Abstract
BackgroundOesophageal carcinoma (OC) is one of the leading cancers in Sri Lanka. Its increasing incidence despite the implementation of various preventive activities addressing the conventional risk factors indicates the possibility of the existence of novel, country-specific risk factors. Thus, the identification of novel risk factors of OC specific to Sri Lanka is crucial for implementation of primary prevention activities.MethodsA case-control study was conducted among 49 incident cases of OC recruited from the National Cancer Institute, Maharagama using a non-probability sampling method, and unmatched hospital controls (n = 196) excluded of having OC recruited from the endoscopy unit of the National Hospital of Sri Lanka. Data were collected using an interviewer administered questionnaire. Risk factors for OC were assessed by odds ratio (OR) with 95% confidence interval (CI). The risk factors were adjusted for possible confounding by logistic regression analysis.ResultsOf the study population, OC was common among males (69%) and the majority presented with squamous cell carcinoma (65%) at late stages (Stage IV: 45%; Stage III: 37%). Following adjusting for confounders, the risk factor profile for OC included; age > 65 years (OR = 4.0; 95% CI: 1.2–14.2); family history of cancer (OR = 5.04; 95% CI: 1.3–19.0); sub-optimal consumption of dietary fibre (OR = 3.58; 95% CI: 1.1–12.3); sub-optimal consumption of anti-oxidants (OR = 7.0; 95% CI: 2.2–22.5); over-consumption of deep fried food (OR = 6.68; 95% CI:2.0–22.6); ‘high risk’ alcohol drinking (OR = 11.7; 95% CI: 2.8–49.4); betel quid chewing (OR = 6.1; 95% CI: 2.0, 20.0); ‘low’ lifetime total sports and exercise activities (MET hours/week/year) (OR = 5.83; 95% CI: 1.5–23.0); agrochemicals exposure (OR = 6.57; 95% CI: 1.4–30.3); pipe-borne drinking water (OR = 5.62; 95% CI:1.7–18.9) and radiation exposure (OR = 4.64; 95% CI: 1.4–15.5). Significant effect modifications were seen between betel quid chewing and male sex (p = 0.01) and between ever exposure to radiation and age over 65 years (p = 0.04).ConclusionsRisk profile for OC includes novel yet modifiable risk factors in relation to diet, occupation, environment and health. Primary prevention should target these to combat OC in Sri Lanka.
Highlights
Oesophageal carcinoma (OC) is one of the leading cancers in Sri Lanka
Of the study population, OC was common among males (69%) and the majority presented with squamous cell carcinoma (65%) at late stages (Stage IV: 45%; Stage III: 37%)
Patients diagnosed of having any cancer, patients referred for high risk screening for oesophageal carcinoma, patients with cirrhosis/chronic liver diseases, patients having any oesophageal/gastric structural abnormalities on upper gastro-intestinal endoscopy (UGIE) such as polyps, ulcers and strictures, patients diagnosed with conditions that may mask visualization of the oesophageal mucosa and patients with a history of dyspeptic symptoms persisting for more than six months were excluded from the study
Summary
Oesophageal carcinoma (OC) is one of the leading cancers in Sri Lanka. Its increasing incidence despite the implementation of various preventive activities addressing the conventional risk factors indicates the possibility of the existence of novel, country-specific risk factors. The identification of novel risk factors of OC specific to Sri Lanka is crucial for implementation of primary prevention activities. Oesophageal carcinoma signifies a disease of public health importance as the eighth commonest cancer in the world [1]. Talagala et al BMC Cancer (2018) 18:1135 reported from Asia and Africa [1], necessitating prompt action for prevention in these regions. Sri Lanka, a developing country located in South Asia reports oesophageal cancer as the third commonest cancer following breast cancer and cancers of the oral cavity [5]. With cancer care being predominantly provided by the state, and increasingly financed by out of pocket spending [7], it poses a great impact on the economy of individuals, households as well as the country
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