Symptoms of gastroesophageal reflux are the only commonly used criterion for endoscopic screening for esophageal adenocarcinoma (EAC). Recent research has elucidated multiple other risk factors for both EAC and Barrett's esophagus (BE). Utilization of these risk factors may allow for the selection of a screening population with a much higher pre-test probability of disease. A recently developed risk-prediction model for BE is a significant step in the right direction; however, further refinements in this model will likely be necessary to optimize utility. Our inability to prognosticate cancer risk in BE does temper enthusiasm for increasing the pool of patients under endoscopic surveillance for BE, and again highlights the need for better, cheaper, and more accurate means of stratifying cancer risk in BE.