Approximately 600 times a day, the esophagus ferries whatever is in your mouth down to your stomach. It’s usually a one-way route, but sometimes acid escapes the stomach and travels back up. That can damage the cells lining the esophagus, prompting them to grow back with genetic mistakes.

About 22,370 times a year in the United States, those mistakes culminate in cancer.

Esophageal cancer can be cured if it’s discovered and treated before it burrows in deep or spreads to other organs. But that’s rarely the case.

“The way this usually goes is a patient has had reflux symptoms for many years, they’ve taken Tums or something, and then all of a sudden they have difficulty swallowing so they come to the ER,” said Dr. Allon Kahn, a gastroenterologist and associate professor of medicine at the Mayo Clinic in Arizona. That’s when doctors discover a tumor that has grown into the walls of the esophagus, and likely beyond.

“At that point,” Kahn said, “it’s incurable.”

This is why only about 20% of Americans with esophageal cancer are still alive five years after their diagnosis. To improve on that figure, doctors say they don’t necessarily need better medicines. What they need are better ways to find the cancer while it’s still in its earliest, highly treatable stages.

And to do that, they need a breakthrough in screening for the disease.

“The concept of screening is to find dangerous things before they do dangerous things,” said Dr. Daniel Boffa, chief of thoracic surgery at Yale.

It works for diseases like breast, lung and colon cancer. In those cases, there’s a clear progression of steps that leads to cancer — and only to cancer.

But that doesn’t seem to be the case with esophageal cancer.

“We don’t really know who to screen, how often to screen, and what is the thing that we can see that will tell us, ‘This person is going to develop a dangerous cancer,’” Boffa said.

He likened the situation to the difficulty of forecasting a tornado.

“Most tornadoes happen when conditions are favorable for a tornado,” he said. “But most of the time that conditions are favorable for a tornado, there’s not a tornado. And a lot of the time, tornadoes happen outside of those conditions.”

Another complicating factor is that cases of esophageal cancer are rare, accounting for about 1% of all cancers diagnosed in the U.S.

Picture the 100,000 college football fans packed into Michigan Stadium in Ann Arbor on a game day, said Dr. Joel Rubenstein, a research scientist based 3 miles away at the Lt. Col. Charles S. Kettles VA Medical Center and a gastroenterologist at the University of Michigan. Then picture yourself having to figure out which four of those fans will develop esophageal cancer this year.

Screening someone for esophageal cancer is not a trivial procedure.

The standard method involves inserting an endoscope — a flexible tube with a camera on one end — into a patient’s throat and threading it down to the stomach. The camera allows doctors to inspect the esophagus up close and check for abnormal cells that could become cancerous.

The tube also serves as a conduit for tools that can collect tissue samples, which can be sent to a pathology lab for diagnostic analysis. If a doctor sees a growth that looks like early-stage cancer, it can be removed on the spot.

It sounds straightforward, but patients must be sedated for the procedure, which means they lose a day of work. Endoscopy is also expensive, and there’s a shortage of doctors who can do it.

“We’re only catching 7% of cancers through endoscopy,” Kahn said. “We’ve got to find a way to increase that number.”

In the U.S., the most common form of the cancer begins at the base of the esophagus. The cells there aren’t built to withstand exposure to stomach acid, so in people with chronic acid reflux, they sometimes adapt by becoming more like intestinal tissue. That condition is called Barrett’s esophagus, and about 5% of U.S. adults have it.

“If that’s all that was, we’d say, ‘That’s great,’” Kahn said. “But unfortunately, when it makes that change in cell type, there are genetic changes that predispose a patient to cancer.”

About 0.3% of people with Barrett’s esophagus develop esophageal cancer each year, said Dr. Sachin Wani, a gastroenterologist and professor at the University of Colorado School of Medicine. And compared to people without Barrett’s, they are roughly nine times more likely to die of esophageal cancer.

That means screening for Barrett’s is tantamount to screening for esophageal cancer.

Doctors largely agree on a core group of risk factors, including chronic gastroesophageal reflux disease, smoking and carrying extra pounds in the abdomen. Other risk factors include being at least 50 years old, male, white and having a family history of either Barrett’s or esophageal cancer.

There is less agreement about how many risk factors a person must have to justify screening.

Based on recommendations from the American College of Gastroenterology, more than 31 million people are eligible for screening. Guidelines from the American Society for Gastrointestinal Endoscopy raise that figure to 52 million, and the American Gastroenterological Assn.’s advice expands it to 120 million, said Dr. Gary Falk, a gastroenterologist and professor of medicine emeritus at the University of Pennsylvania’s Perelman School of Medicine.

All of these recommendations leave room for improvement. Only 50% to 60% of people who meet screening requirements actually have Barrett’s, said Dr. Prasad Iyer, the chair of gastroenterology at the Mayo Clinic in Arizona.

“The screening criteria are not accurate enough,” he said.

Indeed, at least 90% of people who have risk factors for Barrett’s don’t actually have the condition, Iyer said. That includes the vast majority of people with acid reflux.

So doctors are turning to artificial intelligence to identify additional characteristics that can improve their ability to identify those most likely to have Barrett’s and esophageal cancer.

“Everyone in medicine is looking at AI,” Falk said. “We think it’s going to revolutionize things.”

Iyer and his colleagues are developing an AI tool that scours the electronic medical records of Mayo Clinic patients to find those who should be screened for Barrett’s. The tool considers more than 7,500 distinct data points, including past medical procedures, lab test results, prescriptions and more. (Among the surprises: A patient’s triglycerides and electrolytes had predictive value.)

“This is probably something a human would not be able to do efficiently,” Iyer said.

In tests, the overall accuracy of both tools was 84%. While those are substantial improvements, the team would like to bump that up to 90% before they are rolled out in the clinic, Iyer said.

Rubenstein and his colleagues in Michigan created something similar, using machine learning techniques to analyze the health records of VA patients across the country. Their tool also performed better than the official guidelines of medical societies, with an accuracy of 77%. Now the team is working to refine its threshold for screening by adding cost-effectiveness to the mix.

Once in use, tools like these could lighten the load of overburdened primary care doctors, who aren’t necessarily up to date on the latest screening guidelines and refer fewer than half of their eligible patients for testing.

“It will flag a patient and say, ‘This patient should be screened,’ or, ‘This patient should not be screened,’” Iyer said. “That’s what the future really needs.”

When Camp Hess Kramer burned down in 2018, I cried. My family had gone to the summer camp for generations. My grandma won the “best camper” award in the same dining hall where I tried soda for the first time. Overnight, it was gone. The place I grew up, once ringing with songs and laughter, had mutated into a black abyss strewn with the wiry corpses of oak trees.

It was one of the worst fire seasons in California history. Entire towns and many lives were lost.

In 2020, when COVID hit, I was just about to finish middle school. Instead of playing Magic: The Gathering with my friends in the hallways, I stared into my computer screen consuming information about the climate crisis. Feelings of terror morphed into anger. Decades of warning signs had been ignored because big oil was buying out politicians. These disasters were preventable; Hess Kramer didn’t have to burn.

Evacuated horses on a beach in Malibu in 2018 as the Woolsey fire heads seaward. At least 670 structures were destroyed inside the Malibu city limits.

(Los Angeles Times)

Advertisement

So, I signed up for every climate organization I could find online. My first meeting with the Sunrise Movement’s new Los Angeles youth hub was filled with the intimidating faces of high school seniors. I saw the gleam in their eyes as they talked about a future where everyone had a right to clean air, clean water, and good and meaningful jobs. They led protests and created spreadsheets and cold-called people — things I had no idea how to do.

I was 15 when Sunrise asked me to help lead the local portion of a campaign for a national Civilian Climate Corps. The idea was to push the federal government to create a program employing young people in good-paying jobs fighting the climate crisis.

Soon I was planning a sit-in at Sen. Dianne Feinstein’s Los Angeles office. It was 2021. We slept on the sidewalk for two nights until Feinstein agreed to support the program. Then we demanded a Zoom meeting with Sen. Alex Padilla to get his support too. Around the country for many years, our movement continued to push for a Civilian Climate Corps. In June, the first cohort of 9,000 young people were sworn in by the White House.

But fire season is here, and the places I love are still in danger and my future is still uncertain. We could be looking at four years with a presidential administration that is in the pocket of fossil fuel billionaires.

A helicopter flies with a load of water heads to the Bootleg fire near Bly, Ore., in 2021.

(Payton Bruni / AFP / Getty Images)

On July 29, eight of us blockaded the wooden door of JD Vance’s Senate office in Washington. Many more Sunrisers lined the marble hallways. Young people from all walks of life sang in unison: “I went up to JD Vance and I took back my humanity/ Ain’t nobody gonna walk all over me.”

In 2020, Vance, now a potential vice president, asserted that climate change was a threat. Yet after receiving nearly $300,000 from the fossil fuel industry during his 2022 Senate campaign, Vance seems to no longer believe this crisis is human-made.

Police began shoving their way through the crowd toward the door. Handcuffs dangled by their side. I wanted to run, but as the police gave their third warning, I remembered why I was here: An image of Camp Hess Kramer flashed through my head.

I was taken outside with my hands behind my back. I was told I was under arrest, alone in a sea of blue uniforms, but in the distance I heard 150 Sunrisers break out into another song. I could just make out the words. “Where you go, I will go, Simon. Where you go, I will go.”

Simon Aron is a freshman at Brown University, where he plans to continue his activism.

Growing up, I realized that children are a product of their environment, so let me tell you a little bit about mine: I grew up in Secaucus, N.J., a town called “the Jewel of the Meadowlands.” My suburban hometown exists within a large ecosystem of wetlands, the Meadowlands, through which the Hackensack River flows. But with post-agricultural pig farm effluent and debris from New York’s train station decay being dumped into the area, the Meadowlands became a jewel in need of polishing.

Secaucus is working to recover the natural marshes by designating them as protected so fewer apartment complexes can be built and begin to sink a few years down the road, which has happened in the past. The town became environmentally conscious, and existing within that environment, I did the same.

In high school, I worked with the Secaucus Environmental Department for over three years as part of the Next Generation Community Leaders, or NGCL, program created by the Lindsey Meyer Teen Institute. Little did I know just how much this experience would influence my life. Throughout that time, I learned about climate change, the planet’s environmental challenges, and the actions we need to take to reduce our footprint. I helped implement a plastic bag and Styrofoam ban, designed a food waste composting system at my high school and local gardens and created eco-friendly living PSAs. I canvassed to promote eco-friendly living and educated residents on how to compost at home.

I also certified local businesses as “green,” depending on whether they followed practices set by the Sustainable Jersey network. These practices included recycling, reducing food waste, not using Styrofoam, etc. My contributions to the environmental department helped Secaucus to earn recognition from Sustainable Jersey as a Silver Certified Community.

That experience showed me how local actions can create change. By educating residents in Secaucus, we altered their behaviors, if even slightly, to be more environmentally conscious. Residents began to grow produce in the community gardens, compost at home and reduce their plastic bag usage. I witnessed how humans responsible for harming the planet have the potential to make changes to fix it and make it better for future generations. From that day forward, I carried that responsibility with me.

I will be honest: I don’t know the current status of those projects I worked on in Secaucus. I hope that residents are still composting at home and that those businesses continue their green practices.

I began my journey into learning about sustainability at USC with a major in industrial and systems engineering and a minor in law and public policy. Although these are not fields directly tied to the climate ecosphere, my advocacy in Secaucus made me realize that a systematic mindset and policy knowledge would be strong tools with which I can effect change within both the government and private sector in advocating for larger-scale sustainability solutions. With the opportunities provided by USC, I knew I could get involved in environmentalism and sustainability without having to be an environmental science major.

“We have canvassed [local] youth … and discovered that their top environmental priorities are cleaner air, green spaces and green buildings,” says Alyssa Jaipersaud, a member of the L.A. County Youth Climate Commission.

(Michael Blackshire / Los Angeles Times)

Advertisement

If you asked freshman Alyssa what her ultimate career goal was, she would have said, “Facilitate systemic change within the bureaucracy through ecological and climate-preservation policies to make society more sustainably conscious.” I wrote this on an index card and kept it in my backpack throughout college to constantly remind me of the goal because being an environmentalist can be discouraging, given the current climate.

Since then, I think I would have made freshman Alyssa proud. I was accepted into the USC Student Sustainability Committee and became a mentor to new members. The SSC acts as a representative for the student body within the Presidential Working Group for Sustainability. We work on projects such as getting reusable takeout containers in dining halls, ensuring ongoing campus construction is adhering to green practices, and creating a central physical space where sustainability-minded students can gather.

As a member of the SSC, I ensured that sustainability would become a standard educational practice at USC and change student behaviors toward respecting their environment. I continued my education at USC by pursuing a master’s in sustainable engineering, and I have earned the distinction of a National Academy of Engineering Grand Challenges Scholar by focusing on sustainability.

Alyssa Jaipersaud poses for a portrait at Exposition Park Rose Garden.

(Michael Blackshire / Los Angeles Times)

Advertisement

My environmental pursuits have culminated in my becoming a Los Angeles County Youth Climate commissioner in the world’s first such organization. We have canvassed the youth in L.A. County and discovered that their top environmental priorities are cleaner air, green spaces and green buildings.

Now, as a member of the legislative committee, I track all federal and state measures that relate to these priorities and bring them to the attention of the county Board of Supervisors so that they can weigh in on whether the legislation should be amended, supported or rejected. We are working actively to support legislation currently going through the U.S. Senate that would call for establishing opportunities for youths to be involved in policy development so they can ensure a healthy environment for their future and those to come.

Since children are a product of their environment, we should help future generations have a good environment to live in. With the environment constantly changing due to global warming, future generations will have a chance only if we work to make the world sustainable starting today. Instead of forcing future generations to learn how to survive to fix the environmental mistakes we are making today, they should have the opportunity to live without the repercussions of the past.

I witnessed the negative effects of a mistreated environment in my hometown, and I want to make sure future generations aren’t suffering from the consequences of what we are doing. With a sustainability mindset, local changes can influence the politicians and create the systemic change needed to get the biggest offenders under control. One of the significant steps is behavioral changes, which can begin locally and be brought by people not even studying in the environmental field, just like me.

Alyssa Jaipersaud earned a bachelor of science in industrial and systems engineering with a minor in law and public policy at USC and is also completing a master’s of science in sustainable engineering. She is setting her sights on a full-time role in the sustainability industry either as a consultant or practicing engineer.