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. 2023 May 26;34:102264. doi: 10.1016/j.pmedr.2023.102264

Fig. 2.

Fig. 2

Under- and overdiagnosis in the current esophageal adenocarcinoma screening and surveillance paradigm. Legend: 1. Dutch population in 2021. 2. Based on systematic literature review, GERD symptoms are prevalent in 20% of the general population (El-Serag et al., 2014). 3. Calculated from estimated EAC cases (see number 4) and a BE to EAC progression rate of 0.5%/year (Peters et al., 2019). Prior BE diagnosis: 36 000 × 0.5%/year = 180 EAC/year. Estimated undiagnosed BE: 144 000 × 0.5%/year = 720 EAC/year. The calculated total BE prevalence of 180 000 (1.3% of the general population; 6.7% of the population with GERD) is in line with a meta-analysis reporting global BE prevalence of 0.96% and prevalence of BE in GERD of 6.7% (Marques de Sa et al., 2020). 4. There were 2500 esophageal cancer cases in 2021 in the Netherlands, of which approximately 1500 (61%) were adenocarcinomas (Vegt et al., 2022). Based on a meta-analysis, an estimated 180 cases (12%) had prior BE diagnosis (Tan et al., 2020). Approximately 600 (40%) had no prior BE diagnosis and no history of GERD symptoms (Chak et al., 2006). The remaining 720 cases (48%) had history of GERD symptoms without prior BE diagnosis.