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.
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