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The Impact of Uncertainty in Barrett's Esophagus Progression Rates on Hypothetical Screening and Treatment Decisions.
[esophageal adenocarcinoma]
.
Estimates
for
the
annual
progression
rate
from
Barrett
's
esophagus
(
BE
)
to
esophageal
adenocarcinoma
(
EAC
)
vary
widely
.
In
this
explorative
study
,
we
quantified
how
this
uncertainty
affects
the
estimates
of
effectiveness
and
efficiency
of
screening
and
treatment
for
EAC
.
.
We
developed
3
versions
of
the
University
of
Washington
/
Microsimulation
Screening
Analysis-
EAC
model
.
The
models
differed
with
respect
to
the
annual
progression
rate
from
BE
to
EAC
(
0
.
12
%
or
0
.
42
%
)
and
the
possibility
of
spontaneous
regression
of
dysplasia
(
yes
or
no
)
.
All
versions
of
the
model
were
calibrated
to
the
observed
Surveillance
,
Epidemiology
,
and
End
Results
esophageal
cancer
incidence
rates
from
1998
to
2009
.
To
identify
the
impact
of
natural
history
,
we
estimated
the
incidence
and
deaths
prevented
as
well
as
numbers
needed
to
screen
(
NNS
)
and
treat
(
NNT
)
of
a
one
-time
perfect
screening
at
age
65
years
that
detected
all
prevalent
BE
cases
,
followed
by
a
perfect
treatment
intervention
.
.
Assuming
a
perfect
screening
and
treatment
intervention
for
all
patients
with
BE
,
the
maximum
EAC
mortality
reduction
(
64
%
-
66
%
)
and
the
NNS
per
death
prevented
(
470
-
510
)
were
similar
across
the
3
model
versions
.
However
,
3
times
more
people
needed
to
be
treated
to
prevent
1
death
(
24
v
.
8
)
in
the
0
.
12
%
regression
model
compared
with
the
0
.
42
%
progression
model
.
Restricting
treatment
to
those
with
dysplasia
or
only
high
-grade
dysplasia
resulted
in
smaller
differences
in
NNT
(
2
-
3
to
prevent
one
EAC
case
)
but
wider
variation
in
effectiveness
(
mortality
reduction
of
15
%
-
24
%
)
.
.
The
uncertainty
in
the
natural
history
of
the
BE
to
EAC
sequence
influenced
the
estimates
of
effectiveness
and
efficiency
of
BE
screening
and
treatment
considerably
.
This
uncertainty
could
seriously
hamper
decision
making
about
implementing
BE
screening
and
treatment
interventions
.
Diseases
Validation
Diseases presenting
"cancer"
symptom
achondroplasia
acute rheumatic fever
adrenal incidentaloma
alpha-thalassemia
benign recurrent intrahepatic cholestasis
cadasil
canavan disease
carcinoma of the gallbladder
cholangiocarcinoma
coats disease
congenital adrenal hyperplasia
congenital diaphragmatic hernia
cowden syndrome
cushing syndrome
cutaneous mastocytosis
dedifferentiated liposarcoma
dystrophic epidermolysis bullosa
epidermolysis bullosa simplex
erdheim-chester disease
erythropoietic protoporphyria
esophageal adenocarcinoma
esophageal carcinoma
esophageal squamous cell carcinoma
familial hypocalciuric hypercalcemia
familial mediterranean fever
gm1 gangliosidosis
heparin-induced thrombocytopenia
hereditary cerebral hemorrhage with amyloidosis
hirschsprung disease
hodgkin lymphoma, classical
inclusion body myositis
junctional epidermolysis bullosa
kabuki syndrome
kallmann syndrome
kindler syndrome
lamellar ichthyosis
liposarcoma
locked-in syndrome
lymphangioleiomyomatosis
monosomy 21
neuralgic amyotrophy
oculocutaneous albinism
oligodontia
oral submucous fibrosis
papillon-lefèvre syndrome
pendred syndrome
pleomorphic liposarcoma
primary effusion lymphoma
proteus syndrome
pyomyositis
pyruvate dehydrogenase deficiency
severe combined immunodeficiency
sneddon syndrome
systemic capillary leak syndrome
triple a syndrome
von hippel-lindau disease
waldenström macroglobulinemia
well-differentiated liposarcoma
werner syndrome
wiskott-aldrich syndrome
wolf-hirschhorn syndrome
x-linked adrenoleukodystrophy
This symptom has already been validated
