Evolving diagnostic and surveillance strategies in esophageal cancer screening: Evidence from population-based studies in China.

Esophageal cancer (EC) is one of the most common malignancies in China, accounting for over half of the world's new cases and deaths, and posing a severe threat to national health. Currently, the prevention and control of EC primarily rely on secondary prevention through screening, early diagnosis and early treatment to reduce EC-specific mortality. Upper gastrointestinal endoscopy with Lugol's iodine or optical staining followed by histopathological diagnosis of biopsy samples, serves as the gold standard for EC screening and has been widely implemented in numerous national public health programs for early cancer detection and treatment. Nevertheless, traditional pathology-centered diagnostic and surveillance strategies face significant challenges in current screening practices. Relying on large-scale population-based screening cohorts, including the Efficacy of Endoscopic Screening for Esophageal Cancer in China (ESECC) trial (ClinicalTrials.gov, identifier NCT01688908), a series of investigations into the diagnosis and surveillance of EC screening provided critical new insights and evidence for optimizing endoscopic screening strategies for EC in China. Summarizing relevant research findings from the above investigations, this article provides a systematic review of the epidemiology, current screening diagnostic and surveillance strategies, existing challenges, and key innovations related to EC. These insights offer valuable guidance for public health practice and clinical decision-making in the prevention and screening of EC and other cancers.