Risk factors for esophageal cancer in a high-incidence area of Malawi.

Anja L Geßner,Yamikani Mastala,Angelika Borkowetz,Saulos Nyirenda,Enock Ludzu,Henning Mothes,Torsten J Wilhelm,Michael Baier

doi:10.1007/s10552-021-01482-6

Abstract

To explore associations of nutritional, infectious, and lifestyle factors with esophageal cancer (EC) occurrence in a high-risk area of Malawi. This case-control study was performed with 227 patients undergoing endoscopy for dysphagia or other upper gastrointestinal complaints. Data on clinicopathological characteristics and risk factors were collected using a questionnaire developed for this study specifically. Ninety-eight blood samples were collected and the prevalence of antibodies against human immunodeficiency virus, herpes simplex virus, cytomegalovirus, Epstein-Barr virus, varicella-zoster virus, and Helicobacter pylori were determined serologically. The tumor and control groups comprised 157 (69.2%) and 70 (31.8%) patients, respectively. Patients with tumors were significantly older than controls (55.5 vs. 43.5years, p < 0.001). The male/female ratio did not differ between groups (59% and 54% male, respectively; p = 0.469). EC was associated with smoking (p < 0.001), and alcohol consumption (p = 0.020), but 43% of patients with tumors did not smoke or drink. EC was associated with the consumption of hot food and tea (p = 0.003) and smoked fish (p = 0.011). EC was not associated with any serologically investigated infectious agents. In an age adjusted binary logistic regression analysis of all nutritive factors, only locally made alcohol was significant [odds ratio (OR), 9.252; 95% confidence interval (CI), 1.455-58.822; p = 0.018]. Apart from alcohol consumption and smoking, the consumption of hot food or tea and smoked fish are associated with EC. Locally distilled alcohol consumption increases the EC risk in Malawi.

Highlights

Esophageal cancer (EC) is the eighth most common cancer diagnosis, with an incidence of about 604,000 cases worldwide
EC was associated with smoking (P < 0.001) and alcohol consumption (P = 0.020), but 43% of patients with tumors did not smoke or drink
Age [odds ratio (OR), 1.042; 95% confidence interval (CI), 1.019–1.066; P < 0.001] and hot food and tea consumption (OR, 2.331; 95% CI, 1.167–4.656; P = 0.016) were significant

Summary

Introduction

Esophageal cancer (EC) is the eighth most common cancer diagnosis, with an incidence of about 604,000 cases worldwide. Malawi has one of the highest incidence rates of EC worldwide, with 24.2 cases per 100,000 inhabitants, in contrast to 6.6 and 3.2 cases per 100,000 inhabitants in the United States and United Kingdom, respectively [2]. Causative factors for this high incidence have not been identified conclusively. We investigated the association of alcohol and tobacco use with EC in Malawi, the consumption in this country is similar to or lesser than that in other African countries with much lower EC incidence rates [5, 6]. In contrast to other African countries with lower incidence rates of EC, maize consumption is high in Malawi [7]

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