Geophagia and risk of squamous cell esophageal cancer in the African esophageal cancer corridor: Findings from the ESCCAPE multicountry case-control studies

ESCCAPE team

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Abstract

Geophagia, the intentional practice of consuming soil, occurs across the African esophageal cancer corridor, particularly during pregnancy. We investigated whether this practice is linked to endemic esophageal squamous cell carcinoma (ESCC) in this region. We conducted ESCC case-control studies in Tanzania, Malawi and Kenya. Cases were patients with incident histologically/clinically confirmed ESCC and controls were hospital patients/visitors without digestive diseases. Participants were asked if they had ever eaten soil (never/regularly/pregnancy-only). Odds ratios (OR) are adjusted for sex, age, tobacco, alcohol, country, religion and marital status. Overall, 934 cases (Malawi 535, Tanzania 304 and Kenya females 95) and 995 controls provided geophagia information. Among controls, ever-geophagia was common in women (Malawi 49%, Kenya 43% and Tanzania 29%) but not in men (10% Malawi, <1% Tanzania). In women, ESCC ORs were 1.25 (95% CI: 0.70, 2.22) for regular versus never geophagia and 0.88 (95% CI: 0.64, 1.22) for pregnancy-only versus never. Findings were stronger based on comparisons of cases with hospital visitor controls and were null using hospital patients as controls. In conclusion, geophagia is too rare to contribute to the male ESCC burden in Africa. In women, the practice is common but we did not find consistent evidence of a link to ESCC. The study cannot rule out selection bias masking modest effects. Physical effects of geophagia do not appear to have a large impact on overall ESCC risk. Research with improved constituent-based geophagia exposure assessment is needed.

Original languageEnglish
Pages (from-to)1274-1283
Number of pages10
JournalInternational Journal of Cancer
Volume149
Issue number6
Early online date28 May 2021
DOIs
Publication statusPublished - 15 Sep 2021

Bibliographical note

Funding Information:
US National Cancer Institute, Grant/Award Number: R21CA19165; Wereld Kanker Onderzoek Fonds (WKOF), Grant/Award Number: 2018/1795; UK Medical Research Council; IARC Branch of Environment and Lifestyle Epidemiology Funding information

Funding Information:
Team ESCCAPE: N Kigen, M Oduor, SK Maina, F Some, C Kibosia, A Mwasamwaja, A Mremi, I Kiwelu, R Swai, G Kiwelu, S Mustapha, E Mghase, A Mchome, R Shao, E Mallya, K Kilonzo, G Liomba, A Kamkwatira, L Masamba, D Middleton and B Abedi Ardekani. ESCCAPE would like to acknowledge all participants and to the study interviewers, endoscopy and laboratory support: Mary Suwedi, Thandiwe Solomon, Rose Malamba, Mercy Kamdolozi, Godfrey Mushi, Theresia Namwai, Christine Carreira, and the endoscopy teams at the Queen Elizabeth Central Hospital, Blantyre, Moi Teaching and Referral Hospital, Eldoret, and the Kilimanjaro Christian Medical Central, Moshi. We thank Drs Elias Nyanza and Deborah Thomas for their expertise and input on the heterogeneity in the chemical contents of geophagia. ESCCAPE is supported by the Wereld Kanker Onderzoek Fonds (WKOF) which is a member of the World Cancer Research Fund network (2018/1795), the US National Cancer Institute (R21CA19165 to Kenya) and the IARC Branch of Environment and Lifestyle Epidemiology support to etiological research in Sub‐Saharan Africa. Dr Narh is supported by the UK Medical Research Council for capacity building in Africa.

Funding Information:
Team ESCCAPE: N Kigen, M Oduor, SK Maina, F Some, C Kibosia, A Mwasamwaja, A Mremi, I Kiwelu, R Swai, G Kiwelu, S Mustapha, E Mghase, A Mchome, R Shao, E Mallya, K Kilonzo, G Liomba, A Kamkwatira, L Masamba, D Middleton and B Abedi Ardekani. ESCCAPE would like to acknowledge all participants and to the study interviewers, endoscopy and laboratory support: Mary Suwedi, Thandiwe Solomon, Rose Malamba, Mercy Kamdolozi, Godfrey Mushi, Theresia Namwai, Christine Carreira, and the endoscopy teams at the Queen Elizabeth Central Hospital, Blantyre, Moi Teaching and Referral Hospital, Eldoret, and the Kilimanjaro Christian Medical Central, Moshi. We thank Drs Elias Nyanza and Deborah Thomas for their expertise and input on the heterogeneity in the chemical contents of geophagia. ESCCAPE is supported by the Wereld Kanker Onderzoek Fonds (WKOF) which is a member of the World Cancer Research Fund network (2018/1795), the US National Cancer Institute (R21CA19165 to Kenya) and the IARC Branch of Environment and Lifestyle Epidemiology support to etiological research in Sub-Saharan Africa. Dr Narh is supported by the UK Medical Research Council for capacity building in Africa.

Publisher Copyright:
© 2021 The Authors. International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC.

Keywords

  • Africa
  • cancer epidemiology
  • esophageal squamous cell carcinoma
  • geophagia
  • risk factors

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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