XXXX : Can meaningful screening and surveillance guidelines be formulated based on new data and rejigging the old paradigm?

@entity1 @entity135 @entity355 @entity5 @entity876 @entity354 @entity2403 @entity420 @entity1141
UNASSIGNED: @entity354 ( @entity354 ) and @entity355 ( @entity355 ) have been considered to be the most important known risk factors for @entity420 ( @entity420 ). It has been the fastest growing @entity5 in the Western World and has occurred against a backdrop of progressive reduction in the risk estimate of @entity5 associated with @entity355 and no reduction in mortality from @entity420 using the prevailing screening and surveillance guidelines. The recently published link between high risk HPV and Barrett's @entity1141 / @entity5 may be the 'missing' strong risk factor responsible for the significant rise of @entity420 since the 1970's, as has been the case with @entity135 , another viral associated @entity5 . @entity876 immunohistochemistry has been proposed as a good molecular marker for predicting disease progression in @entity2403 . Nevertheless, significant negative staining for this mutation in @entity2403 remains a major hurdle to widespread routine clinical use as a sole molecular marker. Recent data raises the distinct possibility of at least 2 (probably more) carcinogenic pathways operating in @entity420 . One is HPV mediated devoid largely of @entity876 mutations and the other @entity876 dependent. The joint use of both these markers as part of a molecular panel may represent the best bet yet of detecting the high risk group of progressors to @entity420 . @entity1 who are positive for either or both biomarkers i.e @entity876 or/and transcriptional markers of HPV may warrant more intensive screening. In future, genome wide technology may provide molecular signatures to aid diagnosis and risk stratification in @entity355 .
