{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T18:35:10Z","timestamp":1792089310462,"version":"4.4.0"},"reference-count":68,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2023,10,30]],"date-time":"2023-10-30T00:00:00Z","timestamp":1698624000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100006041","name":"Innovate UK","doi-asserted-by":"publisher","award":["41662"],"award-info":[{"award-number":["41662"]}],"id":[{"id":"10.13039\/501100006041","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Oesophageal cancer has significant morbidity and mortality but late diagnosis is common since early signs of disease are frequently misinterpreted. Project DELTA aims to enable earlier detection and treatment through targeted screening using a novel risk prediction algorithm for oesophageal cancer (incorporating risk factors of Barrett\u2019s oesophagus including prescriptions for acid-reducing medications (CanPredict)), together with a non-invasive, low-cost sampling device (Cytosponge<jats:sup>TM<\/jats:sup>). However, there are many barriers to implementation, and this paper identifies key ethical and legal challenges to implementing these personalised prevention strategies for Barrett\u2019s oesophagus\/oesophageal cancer.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>To identify ethical and legal issues relevant to the deployment of a risk prediction tool for oesophageal cancer into primary care, we adopted an interdisciplinary approach, incorporating targeted informal literature reviews, interviews with expert collaborators, a multidisciplinary workshop and ethical and legal analysis.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Successful implementation raises many issues including ensuring transparency and effective risk communication; addressing bias and inequity; managing resources appropriately and avoiding exceptionalism. Clinicians will need support and training to use cancer risk prediction algorithms, ensuring that they understand how risk algorithms supplement rather than replace medical decision-making. Workshop participants had concerns about liability for harms arising from risk algorithms, including from potential bias and inequitable implementation. Determining strategies for risk communication enabling transparency but avoiding exceptionalist approaches are a significant challenge. Future challenges include using artificial intelligence to bolster risk assessment, incorporating genomics into risk tools, and deployment by non-health professional users. However, these strategies could improve detection and outcomes.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Novel pathways incorporating risk prediction algorithms hold considerable promise, especially when combined with low-cost sampling. However immediate priorities should be to develop risk communication strategies that take account of using validated risk algorithms, and to ensure equitable implementation. Resolving questions about liability for harms arising should be a longer-term objective.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0293576","type":"journal-article","created":{"date-parts":[[2023,10,30]],"date-time":"2023-10-30T17:42:17Z","timestamp":1698687737000},"page":"e0293576","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":8,"title":["Ethical and legal implications of implementing risk algorithms for early detection and screening for oesophageal cancer, now and in the future"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8416-1754","authenticated-orcid":true,"given":"Tanya","family":"Brigden","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colin","family":"Mitchell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3987-2872","authenticated-orcid":true,"given":"Elizabeth","family":"Redrup Hill","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alison","family":"Hall","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,10,30]]},"reference":[{"key":"pone.0293576.ref001","volume-title":"Office for Life SciencesDepartment of Health and Social Care, Department for Science, Innovation and Technology, Department of Business Energy & Industrial Strategy, Lord Bethell of Romford","year":"2020"},{"issue":"7659","key":"pone.0293576.ref002","doi-asserted-by":"crossref","first-page":"1475","DOI":"10.1136\/bmj.39609.449676.25","article-title":"Predicting cardiovascular risk in England and Wales: prospective derivation and validation of QRISK2","volume":"336","author":"J Hippisley-Cox","year":"2008","journal-title":"BMJ"},{"issue":"2","key":"pone.0293576.ref003","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1093\/pubmed\/fdt078","article-title":"Implementing risk-stratified screening for common cancers: a review of potential ethical, legal and social issues.","volume":"36","author":"AE Hall","year":"2014","journal-title":"J Public Health (Oxf)."},{"issue":"12","key":"pone.0293576.ref004","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1038\/s41575-020-00368-3","article-title":"A risk-stratified approach to colorectal cancer prevention and diagnosis","volume":"17","author":"MA Hull","year":"2020","journal-title":"Nat Rev Gastroenterol Hepatol"},{"key":"pone.0293576.ref005","doi-asserted-by":"crossref","first-page":"100700","DOI":"10.1016\/j.lanepe.2023.100700","article-title":"Development and validation of a novel risk prediction algorithm to estimate 10-year risk of oesophageal cancer in primary care: prospective cohort study and evaluation of performance against two other risk prediction models","volume":"32","author":"J Hippisley-Cox","year":"2023","journal-title":"The Lancet Regional Health\u2014Europe"},{"issue":"2","key":"pone.0293576.ref006","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1016\/S1470-2045(21)00667-7","article-title":"Use of a Cytosponge biomarker panel to prioritise endoscopic Barrett\u2019s oesophagus surveillance: a cross-sectional study followed by a real-world prospective pilot","volume":"23","author":"ND Pilonis","year":"2022","journal-title":"Lancet Oncol"},{"issue":"5","key":"pone.0293576.ref007","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1038\/s41591-021-01287-9","article-title":"Triage-driven diagnosis of Barrett\u2019s esophagus for early detection of esophageal adenocarcinoma using deep learning","volume":"27","author":"M Gehrung","year":"2021","journal-title":"Nat Med"},{"key":"pone.0293576.ref008","doi-asserted-by":"crossref","first-page":"2042","DOI":"10.1007\/s10620-018-5151-z","article-title":"Histology of Barrett\u2019s Metaplasia: Do Goblet Cells Matter","volume":"63","author":"R. 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