Risk Factors of Esophageal Squamous Cell Cancer in Southwestern Uganda: A Case-Control Study

Abstract

Background: Despite the high rates and regional variations of squamous cell cancer of the esophagus (ESCC) in East Africa, little is known about the region specific risk factors. We aim to determine factors associated with ESCC in southwestern Uganda. Methods: We conducted a case-control study of patients presenting for upper endoscopic examination from 2003 to 2014 at Mbarara Regional Referral Hospital, southwestern Uganda. Demographic and social data were collected prior to endoscopy including: age, gender, smoking status and alcohol use. Cases were those with a histological diagnosis of ESCC. Controls were participants with normal endoscopies or only gastritis. Patients with gastric cancer or peptic ulcer disease by histopathological examination or missing results were excluded. We used logistic regression to assess for association between age, sex, alcohol intake, and smoking with ESCC. Results: Sixty-seven cases and 142 controls were included with a median age of 51 years (IQR 40 - 64); and male predominance (59.43%). Dysphagia and/or odynophagia were more frequent endoscopic indications in cases compared to controls (72.29% vs 5.56%, p<0.0001). Male gender (AOR 16.46, 95% CI 3.21 - 84.48, p=0.001), age group 41 to 50 years (AOR 13.32, 95%CI 1.16 - 15.3, p=0.038), and history of both alcohol and smoking (AOR 4.10, 95%CI 1.14 - 14.78, p=0.031) were associated with ESCC. Conclusion: Our results emphasize the role of younger age, male gender, alcohol intake and smoking as risk factors for ESCC in this population. Expediency and priority should be taken in early evaluation for esophageal cancer in southwestern Uganda in symptomatic patients with these risk factors