Aim
There is a high burden of oesophageal cancer in Malawi with dismal
outcomes. It is not known whether environmental factors are associated
with oesophageal cancer. Without knowing this critical information,
prevention interventions are not possible. The purpose of this analysis
was to explore environmental factors associated with oesophageal cancer
in the Malawian context.
Methods
A hospital-based case-control study of the association between
environmental risk factors and oesophageal cancer was conducted at
Kamuzu Central Hospital in Lilongwe, Malawi and Queen Elizabeth
Central Hospital in Blantyre, Malawi. Ninety-six persons with squamous
cell carcinoma and 180 controls were enrolled and analyzed. These two
groups were compared for a range of environmental risk factors, using
logistic regression models. Unadjusted and adjusted odds ratios and 95%
confidence intervals (CI) were calculated.
Results
Firewood cooking, cigarette smoking, and use of white maize flour all had
strong associations with squamous cell carcinoma of the oesophagus, with
adjusted odds ratios of 12.6 (95% CI: 4.2-37.7), 5.4 (95% CI: 2.0-15.2) and
6.6 (95% CI: 2.3-19.3), respectively.
Conclusions
Several modifiable risk factors were found to be strongly associated with
squamous cell carcinoma. Research is needed to confirm these associations
and then determine how to intervene on these modifiable risk factors in
the Malawian context.