Risk Factors for Esophageal Squamous Cell Carcinoma in a Kenyan Population

Abstract

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.