OR, IF WE'RE SERIOUS ABOUT THE DISEASE, WE COULD JUST BAN TOBACCO:

When the blood test for prostate-specific antigen, or PSA, emerged two decades ago, it represented a simpler and cheaper alternative to the standard at the time -- ultrasound and a biopsy of the prostate done through the rectum.

Promoted by urologists and patient-advocacy groups, the test quickly took off. Doctors began finding tumors early enough to destroy them with surgery and radiation. Some men experienced treatment side effects such as impotence, incontinence and severe infections, but these seemed a tolerable price to pay for thwarting a potentially deadly disease.

In the ensuing years, the picture grew muddy. Reports mounted that many men were submitting to treatments for slow-growing cancers that would never have bothered them in the first place. Scientific evidence showed that the millions of screenings and treatments performed hadn't significantly lowered death rates from prostate cancer.

In a 2010 op-ed article in the New York Times, Richard Ablin, one of the discoverers of PSA, noted that 30 million American men were getting the test every year, racking up a $3 billion bill. "The test's popularity," Ablin wrote, "has led to a hugely expensive public health disaster."

Last year, the U.S. Preventive Services Task Force, a federally funded panel of independent experts that makes recommendations on preventive care, caused an uproar with a draft recommendation against prostate cancer screening.

"Looking hard for asymptomatic cancers will always result in overdiagnosis and overtreatment," says Dr. Michael LeFevre, a member of the task force. The panel does recommend routine screening beyond certain ages for breast, cervical and colo-rectal cancers and other diseases where research has shown that screening reduces deaths. [...]

About 10,500 Americans are diagnosed with esophageal adenocarcinoma each year, according to the American Cancer Society. The number for tumors of the colon and rectum -- the No. 2 killer cancer, after lung cancer -- is 143,000. White men over 50 have an elevated risk for esophageal cancer. Smoking, obesity and chronic acid reflux add to the danger. [...]

Aviv is aware that his campaign for routine screening places him outside the mainstream. "I'm taking an extreme position because of what I have seen with this disease," he says. To underline his point, he ticks off a list of high-profile victims: baseball great Harmon Killebrew, architect Charles Gwathmey, actor Ron Silver, Texas Governor Ann Richards.

In 2009, ENT and Allergy Associates recruited Aviv, then a professor at Columbia University in New York City, to found and run its voice and swallowing center.

At different times over the past decade, he was a paid consultant to three companies that make or sell TNE scopes and related equipment: Minneapolis-based Medtronic Inc, Pentax -- now known as KayPentax, based in Montvale, New Jersey -- and Vision-Sciences Inc, of Orangeburg, New York. Aviv says he is no longer a paid consultant to any of the companies, though he owns several thousand shares in Vision-Sciences and uses its equipment. The company's systems cost between $30,000 and $60,000.

Vision-Sciences says that while it "may not have the marketing power of a larger corporation who might be able to take the promotion directly to the patient," it has supported research on the use of TNE and plans to offer training to teach doctors "about the merits of our TNE product offering."

Nicholas Tsaclas, who has worked in marketing for Pentax and Vision-Sciences, says input from Aviv and Dr. Jamie Koufman, another prominent New York-area ENT, was critical to the development of TNE devices. Among other things, the new cameras have given ENT doctors easier access to parts of the human anatomy -- the esophagus and stomach -- that have typically been out of reach.

In 2009, it was Tsaclas who played the "patient" on "Good Morning America" while Aviv demonstrated TNE screening and host Diane Sawyer told viewers, "It's not painful, you can do it fast, and it can save your life." Since then, Aviv has appeared on "The Dr. Oz Show" and Bloomberg TV and on radio to promote TNE screening.

Many of his critics are worried about the history between doctor and equipment maker -- not a rarity in the medical profession -- as well as the sheer number of people who would be screened if Aviv had his way.

"The unfortunate thing is ... this is something that will be a money-maker for the people who offer it," says Brawley of the American Cancer Society. In the absence of research showing that routine screening yields clear benefits, it's premature to be doing it, "especially if they are charging for the procedure," he says.

"This is marketing, that is all that is," says Dr. H. Gilbert Welch, an internist at the Dartmouth Institute for Health Policy and Clinical Practice in Hanover, New Hampshire, and author of "Overdiagnosed: Making People Sick in the Pursuit of Health."

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