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

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Abstract

Purpose

To explore associations of nutritional, infectious, and lifestyle factors with esophageal cancer (EC) occurrence in a high-risk area of Malawi.

Methods

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.

Results

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. 43.5 years, 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].

Conclusions

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.

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Data availability

All data are accessable from the corresponding author.

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Acknowledgments

We are grateful to Angela Goehlert for histopathological diagnosis of the biopsies. Additionally, we are grateful to Thomas Lehmann for his advice on statistical analysis.

Funding

This study was supported by the German Society for Global and Tropical Surgery.

Author information

Authors and Affiliations

  1. Institute for Pathology, Julius-Maximilian-University, Würzburg, Germany

    Anja L. Geßner

  2. Department of Urology, Technische Universität, Dresden, Germany

    Angelika Borkowetz

  3. Department of General, Visceral and Vascular Surgery, GRN Klinik, Weinheim, Germany

    Torsten J. Wilhelm

  4. Surgical Department, Zomba Central Hospital, Zomba, Malawi

    Enock Ludzu

  5. Institute for Medical Microbiology, University Hospital – Friedrich-Schiller-University, Jena, Germany

    Michael Baier

  6. Medical Department, Zomba Central Hospital, Zomba, Malawi

    Yamikani Mastala & Saulos Nyirenda

  7. Department of General, Visceral and Vascular Surgery, Sophien- und Hufeland-Klinikum, Henry-van-de-Velde-Straße 2, 99425, Weimar, Germany

    Henning Mothes

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  1. Anja L. Geßner
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  2. Angelika Borkowetz
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Correspondence to Henning Mothes.

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The study was approved by the College of Medicine Research and Ethics Committee (Nr P.04/10/930).

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Geßner, A.L., Borkowetz, A., Wilhelm, T.J. et al. Risk factors for esophageal cancer in a high-incidence area of Malawi. Cancer Causes Control 32, 1347–1354 (2021). https://doi.org/10.1007/s10552-021-01482-6

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