Oesphageal squamous cell carcinoma in South Africa--an urgent need for improved efforts at screening and prevention.

1showed that incidence rates of OSCC in certain parts of the Transkei region remain among the highest in the world (e.g. 76.6 and 36.5 per 10 000 respectively for males and females from the Centane district). Clinically, OSCC is a silent but rapidly progressive disease. Typically, patients present at an advanced stage, and 70 - 80% of patients with malignant dysphagia have evidence of extra-oesophageal spread, 2 putting them beyond the hope of cure. Most patients are treated by means of oesophageal intubation, resulting in incomplete palliation and a median survival of only 2.2 months. 2 Important therapeutic advances include improved surgical techniques, newer chemotherapeutic agents, and the development of coated expandable stents for treatment of oesophageal-airway fistulas. 3 However, real improvements in morbidity and mortality rates from this deadly disease will require organised and concerted efforts aimed at screening and prevention. Early diagnostic testing for OSCC currently encompasses blind oesophageal brush cytology and flexible oesophagoscopy with iodine staining and biopsy of unstained lesions. Experience from China indicates that population-based screening is justified in areas endemic for OSCC. 4 High-quality clinical studies from South Africa are required to determine the optimal screening modality, and to enable the establishment of specific local practice guidelines for screening. A cost-efficient infrastructure for carrying out the screening procedures (e.g. by nurse practitioners) needs to be set in place, as well as protocols for the handling and processing of cytological samples. Research is urgently needed to search for better screening modalities for OSCC, including those based on evolving cytogenics and/or genome-wide scanning technologies.