STEP 1: Prevention and early detection

This step outlines recommendations for the prevention and early detection of oesophagogastric cancer.

Evidence shows that not smoking, avoiding or limiting alcohol intake, eating a healthy diet, maintaining a healthy body weight, being physically active, being sun smart and avoiding exposure to oncoviruses or carcinogens may help reduce cancer risk (Cancer Council Australia 2018).

Stopping smoking will reduce the risk of oesophagogastric cancer (NCI 2020a, NCI 2020b; US DHHS 2020).

For more information see the Lifestyle risk factors and primary prevention cancer resource.

Certain regions of the world have a higher incidence of oesophagogastric cancer. This variation of incidence by region is multifactorial and involves different environmental exposures and genetic diversity of the populations, most likely related to dietary factors.

Australia has a higher rate of adenocarcinoma of the oesophagus than SCC – this is reversed in Asian countries. These risk factors persist in more recent immigrants and should be factored into risk assessments.

There are very few people at high risk. However, people with the following risk factors are at increased risk:

Oesophageal SCC Gastric cancer
Male gender


Gastro-oesophageal reflux

Barrett’s oesophagus

• Tobacco smoking

• Alcohol consumption

• Increasing age

Heavy alcohol consumption

Tobacco smoking

• Increasing age

• Caustic injury

• Achalasia

• Increasing age

Helicobacter pylori (H. pylori) bacteria

• Previous partial gastrectomy,

especially more than 20 years ago, usually for benign ulcer disease

• Tobacco smoking

• Pernicious anaemia

• Family history of gastric cancer (hereditary gastric cancer exists)

Note: The most common risk factors are bolded.

Awareness of the risk factors and of who is at high risk can guide appropriate referral for specialist input and potentially surveillance – for example, Barrett’s oesophagus, achalasia, and genetic predisposition.

Careful monitoring of Barrett’s oesophagus may help detect cancer early, and early treatment may lead to better outcomes. Surveillance should be conducted by specialists with expertise in endoscopy and in managing Barrett’s oesophagus. Patient monitoring may include regular (as per clinical guidelines) upper endoscopies and tissue biopsies. The frequency of surveillance is based on the presence or absence of dysplasia. Refer to Cancer Council Australia’s guidelines.

Reflux symptoms in patients with Barrett’s oesophagus should be adequately treated (medically or surgically). Any change in symptoms should be reported early and investigated.

If there is high-grade dysplasia in Barrett’s oesophagus, subsequent treatment is usually recommended. Patients with high-grade dysplasia should be discussed in an MDM. After such discussion, treatment might include endoscopic therapies or surgery.

There are no formal population-based screening programs for oesophagogastric cancer in Australia.