Risk Factors for Esophageal Squamous Cell Carcinoma in a Kenyan Population
Machoki MS1, Saidi H2, Raja A1, Ndonga A3, Njue A3, Biomdo I4,Kimani S2, Arudo J1, Mushtaq A1
Aga Khan University Hospital, Nairobi
School of Medicine, University of Nairobi
St. Mary’s Mission Hospital Nairobi
Chogoria Mission Hospital
Correspondence to: Dr Stanley M Machoki, P.O Box 30270-00100 GPO Nairobi, Kenya. Email: stanley. firstname.lastname@example.org
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 first degree 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, Kenya