub date: 2017-04-04 00:00:00.0.
PMID: 28374815
Related Citations

Cost-Effectiveness of Screening Patients with Gastroesophageal Reflux Disease for Barrett's Esophagus With a Minimally Invasive Cell Sampling Device.
Authors: Heberle C.R. , Omidvari A.H. , Ali A. , Kroep S. , Kong C.Y. , Inadomi J.M. , Rubenstein J.H. , Tramontano A.C. , Dowling E.C. , Hazelton W.D. , et al. .
Source: Clinical Gastroenterology And Hepatology : The Official Clinical Practice Journal Of The American Gastroenterological Association, 2017-02-23 00:00:00.0; , .
EPub date: 2017-02-23 00:00:00.0.
PMID: 28238953
Related Citations

Impact Of Radiofrequency Ablation Treatment Of Barrett's Esophagus On Esophageal Adenocarcinoma: A Comparative Modeling Analysis
Authors: Kroep S. , Heberle C.R. , Curtius K. , Kong C.Y. , Lansdorp-Vogelaar I. , Ali A. , Wolf W.A. , Shaheen N.J. , Spechler S.J. , Rubenstein J.H. , et al. .
Source: Clinical Gastroenterology And Hepatology : The Official Clinical Practice Journal Of The American Gastroenterological Association, 2017-01-12 00:00:00.0; , .
PMID: 28089850
Related Citations

Early Pancreatic Ductal Adenocarcinoma Survival Is Dependent On Size: Positive Implications For Future Targeted Screening
Authors: Hur C. , Tramontano A.C. , Dowling E.C. , Brooks G.A. , Jeon A. , Brugge W.R. , Gazelle G.S. , Kong C.Y. , Pandharipande P.V. .
Source: Pancreas, 2015-12-18 00:00:00.0; , .
PMID: 26692444
Related Citations

High-resolution microendoscopy for esophageal cancer screening in China: A cost-effectiveness analysis.
Authors: Hur C. , Choi S.E. , Kong C.Y. , Wang G.Q. , Xu H. , Polydorides A.D. , Xue L.Y. , Perzan K.E. , Tramontano A.C. , Richards-Kortum R.R. , et al. .
Source: World Journal Of Gastroenterology, 2015-05-14 00:00:00.0; 21(18), p. 5513-23.
PMID: 25987774
Related Citations

Preference Of Endoscopic Ablation Over Medical Prevention Of Esophageal Adenocarcinoma By Patients With Barrett's Esophagus
Authors: Yachimski P. , Wani S. , Givens T. , Howard E. , Higginbotham T. , Price A. , Berman K. , Hosford L. , Katcher P.M. , Ozanne E. , et al. .
Source: Clinical Gastroenterology And Hepatology : The Official Clinical Practice Journal Of The American Gastroenterological Association, 2015 Jan; 13(1), p. 84-90.
PMID: 24681073
Related Citations

Incidence and predictors of adenocarcinoma following endoscopic ablation of Barrett's esophagus.
Authors: Yasuda K. , Choi S.E. , Nishioka N.S. , Rattner D.W. , Puricelli W.P. , Tramontano A.C. , Kitano S. , Hur C. .
Source: Digestive Diseases And Sciences, 2014 Jul; 59(7), p. 1560-6.
PMID: 24395382
Related Citations

Statins and aspirin for chemoprevention in Barrett's esophagus: results of a cost-effectiveness analysis.
Authors: Choi S.E. , Perzan K.E. , Tramontano A.C. , Kong C.Y. , Hur C. .
Source: Cancer Prevention Research (philadelphia, Pa.), 2014 Mar; 7(3), p. 341-50.
PMID: 24380852
Related Citations

Trends in esophageal adenocarcinoma incidence and mortality.
Authors: Hur C. , Miller M. , Kong C.Y. , Dowling E.C. , Nattinger K.J. , Dunn M. , Feuer E.J. .
Source: Cancer, 2013-03-15 00:00:00.0; 119(6), p. 1149-58.
EPub date: 2013-03-15 00:00:00.0.
PMID: 23303625
Related Citations

The cost effectiveness of radiofrequency ablation for Barrett's esophagus.
Authors: Hur C. , Choi S.E. , Rubenstein J.H. , Kong C.Y. , Nishioka N.S. , Provenzale D.T. , Inadomi J.M. .
Source: Gastroenterology, 2012 Sep; 143(3), p. 567-75.
PMID: 22626608
Related Citations

Aspirin protects against Barrett's esophagus in a multivariate logistic regression analysis.
Authors: Omer Z.B. , Ananthakrishnan A.N. , Nattinger K.J. , Cole E.B. , Lin J.J. , Kong C.Y. , Hur C. .
Source: Clinical Gastroenterology And Hepatology : The Official Clinical Practice Journal Of The American Gastroenterological Association, 2012 Jul; 10(7), p. 722-7.
PMID: 22426086
Related Citations

Screening and surveillance for Barrett's esophagus: current issues and future directions.
Authors: Choi S.E. , Hur C. .
Source: Current Opinion In Gastroenterology, 2012 Jul; 28(4), p. 377-81.
PMID: 22508325
Related Citations

The impact of obesity on the rise in esophageal adenocarcinoma incidence: estimates from a disease simulation model.
Authors: Kong C.Y. , Nattinger K.J. , Hayeck T.J. , Omer Z.B. , Wang Y.C. , Spechler S.J. , McMahon P.M. , Gazelle G.S. , Hur C. .
Source: Cancer Epidemiology, Biomarkers & Prevention : A Publication Of The American Association For Cancer Research, Cosponsored By The American Society Of Preventive Oncology, 2011 Nov; 20(11), p. 2450-6.
PMID: 21930957
Related Citations

The Prevalence Of Barrett's Esophagus In The Us: Estimates From A Simulation Model Confirmed By Seer Data
Authors: Hayeck T.J. , Kong C.Y. , Spechler S.J. , Gazelle G.S. , Hur C. .
Source: Diseases Of The Esophagus : Official Journal Of The International Society For Diseases Of The Esophagus / I.s.d.e, 2010 Aug; 23(6), p. 451-7.
PMID: 20353441
Related Citations