Craig Griffeth, 74, has always worried about cancer. “My aunts and uncles, almost all of them on both sides, died of cancer,” he said. “So, I figured that one day I’m going to get cancer, and I’ll probably die of cancer.”
Previously, Griffeth had been diagnosed and treated for non-Hodgkin’s lymphoma and prostate cancer. Now, he was worried about what was causing his gastrointestinal symptoms, including reflux.
Craig asked his son, Jordan Griffeth, a gastrointestinal (GI) nurse practitioner, what he should do about his upper GI discomfort. Jordan encouraged his father to get evaluated by the doctor with whom he worked.
“We decided to send him for an upper endoscopy, and our gastroenterologist took biopsies and found that he had Barrett’s,” Jordan said.
Understanding Barrett’s Esophagus
Every year, more than 22,000 esophageal cancer cases are diagnosed in the United States. It’s the 11th most common cancer globally with a grim five-year survival rate of less than 22%.1
BE is the only known precursor to esophageal cancer. The condition is caused by prolonged exposure of the esophagus to stomach acid from chronic gastroesophageal reflux disease (also known as GERD). The lining of the lower esophagus changes to look like the lining of the intestine. Over time, the damage can lead to abnormal, precancerous cell growth, called dysplasia, which could lead to esophageal cancer in the future. A small percentage of patients with BE may develop esophageal cancer, specifically esophageal adenocarcinoma.
There are many risk factors for BE, including long-standing GERD, obesity, being over the age of 50, white, male, having a hiatal hernia, tobacco and alcohol use, and family history of BE. The American Gastroenterological Association recommends upper endoscopy screening for patients who have at least three established risk factors. During an upper endoscopy, doctors take small biopsies (samples of esophageal tissue) to look for dysplasia.
Those biopsies are sent to a pathologist to confirm whether BE is present and assign it to one of four grades: non-dysplastic, indefinite for dysplasia, low-grade dysplasia, or high-grade dysplasia. The patient’s gastroenterologist will use the pathology grade to determine the patient’s risk of progression to more advanced dysplasia and discuss the next steps, which may include routine surveillance or discussion of BE treatment with endoscopic eradication therapy (EET). Even though some patients may not show signs of dysplasia at the time of endoscopy, they could still be at high risk of progressing to esophageal cancer in the future.
The risk of progressing to cancer despite no physical signs is why BE can be such a challenging condition for doctors to manage. Predicting which patients among the estimated 4 million with BE in the United States who may ultimately develop esophageal cancer down the road is like trying to find a needle in a haystack.
Jordan was well aware of this challenge and was familiar with an AI-driven test called TissueCypher® designed to detect molecular changes in esophageal tissue to predict a patient’s risk of developing esophageal cancer. Jordan insisted on having the test run on his dad’s biopsy. That test may have helped saved his father’s life.
Early warning
Craig’s endoscopy showed he had a 2-cm region in the esophagus that was consistent with BE and a hiatal hernia, which is not uncommon for patients with BE. Based on just standard pathology review, a patient like Craig might have been placed in BE surveillance; a watch-and-wait approach that hopes to detect disease progression before it becomes malignant.
But testing with TissueCypher helped show that Craig had an elevated risk of developing esophageal cancer. That early information prompted his care team to intervene with an EET procedure called radiofrequency ablation, used to remove the precancerous cells before they can progress to esophageal cancer.
Craig was relieved. TissueCypher gave him an early warning, and he was able to avert esophageal cancer before it developed.
“It was nice to know that it wasn’t cancer yet — that something could be done to correct the disease and eradicate it so that I didn’t have to worry about having cancer again,” Craig said.
Game-changing technology
TissueCypher, a test offered by Castle Biosciences, is designed to look deeply into a patient’s esophageal biopsy to predict their specific calculated risk of developing cancer over the next five years, much more than a traditional pathology review of biopsies can do. It can potentially spot molecular changes in a patient’s tissue, which is designed to predict which patients may develop cancer over time. The AI platform used by the TissueCypher test was trained by analyzing data points from patients whose BE didn’t progress to cancer, as well as those whose did progress to cancer. This provided a “signature” that may identify disease progression and give patients a risk score for potential development of cancer.
Emmanuel Gorospe, M.D., M.P.H., FACG, FASGE
Gastroenterology Medical Director, Castle Biosciences
“The TissueCypher test is designed to identify nine biomarkers and the structure of the tissue,” said Emmanuel Gorospe, M.D., M.P.H., FACG, FASGE, gastroenterology medical director at Castle Biosciences. “It looks at those together to produce a risk class for each patient — either low, intermediate, or high — as well as a score; a numerical figure that has a corresponding probability of cancer progression. It’s a game-changer that may lead to earlier detection, earlier treatment, and better patient outcomes.”
The technology is also a game-changer for patients like Craig and their families.
Potentially life-saving test
Jordan credits the test with saving his father’s life. He says that without TissueCypher, Craig probably would have waited years for another biopsy, but by then, it could have been too late.
“That’s what TissueCypher has done for our family; it saved my dad from having to go through chemotherapy again, or radiation or surgeries again. We could nip it in the bud and make him as healthy as possible without so many more interventions in his life,” Jordan said.
Getting more patients with chronic heartburn or GERD screened for BE is key to helping reduce the development of esophageal cancer. TissueCypher can then be used to potentially identify which patients with BE are at high or low risk of progression to cancer. High-risk patients may receive escalated care to help prevent a future cancer diagnosis, while low-risk patients can potentially avoid unnecessary and costly procedures due to their low risk of developing cancer. The potential result? Better care for patients while ensuring healthcare resources — including a physician’s time and ability to appropriately triage care — are allocated to the patients who need them most.
Craig’s son Jordan encourages patients and their loved ones to be proactive about getting symptoms checked. “When you have these symptoms, go get help,” Jordan said. “Go check, make sure, because if we can catch it before it progresses, it’s going to be so much easier on you and us.”
Now, Craig, a retired father of five who lives in Utah, has more time to spend with his wife, kids, and 20 grandchildren.
“Nothing can bring you more joy than to know your loved one is going to be around a little bit longer,” Jordan said. “Have him be a grandpa, continue to be a grandpa, and not have to worry about Barrett’s esophagus or the plague of cancer being on our family again.”
- Siegel RL, Giaquinto AN, Jemal A. Cancer statistics, 2024. CA Cancer J Clin. 2024;74(1):12-49. doi:10.3322/caac.21820. ↩︎
