Risk factors associated with oesophageal malignancy among Ethiopian patients: a case control study

Abstract

Background: The incidence of Oesophageal cancer is increasing worldwide. Genetics, obesity, smoking, and alcohol consumption are among the known risk factors for this deadly cancer.  Although Oesophageal cancer was noted to be common in Arsi and Bale regions of Ethiopia, the risk factors predisposing to this cancer have not yet been identified or reported to the best of our knowledge. The main objective of this study was to identify the risk factors associated with oesophageal cancer among the study population.

Methods: A case-control study where volunteer adult patients aged 18 and above with diagnosis of oesophageal cancer (cases) and non-esophageal cancer patients (controls) were included was conducted in 2015 in Addis Ababa. The patients with dysphagia were referred to Adera Medical and Gastroenterology center from various regions of the country for Endoscopy. Patient data on socio-demographic and socio-economic variables, family history of similar illness and dietary history were collected using a pre specified questionnaire Patients’ clinical features, Endoscopic diagnosis and histology reports were retrieved from patients chart. Data were entered and analyzed using SPSS version 20 software. Frequency tables and figures were used to describe cases and controls. Odds ratio and 95% confidence interval were used to establish the strength and the significance of the association between independent and outcome (development of Esophageal Cancer) variables, respectively.

Results: A total of 215 patients were diagnosed to have esophageal cancer at the center during April 1,2014 through March 31, 2015. A total of 115 (55%)of cases were females with a mean age of 50 years while 96 (45%) were males with a mean age of 55 years. Most of the patients were Muslim farmers from rural Arsi and Bale regions of the country where consumption of hot wheat porridge is very common as staple diet. Majority had mid esophageal mass lesion followed by distal and proximal lesions, in 45%, 34%, and 21% of the patients, respectively. Most (88%) of the patients had Esophageal squamous cell cancer (SCC) while the rest 12% had adenocarcinoma on histologic diagnosis.

Conclusion: Oesophageal cancer was noted to be more common among the farmers from Arsi and Bale regions of the country. Consumption of hot porridge for long time was noted to be significantly associated with having oesophageal cancer among the farmers from the two regions possibly due to the thermal effect, which could lead to dysplasia and later cancer.

Keywords: Oesophageal cancer, Risk factors, Ethiopia