(Mahboubi et al., 1973), whereas the probable incidence in the Yemen, from the experience of neighbouring countries (Parkin, 1986;Muir et al., 1987;Cook-Mozaffari, 1989), is only moderate by world standards. Comparison of the gastroendoscopic data from Sana'a with that from other centres in the country suggests that the rates may be locally elevated in Sana'a, perhaps because of the unusually high number of female patients.In western populations, where the disease is generally rare but affects men more than women, smoking and alcohol together account for a high proportion of oesophageal cancer risk (Day and Munoz, 1982). In Yemen, as in the highincidence belt of central Asia, cigarette smoking is rare and alcohol consumption is socially unacceptable in the Moslem culture. However, the water-pipe (Mada'a) is widely smoked by both men and women in Yemen, and the leaves of the Qat plant (Catha edulis) are commonly chewed for their mild stimulant properties, attributable to the alkaloid cathinone, which has close structural and pharmacological similarity to amphetamine. Qat contains tannins that thicken the mucosa of the oropharynx and oesophagus (Drake, 1988) and may be carcinogenic (Craddock, 1993). In India, a particularly elevated risk of oesophageal cancer has previously been found for smokers who also chew betel quid without tobacco (Jussawala, 1971).A preliminary survey has been carried out in Sana'a, in which the smoking and Qat-chewing habits, as well as the age/sex and demographic features, of all oesophageal cancer patients diagnosed during 1991 were investigated by questionnaire and were compared with those of gastric cancer patients. Known risk factors are generally dissimilar for the two sites of malignancy, apart from an apparent protective effect of fresh fruit and vegetables that affects both sites (Cook-Mozaffari, 1989;Forman, 1991) and a slight effect of smoking for gastric malignancies that mostly seems to be associated with tumours of the cardia (Rios-Castellanos, 1992). In Sana'a, only 17 male and one female cigarette smoker were found among the total sample of 183 patients, with an even site distribution. Only one patient admitted to drinking alcohol. A higher (but not statistically significant) frequency of Qat chewing and/or water-pipe smoking was found among oesophageal cancer patients for both men and women and for a group (20 men and three women) with tumours at the gastro-oesophageal junction or cardia (Table I).Most Qat chewers were also water-pipe smokers, and numbers were too few to isolate any independent effect of either factor individually. The proportion of chewers and smokers among women was only about half that in men, so that these habits alone could not account for the apparent elevated risk in women seen in Sana'a. No differences were found in the patients' residence and age distribution.A case-control study of oesophageal and gastric cancer is now under way in the Yemen to investigate further these preliminary findings and also to look at other factors which might affect ...
This investigation was aimed at assessing whether the Yemeni habit of chewing Qat on a regular basis had a significant effect on the upper alimentary tract. Seventy patients with dyspepsia attending Al-Thawra Hospital in Taiz, Yemen Republic were examined by endoscopy. Biopsies were taken from the oesophagus, stomach and duodenum. The patients included 28 who gave a history of daily Qat intake, 21 with less frequent intake and 21 who took none. The only statistically significant finding associated with daily Qat intake was a higher prevalence of duodenal ulcer, particularly in females. However, a strong association was also found between heavy smoking and ulcer, with most ulcer patients who chewed Qat daily being heavy smokers. Chewing Qat was not associated with a higher prevalence of oesophageal dysplasia, making it unlikely to be the cause of the perceived high incidence of oesophageal carcinoma in Yemen. There was a high prevalence of gastric H. pylori colonization (93%) and columnar-lined lower end of oesophagus (18%), as well as low prevalence of intestinal metaplasia of stomach (4%); this was not, however, related to chewing Qat. Further epidemiological and histological studies are needed to assess the significance of these findings in relation to the incidence of oesophageal and gastric carcinoma in Yemen.
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