HIV infection and domestic smoke exposure, but not human papillomavirus, are risk factors for esophageal squamous cell carcinoma in Zambia: a case-control study

(c) 2015 The Authors. Cancer Medicine published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited

Characteristics of Esophageal Cancer Cases in Tanzania.

PurposeAge-standardized incidence rates for esophageal cancer (EC) in East Africa have been reported as disproportionately high compared with the worldwide incidence of nine per 100,000 population. This study aimed to characterize EC cases seen at Muhimbili National Hospital and Ocean Road Cancer Institute in Dar es Salaam, Tanzania.MethodsDemographic, clinical, and treatment variables were abstracted from charts of patients who received care for a diagnosis of EC at one or both institutions between 2011 and 2013. Categorical data were summarized as frequency counts and percentages. Continuous data were presented as medians and ranges. To compare men and women, Pearson's χ2 and two-sample t tests were applied.ResultsSeven hundred thirty-eight unique cases of EC were identified, of whom 68% were men and the median age was 60 years (range, 19 to 95 years). Notably, 93 cases (13%) were ≤ 40 years old at diagnosis. Squamous cell carcinoma was the dominant histology, comprising 90% of cases with documented histopathology. However, 34% of cases with a diagnosis of EC were not pathologically confirmed. The stage was documented as locoregional in 4% of cases, locally advanced in 20% of cases, metastatic in 14% of cases, and unknown in 63% of cases. Of 430 patients who received treatment at Ocean Road Cancer Institute, 76% were treated with radiation, 44% were treated with chemotherapy, 3% underwent a cancer-related surgical procedure, and 10% of cases received no cancer-directed therapy. The median overall survival for all patients was 6.9 months (95% CI, 5.0 to 12.8), regardless of stage at presentation.ConclusionBetween 2011 and 2013, cases of EC represented a large clinical burden at both institutions

Sedation for Gastrointestinal Endoscopic Procedures in the Elderly: Getting Safer but Still Not Nearly Safe Enough

Previously published UK reports showed that excessively large doses of benzodiazepines and opiates were being commonly used to sedate elderly patients for gastrointestinal (GI) endoscopy. This unsafe practice has lead to avoidable morbidity and mortality. We have taken the opportunity provided by recent reports to examine whether GI endoscopy sedation practice in the elderly has improved in the light of this evidence and the publication of guidelines in which specific recommendations on sedation dosage are given

Informing etiologic research priorities for squamous cell esophageal cancer in Africa: a review of setting-specific exposures to known and putative risk factors

Esophageal squamous cell carcinoma (ESCC) is one of the most common cancers in most Eastern and Southern African countries, but its etiology has been understudied to date. To inform its research agenda, we undertook a review to identify, of the ESCC risk factors which have been established or strongly suggested worldwide, those with a high prevalence or high exposure levels in any ESCC-affected African setting and the sources thereof. We found that for almost all ESCC risk factors known to date, including tobacco, alcohol, hot beverage consumption, nitrosamines and both inhaled and ingested PAHs, there is evidence of population groups with raised exposures, the sources of which vary greatly between cultures across the ESCC corridor. Research encompassing these risk factors is warranted and is likely to identify primary prevention strategies

Risk factors for oesophageal, lung, oral and laryngeal cancers in black South Africans

The authors used data collected from 1995 to 1999, from an on-going cancer case–control study in greater Johannesburg, to estimate the importance of tobacco and alcohol consumption and other suspected risk factors with respect to cancer of the oesophagus (267 men and 138 women), lung (105 men and 41 women), oral cavity (87 men and 37 women), and larynx (51 men). Cancers not associated with tobacco or alcohol consumption were used as controls (804 men and 1370 women). Tobacco smoking was found to be the major risk factor for all of these cancers with odds ratios ranging from 2.6 (95% CI 1.5–4.5) for oesophageal cancer in female ex-smokers to 50.9 (95% CI 12.6–204.6) for lung cancer in women, and 23.9 (95% CI 9.5–60.3) for lung cancer and 23.6 (95% CI 4.6–121.2) for laryngeal cancer in men who smoked 15 or more grams of tobacco a day. This is the first time an association between smoking and oral and laryngeal cancers has been shown in sub-Saharan Africa. Long-term residence in the Transkei region in the southeast of the country continues to be a risk factor for oesophageal cancer, especially in women (odds ratio=14.7, 95% CI 4.7–46.0), possibly due to nutritional factors. There was a slight increase in lung cancer (odds ratio=2.9, 95% CI 1.1–7.5) in men working in ‘potentially noxious’ industries. ‘Frequent’ alcohol consumption, on its own, caused a marginally elevated risk for oesophageal cancer (odds ratio=1.7, 95% CI 1.0–2.9, for women and odds ratio=1.8, 95% CI 1.2–2.8, for men). The risks for oesophageal cancer in relation to alcohol consumption increased significantly in male and female smokers (odds ratio=4.7, 95% CI=2.8–7.9 in males and odds ratio=4.8, 95% CI 3.2–6.1 in females). The above results are broadly in line with international findings

Risk Factors for Esophageal Squamous Cell Carcinoma in a Kenyan Population

Background: Esophageal squamous cell carcinoma (ESCC) is common in some parts of Kenya. Both the regional factors associated with ESCC in  Kenya and geographic distribution has not been completely described. Methods: We analyzed the association of ESCC with smoking, khat  chewing, alcohol, diet, socioeconomic status, caustic ingestion and firstdegree family history of ESCC in a multi-center based matched case-control study. We also determined the geographic origin, age, gender and ethnicity of patients visiting the participating centers between August 2008 and April 2009. Results: Eighty three cases and 166 controls matched for age and gender were studied. The male to female ratio of cases was 2.1:1, majority were from Central and Eastern provinces of Kenya, about one fifth (19%) were younger than 45 years of age. On multivariate analysis, caustic ingestion (OR 11.3 CI 3.0 – 42.5), first degree family history of ESCC (OR 3.5 CI 1.3 – 9.5) and poor housing (OR 2.0 CI 1.1 – 3.5) were independent predictors.Conclusions: Majority hailed from the Central and Eastern provinces  probably due to proximity to the study centres. A large proportion of cases were young compared to studies in other high incidence regions in the world. Low socio-economic status, family history of ESCC and a history of caustic ingestion were significant risk factors.Key Words: Esophageal, Squamous Cell Carcinoma, Risk Factors, Keny

Effects of smoking and alcohol use on oesophageal cancer amongst Black South Africans in Johannesburg from 1999-2009

Background: Oesophageal cancer is the fourth most common cancer in black South African males with an age-standardised incidence rate of 7.31 per 100 000 in 2010, and sixth in black South African females, 3.59 per 100 000. The adoption of lifestyle behaviours such as tobacco and alcohol use was on the rise in that decade, amongst black South Africans living in Johannesburg. Aim: The overall aim was to investigate the association of smoking and alcohol use on oesophageal cancer amongst 18 to 74-year-old black South Africans in Johannesburg from 1999 to 2009. Methods: Secondary analysis were done based on a matched case-control study design. We used the conditional univariate and matched multiple logistic regression for statistical analysis as the main analysis. Gender was ascertained as an effect modifier therefore the analysis were done separately for males and females. Sensitivity analysis of the findings were tested using the unconditional univariate and unmatched multiple logistic regression. Results: Heavy smokers had an increased likelihood of oesophageal cancer as shown in the conditional multivariate logistic regression (AOR = 9.0; 95% CI: 5.2 – 15.5) in males and (AOR = 5.2; 95% CI: 1.3 – 20.1) in females. Alcohol consumption was a much stronger risk factor for oesophageal cancer among female heavy drinkers (AOR = 2.1; 95% CI: 1.5 – 2.9) relative to the light drinkers, controlling for other variables. There was a significant interaction of tobacco use and alcohol drinking as they acted synergistically to increase the likelihood of oesophageal cancer among current heavy smokers and heavy drinkers, (AOR = 15.0; 95% 7.2 – 31.3) in males and (AOR = 2.7; 95% 0.6 – 11.2) in females, compared to non-drinkers. iv Conclusion: We established that over the ten-year study period, smoking and alcohol use were both associated with oesophageal cancer independently and as combined exposures. An increase in sin tax on cigarettes and alcohol as well as increased education on the risk factors associated with the development of oesophageal cancer could be used as interventions to decrease the burden of this disease. Keywords: Smoking, Alcohol, Cancer, South AfricaLG201