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Endoscopic Screening for Esophageal Squamous Cell Carcinoma

Gholamreza Roshandel MD PhD1,2, Alireza Nouroozy MD2, Akram Pourshams MD1, Shahryar Semnani MD2, Shahin Merat MD1, Masoud Khoshnia MD2

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Authors’ affiliations: 1Digestive Diseases Research Institute (DDRI), Tehran University of Medical Sciences (TUMS), Tehran, Iran. 2Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran.

•Corresponding author and reprints: Masoud Khoshnia MD, Assistant professor of Gastroenterology, 2Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran. Tel: +98-911-178-6541, E-mail:


Accepted for publication: 26 December 2012


Esophageal cancer (EC) is the eighth common cancer and the sixth most common cause of death from cancer worldwide. Esophageal squamous cell carcinoma (ESCC) remains the most common type of EC in the developing world and an important health problem in high-risk areas. Most of ESCC cases present in late stages, resulting in delayed diagnosis and poor prognosis. Prevention is the most effective strategy to control ESCC. Primary and secondary preventive methods may be considered for ESCC. In primary prevention, we try to avoid known risk factors. The aim of the secondary preventive method (ESCC screening programs) is to detect and eliminate premalignant precursor lesion of ESCC, preventing its progression into advanced stages. Similar to all population-based screening programs, any screening for early detection of ESCC must be cost-effective; otherwise, screening may not be indicated in that population. Endoscopy with iodine staining has been accepted as a population-level ESCC screening program in some high-risk areas including parts of China. This method may be too expensive and invasive in other high-risk communities. Nonendoscopic methods may be more applicable in these populations for population-based screenings. The limitations (questionable validity and costs) of new endoscopic imaging modalities, including narrow-band imaging (NBI), made them inappropriate to be used in population-level ESCC screening programs. Low-cost, less-invasive endoscopic imaging methods with acceptable diagnostic performance may make screening of ESCC in high-risk areas cost-effective.

Archives of Iranian Medicine,Vol. 16, No. 06, June 2013, -
Keywords: Carcinoma, endoscopic screening, esophageal cancer, Iran, squamous cell carcinoma
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