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Cancer Epidemiology, Biomarkers & Prevention
Cancer Epidemiology, Biomarkers & Prevention
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Research Article

A Case–Control Study to Evaluate Environmental and Lifestyle Risk Factors for Esophageal Cancer in Tanzania

Elia J. Mmbaga, Beatrice P. Mushi, Katrina Deardorff, William Mgisha, Larry O. Akoko, Alan Paciorek, Robert A. Hiatt, Geoffrey C. Buckle, Julius Mwaiselage, Li Zhang and Katherine Van Loon
Elia J. Mmbaga
1Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
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  • For correspondence: eliajelia@yahoo.co.uk
Beatrice P. Mushi
1Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
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Katrina Deardorff
2University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, California.
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  • ORCID record for Katrina Deardorff
William Mgisha
1Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
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Larry O. Akoko
1Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
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  • ORCID record for Larry O. Akoko
Alan Paciorek
2University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, California.
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  • ORCID record for Alan Paciorek
Robert A. Hiatt
2University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, California.
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  • ORCID record for Robert A. Hiatt
Geoffrey C. Buckle
2University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, California.
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  • ORCID record for Geoffrey C. Buckle
Julius Mwaiselage
3Ocean Road Cancer Institute, Dar es Salaam, Tanzania.
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Li Zhang
2University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, California.
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Katherine Van Loon
2University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, California.
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DOI: 10.1158/1055-9965.EPI-20-0660
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Abstract

Background: East Africa is affected by a disproportionately high burden of esophageal squamous cell carcinoma (ESCC).

Methods: We conducted an incident case–control study in Dar es Salaam, Tanzania with 1:1 matching for gender and age. A questionnaire evaluated known and putative risk factors for ESCC. Cochran–Mantel–Haenszel and multivariable conditional logistic regression analyses were applied to evaluate associations with ESCC risk, with adjustment for geographic zone.

Results: Of 471 cases and 471 controls, the majority were male (69%); median ages were 59 and 55, respectively. In a multivariable logistic regression model, a low International Wealth Index (IWI) score [OR 2.57; 95% confidence interval (CI), 1.41–4.68], former smoking (OR 2.45; 95% CI, 1.46–4.13), second-hand smoke in the household (OR 1.67; 95% CI, 1.01–2.77), daily spicy chilies (OR 1.62; 1.04–2.52), and daily salted foods (OR 2.02; 95% CI, 1.06–3.85) were associated with increased risk of ESCC. Daily consumption of raw greens (OR 0.36; 95% CI, 0.16–0.80), fruit (OR 0.47; 95% CI, 0.27–0.82), and smoked fish (OR 0.31; 95% CI, 0.15–0.66) were protective. Permanent residence in the Central (OR 5.03; 95% CI, 2.16–11.73), Northern-Lake (OR 2.40; 95% CI, 1.46–3.94), or Southern Highlands zones (OR 3.18; 95% CI, 1.56–6.50) of Tanzania were associated with increased risk compared with residence in the Eastern zone.

Conclusions: Low IWI score, smoke exposure(s), geographic zone, and dietary factors were associated with risk for ESCC in Tanzania.

Impact: These findings will inform the development of future hypothesis-driven studies to examine risk factors for the high burden of ESCC in East Africa.

Footnotes

  • Note: Supplementary data for this article are available at Cancer Epidemiology, Biomarkers & Prevention Online (http://cebp.aacrjournals.org/).

  • Prior presentation: Preliminary data from this study were presented an an oral presentation at the 2016 NCI/CUGH Symposium on Global Cancer Research in San Francisco, CA.

  • Cancer Epidemiol Biomarkers Prev 2020;XX:XX–XX

  • Received May 8, 2020.
  • Revision received July 3, 2020.
  • Accepted October 22, 2020.
  • Published first November 3, 2020.
  • ©2020 American Association for Cancer Research.

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This OnlineFirst version was published on November 24, 2020
doi: 10.1158/1055-9965.EPI-20-0660

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A Case–Control Study to Evaluate Environmental and Lifestyle Risk Factors for Esophageal Cancer in Tanzania
Elia J. Mmbaga, Beatrice P. Mushi, Katrina Deardorff, William Mgisha, Larry O. Akoko, Alan Paciorek, Robert A. Hiatt, Geoffrey C. Buckle, Julius Mwaiselage, Li Zhang and Katherine Van Loon
Cancer Epidemiol Biomarkers Prev November 24 2020 DOI: 10.1158/1055-9965.EPI-20-0660

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A Case–Control Study to Evaluate Environmental and Lifestyle Risk Factors for Esophageal Cancer in Tanzania
Elia J. Mmbaga, Beatrice P. Mushi, Katrina Deardorff, William Mgisha, Larry O. Akoko, Alan Paciorek, Robert A. Hiatt, Geoffrey C. Buckle, Julius Mwaiselage, Li Zhang and Katherine Van Loon
Cancer Epidemiol Biomarkers Prev November 24 2020 DOI: 10.1158/1055-9965.EPI-20-0660
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