Epidemiology of Esophageal Cancer (EC) In Oromia Region, Ethiopia 2016: A 4-Year Medical Record Review

Abstract

Background: It is difficult to determine the prevalence/incidence of EC without an established functional national cancer registry, which helps to demarcate the population at-risk and monitor cancer trends over time. The review of medical records can help to identify areas in a country with high number of diagnosed EC cases and help set public health priorities. Aim: To describe EC hospital case series during a period of 4 years at the main cancer treatment center in Ethiopia and two hospitals in the EC high-risk zones in the Oromia region, concentrating on residents of Oromia region and to offer recommendations for public health officials. Methods: All EC malignancy data from the period 2013-2016 were collected by reviewing patient charts at the selected hospitals: Tikur Anbessa Teaching hospital (TATH) in Addis Ababa, Adama General and Medical Teaching Hospital (AGMTH) and Adama Referral and Medical Teaching Hospital (ARMTH). Cases with insufficient residence information and residents of other regions were excluded from the summary. The number of EC cases is presented by age, sex and site as well as method of diagnosis. Data were expressed as percentages (%). Statistical analysis was done using SPSS 20 software. Results: Over the study period, a total of 669 EC cases who resided in Oromia region were identified in the selected hospitals out of 2211 registered in the referral surgical departments of hospitals in the study, with insignificant difference by sex. A total of 457 (68%) were residents from high risk Arsi/Bale zones and the rest 212 (32%) from other zones of the region. The mean age at diagnosis was 52.4 years with the majority of cases in the age range 45-69 years. A total of 34 (5%) EC cases were younger at diagnosis (15-29 years). A total of 258 (38.5%) cases were identified at TATH, 305 (46%) from AGHMT/ARHMT and 106 (16%) cases from both TATH/AGHMT. Data were gathered from patient charts at endoscopy departments 227 (34%), endoscopy and pathology departments 246 (37%) and all other sources (ie surgical department) 196 (29%). Most patients complained dysphagia for solids 664 (99%) and weight loss 352 (53%). Cases were histopathology proven (256, 38%), identified through endoscopy investigation (385, 58%) or radiology (28, 4%). Squamous cell carcinoma was the predominant histology type with 160 cases (62.5%) of those histologically proven. Among the total of 420 cases whose risk factor history was recorded, 401 (97%) had a previous history of digestive disease, 49% reported hot beverage consumption and 34% persistent heart burn. Conclusion: Two thirds of EC incident cases came from Arsi and Bale zones with decreasing trends over the period considered. Such trends warrant in depth investigation for possible reasons and future study to investigate local based risk factors associated with the disease.