Chemoprevention of esophageal cancer

Abstract

Chemoprevention of cancer is an emerging field: using well-known supplements or medications to prevent carcinoma before invasion. Numerous agents are being studied to try to prevent esophageal malignancy given its high burden of mortality and late stage at diagnosis. Proton pump inhibitors (PPIs), widely used in symptom management, have a role in controlling the progression of Barrett’s esophagus. Studies have moved towards defining optimum dosing required for PPIs as a chemopreventive agent. Aspirin is implicated in preventing esophageal cancer via pathways including COX inhibition and beta-catenin. Its use for colorectal cancer prevention is already clear, and its use in cardiovascular disease gives it promise as a cheap, multi-disease agent. Statins hold promise as an agent that can both benefit cardiovascular disease and prevent cancer. Studies show links with esophageal cancer, although safety concerns and numbers needed to treat are so far high. Metformin is linked with reduced numbers of all cancers in diabetic patients. Its role in esophageal chemoprevention is still being explored, but helping to prevent other factors such as diabetes and obesity could augment this. Further high-quality studies are required, and risk stratification of patients at higher cancer potential is likely to shape the use of chemoprevention in the future.