Early detection of esophageal cancer: is there support for screening among professionals and the general population?Screening op slokdarmkanker: is er draagvlak voor een bevolkingsonderzoek onder professionals en de algemene bevolking?

BACKGROUND The ongoing increasing incidence of esophageal adenocarcinoma (EAC) during the last few decades and its dismal prognosis has stimulated interest in screening for its precursor Barrett’s esophagus (BE). Although BE is a known precursor of EAC, a minority of patients with EAC (<10%) are known with a previous diagnosis of BE, and hence, most cases of BE are undiagnosed. Screening programs to detect BE followed by endoscopic surveillance and treatment of dysplasia and early neoplasia may reduce the incidence of EAC and thereby reduce mortality. However, implementation of EAC screening could face considerable challenges. A key factor driving the success or failure of EAC screening is the acceptability and support among professionals and the general population. OBJECTIVE The aims of this project are to explore determinants associated with potential implementation of EAC screening and to make an inventory on communication, medico-legal and ethical considerations related to EAC screening and present a synthesis at an interdisciplinary expert and patient meeting in order to discuss implications and recommendations for future screening studies and potential future implementation. PLAN OF WORK The project can be characterized as a pre-implementation study to investigate support for EAC screening and to optimize potential implementation in screening practice. The study objective will be addressed using mixed-methods research to investigate barriers and facilitators from scientific literature and input from all relevant stakeholders. A systematic literature search will be conducted to identify factors that may facilitate or hinder the acceptability of EAC screening from the perspective of professionals and/or the population. A second systematic literature search will be performed to look for ethical, medico-legal, logistical, and financial implications raised by the potential introduction of EAC screening. Although we will perform a systematic search, it is likely that we will miss relevant themes/perceptions, particularly related to new ways of EAC screening that have not yet been implemented in practice. We will therefore further explore the acceptability of EAC screening from the perspective of both Dutch and international professionals using digital concept mapping. Subsequently, focus group discussions with members of the public with reflux symptoms will be organized to explore the population’s perceptions of the potential implementation of EAC screening in the Netherlands. The interview guide will be based on the information obtained from the literature review and the concept mapping study with professionals. The outcomes of the three subprojects will be used to develop an online questionnaire to assess perceptions and acceptability in a larger sample of the population. RELEVANCE AND WHAT THIS PROJECT ADDS By 2030, the Netherlands is expected to have the largest annual number of EAC diagnoses compared to other countries worldwide. The future of esophageal cancer prevention relies on early detection of BE followed by effective endoscopic treatment for neoplasia in BE. Early detection and treatment of dysplasia in BE could decrease (advanced) EAC incidence, leading to higher survival rates and lower healthcare costs per patients. As recently novel, less invasive (non) endoscopic techniques for BE detection in the community have been developed, there is now renewed interest in screening for BE and related neoplasia EAC screening is an innovative concept and not (yet) used in Dutch practice. The project will identify individuals’ preferences as well as ethical and psychological factors related to the potential uptake of targeted screening regimens. Also, future organizational implications of possible introduction of EAC screening will be identified. Furthermore, it will provide insight on which changes in policy and practice are warranted. Obtained data will contribute to ensure potential, efficient, effective, and sustainable implementation of EAC screening in current clinical practice. IMPLEMENTATION Targeted screening of high-risk patients using minimally invasive techniques may detect premalignant stages or early-stage EAC and improve survival in these patients. Potential implementation of EAC screening will raise additional questions with respect to, among others, communication, medico-legal and ethical considerations. This application will provide a complete inventory of determinants of implementation and acceptance of EAC screening among health professionals and the target screening population. The aim of the interdisciplinary meetings will be to discuss possible decision and implementation strategies related to the potential introduction of targeted screening in current clinical practice. This application entails a transdisciplinary action of professionals, patient organizations, and other stakeholders to ensure knowledge transfer and preparation for future screening studies and potential implementation.