Abstract
There is emerging evidence that esophageal cancer occurs in younger adults in sub-Saharan Africa than in Europe or North America. The burden of human immunodeficiency virus (HIV) is also high in this region. We postulated that HIV and human papillomavirus (HPV) infections might contribute to esophageal squamous cell carcinoma (OSCC) risk. This was a case–control study based at the University Teaching Hospital in Lusaka, Zambia. Cases were patients with confirmed OSCC and controls had completely normal upper endoscopic evaluations. A total of 222 patients were included to analyze the influence of HIV infection; of these, 100 patients were used to analyze the influence of HPV infection, alcohol, smoking, and exposure to wood smoke. The presence of HIV infection was determined using antibody kits, and HPV infection was detected by polymerase chain reaction. HIV infection on its own conferred increased risk of developing OSCC (odds ratio [OR] 2.3; 95% confidence interval [CI] 1.0–5.1; P = 0.03). The OR was stronger when only people under 60 years were included (OR 4.3; 95% CI 1.5–13.2; P = 0.003). Cooking with charcoal or firewood, and cigarette smoking, both increased the odds of developing OSCC ([OR 3.5; 95% CI 1.4–9.3; P = 0.004] and [OR 9.1; 95% CI 3.0–30.4; P < 0.001], respectively). There was no significant difference in HPV detection or alcohol intake between cases and controls. We conclude that HIV infection and exposure to domestic and cigarette smoke are risk factors for OSCC, and HPV immunization unlikely to reduce OSCC incidence in Zambia.
Highlights
Esophageal cancer is the eighth most common cancer globally and the sixth most common cause of cancer deaths [1]
In recent years we have observed a worrying trend of increased occurrence of OSCC in young Zambian adults
We report an investigation into the association of OSCC with various lifestyle risk factors, and the possible influence of human immunodeficiency virus (HIV) and human papillomavirus (HPV) infection on the occurrence of OSCC among Zambian adults
Summary
Esophageal cancer is the eighth most common cancer globally and the sixth most common cause of cancer deaths [1]. In Zambia, available registry data suggest that esophageal cancer is the fifth most common cancer, and is ranked fourth among the causes of cancer deaths [2]. There has been a steady increase in esophageal cancer cases in sub-Saharan Africa [5, 6], it is not clear if this is a real increase or a reflection of improved case detection. Esophageal cancer in sub-Saharan Africa develops at a considerably younger age than in other regions [7, 8], and we reported that up to 27% of esophageal cancer patients seen in Zambia were below the age of 45 years [7]. The risk factors for esophageal cancer in these young adults have not been established
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