There are around 9,200 new oesophageal cancer cases diagnosed in the UK each year. Patients with oesophageal cancer have a poor survival rate (about 17% of patients in England survive for 5 years or more). There are two major reasons for such a poor prognosis; firstly, oesophageal cancers present at an advanced stage, and secondly, we do not fully understand the evolution of common precursor conditions such as Barrett’s oesophagus.

Barrett’s is the erosive replacement of the normal squamous epithelium with a metaplastic columnar phenotype and confers a 40-fold increase in oesophageal cancer risk over the normal population. The cancer risk for an individual Barrett’s patient is low but all patients are enrolled in regular and life-long endoscopic surveillance programmes in which there are no predictive biomarkers to evaluate an individual’s risk of developing cancer. When we consider that there are large numbers of Barrett’s patients, predicting an individual’s risk of developing cancer becomes critical. Additionally, most oesophageal cancer patients are diagnosed outside surveillance programmes and it is critical that we develop the means to identify those patients before cancer develops.