Successful screening for early esophageal cancer in alcoholics using endoscopy and mucosa iodine staining

Abstract

Background. Epidemiologic studies have provided evidence that alcohol abuse is an important risk factor for esophageal carcinoma. However, no systematic screening program has been established yet in the early detection of esophageal cancer in high risk populations of heavy drinkers. Methods. A cohort of 629 male alcoholics (54 ± 8 years old) were consecutively and systematically screened by endoscopy combined with iodine staining and targeted biopsy at the National Institute on Alcoholism (Kanagawa, Japan). For mucosal carcinomas, endoscopic esophageal mucosal resection (EEMR) was used to serve confirmatory diagnostic and therapeutic purposes. Results. Iodine‐unstained lesions, distinctly demarcated, white, and 5 mm or larger in greatest dimension, were observed on the esophageal wall in 162 patients (25.8%). Thirty‐six such unstained lesions in 21 of 629 patients, with an unexpectedly high rate of 3.3%, turned out to be squamous cell carcinomas of the superficial type. According to some established criteria, EEMR was performed in 17 of these patients, 3 of whom were given additional irradiation. Esophagectomy was performed in two patients, chemotherapy combined with irradiation in one, whereas still another was followed endoscopically. The cancer invasion was confined within the epithelium in eight patients, to the proper mucosal layer in nine, and to the submucosa in four. Multiple logistic regression revealed that the risks for distinct iodine‐unstained lesions and superficial esophageal carcinoma increased independently for users of stronger alcoholic beverages, i.e., whiskey or shochu (odds ratio [OR] = 1.47 and 2.94, respectively) compared with lighter beverages, i.e., sake or beer and 30+ cigarettes/day (OR = 1.68 and 3.85, respectively). Conclusion. Routine application of this program for these high risk individuals yielded an unusually high rate of detection of esophageal carcinoma. Cancer 1995;76:928–34.

Alcohol and Aldehyde Dehydrogenase Polymorphisms and a New Strategy for Prevention and Screening for Cancer in the Upper Aerodigestive Tract in East Asians

“…5,58,66,67,69,70 The 6 year cumulative rates of detection of metachronous SCC in the esophagus and oropharyngolarynx were 56% and 35%, respectively, in Japanese alcoholics after endoscopic mucosectomy of esophageal SCC, as opposed to 31% and 20%, respectively, in those with esophageal dysplasia ≥ 5 mm, and 4% and 4%, respectively, in those without DIULs ≥ 5 mm. 7 1 Esophageal dysplasia ≥ 5 mm is associated with a very high risk of SCC in the UADT. The presence of multiple esophageal iodine-unstained lesions is a strong predictor of the development of metachronous SCC in the esophagus 6 9 and head and neck 7 0 in Japanese patients after endoscopic mucosectomy for esophageal SCC.…”

“…Many Japanese alcoholic patients are also heavy smokers, and their poor nutritional status and low BMI are largely attributable to poor dietary habits, including a low intake of green and yellow vegetables, and smoking. 6 We introduced an endoscopic screening program at Kurihama Alcoholism Center in 1993, 7 and by 2008, initial screening of 5210 Japanese alcoholic men by endoscopy combined with oropharyngolaryngeal inspection and esophageal iodine staining had detected esophageal SCC in 206 (4.0%) and oropharyngolaryngeal SCC in 55 (1.1%). Recent technical improvements in endoscopes and a growing understanding of the endoscopic findings of early SCC in the esophagus 7,8 and pharynx 9 have enabled very early detection of SCC in the UADT.…”

“…6 We introduced an endoscopic screening program at Kurihama Alcoholism Center in 1993, 7 and by 2008, initial screening of 5210 Japanese alcoholic men by endoscopy combined with oropharyngolaryngeal inspection and esophageal iodine staining had detected esophageal SCC in 206 (4.0%) and oropharyngolaryngeal SCC in 55 (1.1%). Recent technical improvements in endoscopes and a growing understanding of the endoscopic findings of early SCC in the esophagus 7,8 and pharynx 9 have enabled very early detection of SCC in the UADT. Treatment of early esophageal SCC by endoscopic mucosectomy has become widespread in Japan and has succeeded in improving the outcome of this high-mortality cancer 1 0, 11 ; early pharyngeal SCC is also now being treated by endoscope-guided mucosectomy 1 2 with excellent outcomes.…”

Health Risk Appraisal Models for Mass Screening of Esophageal Cancer in Japanese Men

“…Because early squamous cell carcinoma (SCC) of the esophagus and oropharyngolarynx can be treated by endoscopic mucosectomy (1,2) or endoscope-guided mucosectomy (3), it is important to develop methods to identify individuals at increased risk of cancer of the upper aerodigestive tract to provide detailed examinations by the upper aerodigestive tract endoscopy combined with esophageal iodine staining. Without using the esophageal iodine staining, more than half of intraepithelial or mucosal esophageal SCC would be missed (2,4).…”

“…Without using the esophageal iodine staining, more than half of intraepithelial or mucosal esophageal SCC would be missed (2,4). A possible approach to mass screening of high-risk individuals is to classify them according to exposure to risk factors such as heavy alcohol drinking and smoking.…”