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:

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.