Screen for Esophageal Adenocarcinoma
Description
Veterans disproportionately have many of the important risk factors for esophageal adenocarcinoma (EAC), and research has demonstrated that Veterans are a substantial gap in the prevention of EAC. Healthcare providers can utilize Kettles Esophageal and Cardia Adenocarcinoma prediction tool (K-ECAN) to guide decision-making and identify potential patients who should be offered screening for EAC.
Detailed example
The K-ECAN is an automated prediction tool for EAC that harnesses the electronic health record at the point of contact during opportune moments (such as at the time of scheduling colorectal cancer screening) to guide decision-making and identify patients who should be offered screenings for EAC. The provider would know their patient's predicted annual incidence of EAC or esophagogastric junction adenocarcinoma (EGJAC) (at least [XXX per 100,000) and their predicted annual mortality (at least [YYY] per 100,000). They would also know additional risk factors, such as age, sex, Body Mass Index (BMI), Gastroesophageal reflux disease (GERD), and smoking history.
AI / analytics pattern
Classical/Predictive Machine Learning: Models trained on data to make predictions or classifications based on identified patterns or relationships.
Automation level / stage
b) Pilot – The use case has been deployed in a limited test or pilot capacity.
Expected benefit
If EAC is identified at the earliest stage (intramucosal cancer without metastases), the 5-year survival with surgery is greater than 85%, and at least as good with endoscopic therapy alone. Implementation of such an intervention would bridge the gap between population-health screenings and personalized management in a manner that would minimize the impact on payer budget and resources. Since individuals are more commonly up to date for colorectal cancer screening (for instance, with colonoscopy), it is particularly suitable to harness the missed opportunity of EAC screening at the time of screening for colorectal cancer. Also, when an EAC screening with upper endoscopy is performed simultaneously with colonoscopy, it is much less expensive. This project will also serve as a roadmap for how such precision approaches to screening can be applied to other rare cancers.
Controls / human review
ATO: Not reported; PIA: Not published