The strategy for esophageal cancer control in high-risk areas of China

Even though the mortality from esophageal cancer has decreased during the last two decades nationwide in China, the mortality from esophageal cancer in high-risk areas is still at a high level. Moreover, the 5-year survival rate of patients with resectable esophageal cancer after treatment ranges between 20 and 30%, as majority of patients with esophageal cancer were diagnosed in late stages. Therefore, esophageal cancer control in high-risk areas in China remains a critical task. A strategy is proposed that the high-risk population would be screened by endoscopy with mucosal iodine staining and biopsy of all unstained lesions and diagnosis of severe dysplasia carcinoma in situ, and intra-mucosal carcinoma could be cured by radical mucosectomy. A pilot study showed that the strategy is feasible and cost-effective for the high prevalence of premalignant lesions and carcinomas in early stages. It would be expected that the mortality from esophageal cancer could be decreased in high-risk areas if the proposed strategy is carried out on a large scale.