Environmental risk factors for oesophageal cancer in Malawi: A case-control study

Abstract

AimThere is a high burden of oesophageal cancer in Malawi with dismal outcomes. It is not known whether environmental factors are associated with oesophageal cancer. Without knowing this critical information, prevention interventions are not possible. The purpose of this analysis was to explore environmental factors associated with oesophageal cancer in the Malawian context. MethodsA hospital-based case-control study of the association between environmental risk factors and oesophageal cancer was conducted at Kamuzu Central Hospital in Lilongwe, Malawi and Queen Elizabeth Central Hospital in Blantyre, Malawi. Ninety-six persons with squamous cell carcinoma and 180 controls were enrolled and analyzed. These two groups were compared for a range of environmental risk factors, using logistic regression models. Unadjusted and adjusted odds ratios and 95% confidence intervals (CI) were calculated. ResultsFirewood cooking, cigarette smoking, and use of white maize flour all had strong associations with squamous cell carcinoma of the oesophagus, with adjusted odds ratios of 12.6 (95% CI: 4.2-37.7), 5.4 (95% CI: 2.0-15.2) and 6.6 (95% CI: 2.3-19.3), respectively. ConclusionsSeveral modifiable risk factors were found to be strongly associated with squamous cell carcinoma. Research is needed to confirm these associations and then determine how to intervene on these modifiable risk factors in the Malawian context.

Protective Effect of Dietary Calcium Intake on Esophageal Cancer Risk: A Meta-Analysis of Observational Studies

“…Epidemiologic evidence demonstrated a number of risk factors for esophageal cancer, such as age, gender, alcohol drinking, tobacco smoking, obesity, chronic gastroesophageal reflux disease, dietary carcinogens, and insufficiencies of micronutrient consumption [3,4,5], among which dietary factors may play a more important role [6]. Accordingly, chemopreventive agents for esophageal cancer have attracted great attention, including vitamin C, vitamin E, carotenoids, and various minerals [7,8].…”

Screening and Preventive Strategies in Esophagogastric Cancer

“…80 Wood burning for heating and cooking has been associated with ESCC in Africa, Iran, and Brazil. 82 This may be related to increased exposure to polycyclic aromatic hydrocarbons. 83 …”

“…76 Although several nonendoscopic techniques to obtain esophageal cytology exist, these techniques have a sensitivity of only 24% to 47% for dysplasia-cancer and 18% to 44% for cancer, making them unsuitable for screening. 82 Very few studies looked at serum biomarkers but those that exist suggest these could be used in the future. 82 …”

“…82 Very few studies looked at serum biomarkers but those that exist suggest these could be used in the future. 82 …”

Guest Editorial

“…Mlombe et al's case-control study reported in the current issue is, to my knowledge, the first systematic attempt to answer this question locally. 9 There are other big studies in this area within the sub-Saharan African region, supported by the International Agency for Research on Cancer (IARC) and NIH, for which results are awaited. The country has seen the establishment of the head and neck surgery discipline at Queen Elizabeth Central Hospital (QECH).…”