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Noureldin M, Rubenstein JH, Kenney B, Waljee AK. Re-evaluating early-onset OSCC in Africa: findings of minimal cumulative incidence. Gut 2024:gutjnl-2023-331687. [PMID: 38360071 DOI: 10.1136/gutjnl-2023-331687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 02/02/2024] [Indexed: 02/17/2024]
Affiliation(s)
- Mohamed Noureldin
- Division of Gastroenterology, University of Michigan, Ann Arbor, MI, USA
| | - Joel H Rubenstein
- Division of Gastroenterology, University of Michigan, Ann Arbor, MI, USA
- Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, MI, USA
- Cancer Control and Population Sciences Program, Rogel Cancer Center, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Brooke Kenney
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Akbar K Waljee
- Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, MI, USA
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, USA
- Center for Global Health Equity, University of Michigan, Ann Arbor, MI, USA
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Khanna D, Sharma P, Budukh A, Vishwakarma R, Sharma AN, Bagal S, Tripathi V, Maurya VK, Chaturvedi P, Pradhan S. Rural-urban disparity in cancer burden and care: findings from an Indian cancer registry. BMC Cancer 2024; 24:308. [PMID: 38448839 PMCID: PMC10916062 DOI: 10.1186/s12885-024-12041-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 02/22/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Cancer incidence and mortality vary across the globe, with nearly two-thirds of cancer-related deaths occurring in low- and middle-income countries. The rural-urban disparity in socio-demographic, behavioural, and lifestyle-related factors, as well as in access to cancer care, is one of the contributing factors. Population-based cancer registries serve as a measure for understanding the burden of cancer. We aimed to evaluate the rural-urban disparity in cancer burden and care of patients registered by an Indian population-based cancer registry. METHODS This study collected data from Varanasi, Uttar Pradesh, India, between 2017 and 2019. Sex and site-specific age-standardised rates for incidence and mortality per 100,000 population were calculated. Rural-urban disparities in cancer incidence and mortality were estimated through rate differences and standardised rate ratios (with 95% confidence intervals). Univariable and multivariable regressions were applied to determine any significant differences in socio-demographic and cancer-related variables according to place of residence (rural/urban). Crude and adjusted odds ratios with 95% confidence intervals were calculated. RESULTS 6721 cancer patients were registered during the study duration. Urban patients were older and had better literacy and socioeconomic levels, while rural patients had higher odds of having unskilled or semi-skilled professions. Diagnostic and clinical confirmation for cancer was significantly higher in urban patients, while verbal autopsy-based confirmation was higher in rural patients. Rural patients were more likely to receive palliative or alternative systems of medicine, and urban patients had higher chances of treatment completion. Significantly higher incidence and mortality were observed for oral cancer among urban men and for cervical cancer among rural women. Despite the higher incidence of breast cancer in urban women, significantly higher mortality was observed in rural women. CONCLUSIONS Low- and middle-income countries are facing dual challenges for cancer control and prevention. Their urban populations experience unhealthy lifestyles, while their rural populations lack healthcare accessibility. The distinctness in cancer burden and pattern calls for a re-evaluation of cancer control strategies that are tailor-made with an understanding of urban-rural disparities. Context-specific interventional programmes targeting risk-factor modifications, cancer awareness, early detection, and accessibility to diagnosis and care are essential.
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Affiliation(s)
- Divya Khanna
- Department of Preventive Oncology and Varanasi Cancer Registry, Mahamana Pandit Madan Mohan Malaviya Cancer Centre (MPMMCC) and Homi Bhabha Cancer Hospital (HBCH), Tata Memorial Centres, 221005, Varanasi, Uttar Pradesh, India.
| | - Priyanka Sharma
- Department of Preventive Oncology and Varanasi Cancer Registry, Mahamana Pandit Madan Mohan Malaviya Cancer Centre (MPMMCC) and Homi Bhabha Cancer Hospital (HBCH), Tata Memorial Centres, 221005, Varanasi, Uttar Pradesh, India
| | - Atul Budukh
- Centre for Cancer Epidemiology, Tata Memorial Centre, Homi Bhabha National Institute, 400012, Mumbai, India
| | - Rajesh Vishwakarma
- Department of Preventive Oncology and Varanasi Cancer Registry, Mahamana Pandit Madan Mohan Malaviya Cancer Centre (MPMMCC) and Homi Bhabha Cancer Hospital (HBCH), Tata Memorial Centres, 221005, Varanasi, Uttar Pradesh, India
| | - Anand N Sharma
- Department of Preventive Oncology and Varanasi Cancer Registry, Mahamana Pandit Madan Mohan Malaviya Cancer Centre (MPMMCC) and Homi Bhabha Cancer Hospital (HBCH), Tata Memorial Centres, 221005, Varanasi, Uttar Pradesh, India
| | - Sonali Bagal
- Centre for Cancer Epidemiology, Tata Memorial Centre, Homi Bhabha National Institute, 400012, Mumbai, India
| | - Varsha Tripathi
- Department of Preventive Oncology and Varanasi Cancer Registry, Mahamana Pandit Madan Mohan Malaviya Cancer Centre (MPMMCC) and Homi Bhabha Cancer Hospital (HBCH), Tata Memorial Centres, 221005, Varanasi, Uttar Pradesh, India
| | - Vijay Kumar Maurya
- Department of Preventive Oncology and Varanasi Cancer Registry, Mahamana Pandit Madan Mohan Malaviya Cancer Centre (MPMMCC) and Homi Bhabha Cancer Hospital (HBCH), Tata Memorial Centres, 221005, Varanasi, Uttar Pradesh, India
| | - Pankaj Chaturvedi
- Department of Surgical Oncology, Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, 400094, Mumbai, India
| | - Satyajit Pradhan
- Department of Radiation Oncology and Director, Mahamana Pandit Madan Mohan Malaviya Cancer Centre (MPMMCC) and Homi Bhabha Cancer Hospital (HBCH), Tata Memorial Centres, 221005, Varanasi, Uttar Pradesh, India
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Mima K, Hamada T, Inamura K, Baba H, Ugai T, Ogino S. The microbiome and rise of early-onset cancers: knowledge gaps and research opportunities. Gut Microbes 2023; 15:2269623. [PMID: 37902043 PMCID: PMC10730181 DOI: 10.1080/19490976.2023.2269623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 10/06/2023] [Indexed: 10/31/2023] Open
Abstract
Accumulating evidence indicates an alarming increase in the incidence of early-onset cancers, which are diagnosed among adults under 50 years of age, in the colorectum, esophagus, extrahepatic bile duct, gallbladder, liver, stomach, pancreas, as well as the bone marrow (multiple myeloma), breast, head and neck, kidney, prostate, thyroid, and uterine corpus (endometrium). While the early-onset cancer studies have encompassed research on the wide variety of organs, this article focuses on research on digestive system cancers. While a minority of early-onset cancers in the digestive system are associated with cancer-predisposing high penetrance germline genetic variants, the majority of those cancers are sporadic and multifactorial. Although potential etiological roles of diets, lifestyle, environment, and the microbiome from early life to adulthood (i.e. in one's life course) have been hypothesized, exact contribution of each of these factors remains uncertain. Diets, lifestyle patterns, and environmental exposures have been shown to alter the oral and intestinal microbiome. To address the rising trend of early-onset cancers, transdisciplinary research approaches including lifecourse epidemiology and molecular pathological epidemiology frameworks, nutritional and environmental sciences, multi-omics technologies, etc. are needed. We review current evidence and discuss emerging research opportunities, which can improve our understanding of their etiologies and help us design better strategies for prevention and treatment to reduce the cancer burden in populations.
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Affiliation(s)
- Kosuke Mima
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Tsuyoshi Hamada
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Hepato-Biliary-Pancreatic Medicine, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Kentaro Inamura
- Division of Pathology, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan
- Department of Pathology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Tomotaka Ugai
- Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Cancer Epidemiology Program, Dana-Farber Harvard Cancer Center, Boston, MA, USA
| | - Shuji Ogino
- Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Cancer Epidemiology Program, Dana-Farber Harvard Cancer Center, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Cancer Immunology Program, Dana-Farber Harvard Cancer Center, Boston, MA, USA
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4
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Van Loon K, Mmbaga EJ, Mushi BP, Selekwa M, Mwanga A, Akoko LO, Mwaiselage J, Mosha I, Ng DL, Wu W, Silverstein J, Mulima G, Kaimila B, Gopal S, Snell JM, Benz SC, Vaske C, Sanborn Z, Sedgewick AJ, Radenbaugh A, Newton Y, Collisson EA. A Genomic Analysis of Esophageal Squamous Cell Carcinoma in Eastern Africa. Cancer Epidemiol Biomarkers Prev 2023; 32:1411-1420. [PMID: 37505926 DOI: 10.1158/1055-9965.epi-22-0775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 04/19/2023] [Accepted: 07/26/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Esophageal squamous cell carcinoma (ESCC) comprises 90% of all esophageal cancer cases globally and is the most common histology in low-resource settings. Eastern Africa has a disproportionately high incidence of ESCC. METHODS We describe the genomic profiles of 61 ESCC cases from Tanzania and compare them to profiles from an existing cohort of ESCC cases from Malawi. We also provide a comparison to ESCC tumors in The Cancer Genome Atlas (TCGA). RESULTS We observed substantial transcriptional overlap with other squamous histologies via comparison with TCGA PanCan dataset. DNA analysis revealed known mutational patterns, both genome-wide as well as in genes known to be commonly mutated in ESCC. TP53 mutations were the most common somatic mutation in tumors from both Tanzania and Malawi but were detected at lower frequencies than previously reported in ESCC cases from other settings. In a combined analysis, two unique transcriptional clusters were identified: a proliferative/epithelial cluster and an invasive/migrative/mesenchymal cluster. Mutational signature analysis of the Tanzanian cohort revealed common signatures associated with aging and cytidine deaminase activity (APOBEC) and an absence of signature 29, which was previously reported in the Malawi cohort. CONCLUSIONS This study defines the molecular characteristics of ESCC in Tanzania, and enriches the Eastern African dataset, with findings of overall similarities but also some heterogeneity across two unique sites. IMPACT Despite a high burden of ESCC in Eastern Africa, investigations into the genomics in this region are nascent. This represents the largest comprehensive genomic analysis ESCC from sub-Saharan Africa to date.
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Affiliation(s)
- Katherine Van Loon
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | - Elia J Mmbaga
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Beatrice P Mushi
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Msiba Selekwa
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Ally Mwanga
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Larry O Akoko
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | | | - Dianna L Ng
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | - Wei Wu
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | - Jordyn Silverstein
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | | | | | - Satish Gopal
- UNC Project-Malawi, Lilongwe, Malawi
- University of North Carolina, Chapel Hill, North Carolina
| | - Jeff M Snell
- University of North Carolina, Chapel Hill, North Carolina
| | | | | | - Zack Sanborn
- NantOmics/NantHealth, Inc., El Segundo, California
| | | | | | - Yulia Newton
- NantOmics/NantHealth, Inc., El Segundo, California
| | - Eric A Collisson
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
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Obayo S, Mulumba Y, Thompson CL, Gibson MK, Cooney MM, Orem J. Clinicopathological characteristics and treatment outcomes of oesophageal cancer patients in Uganda. Ecancermedicalscience 2023; 17:1576. [PMID: 37533943 PMCID: PMC10393309 DOI: 10.3332/ecancer.2023.1576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Indexed: 08/04/2023] Open
Abstract
Background Oesophageal cancer is the seventh most common cancer and the sixth leading cause of cancer death worldwide, and its incidence varies globally. In Uganda, the incidence and trend are on the increase. However, there is a paucity of published data regarding this population's oesophageal cancer clinicopathologic characterisation and treatment outcomes. Objectives To study the patients' clinicopathologic characteristics and treatment outcomes of oesophageal cancer over 10 years at the Uganda Cancer Institute. Methods Patients' charts with histologically confirmed diagnoses of oesophageal cancer for 2009-2019 were identified. Case information, which included patient demographics, history of alcohol use or smoking, tumour location, histological type, tumour grade, clinical TNM (Tumour, Node, Metastasis) staging treatment exposure and treatment outcomes, was evaluated retrospectively. The median survival time was estimated with the Kaplan-Meier method and the median follow-up period was estimated using the reverse Kaplan-Meier. Results 1,965 oesophageal cancer patients were identified; 1,380(70.23%) were males and 585(29.77 %) females, their mean age was 60.20 years (±12.66). Most males had a history of both alcohol consumption and smoking 640(46.38%). The lower third of the oesophagus was the most common anatomical location 771(39.24%). The majority had squamous cell carcinoma histological type 1,783(90.74%) followed by adenocarcinomas 182(9.26%) in the distal oesophagus. Poorly differentiated tumour grade 743(37.81%) was predominant. The majority of the patients were in stage IVB, 733(37.30%), and most patients were planned for the best supportive care, 731(37.20%). Radiation alone was offered to 621(31.60%) and feeding gastrostomy to 249(12.70%). Treatment outcomes: at the time of the current analysis, 58.68% had died, 1.48% were alive and 39.84% were lost to follow-up. The median follow-up period was 65 months (IQR:35.83-83.30) with a median survival time of 4.47 months (95% CI: 4.17-4.80). Conclusion Treatment outcomes of Ugandan oesophageal cancer patients seeking care are poor as most patients present with advanced disease. There is a significant loss of follow-up after treatment initiation. Therefore, reduction in exposure to known modifiable risk factors, early detection and timely referral for treatment strategies are needed to improve outcomes of these patients in our population. Designing interventions to improve treatment adherence is necessary.
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Affiliation(s)
- Siraji Obayo
- Uganda Cancer Institute, Upper Mulago Hill Road PO Box 3935, Kampala, Uganda
| | - Yusuf Mulumba
- Uganda Cancer Institute, Upper Mulago Hill Road PO Box 3935, Kampala, Uganda
| | - Cheryl L Thompson
- Case Western Reserve University, Case Comprehensive Cancer Centre, Cleveland, OH 44106, USA
- Case Western Reserve University, University Hospitals Seidman Cancer Center, Cleveland, OH 44106, USA
| | - Michael K Gibson
- Vanderbilt University Medical Centre, Vanderbilt-Ingram Cancer Center, Nashville, TN 37232, USA
| | - Matthew M Cooney
- Case Western Reserve University, Case Comprehensive Cancer Centre, Cleveland, OH 44106, USA
- Case Western Reserve University, University Hospitals Seidman Cancer Center, Cleveland, OH 44106, USA
| | - Jackson Orem
- Uganda Cancer Institute, Upper Mulago Hill Road PO Box 3935, Kampala, Uganda
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6
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Nomburg J, Bullman S, Nasrollahzadeh D, Collisson EA, Abedi-Ardekani B, Akoko LO, Atkins JR, Buckle GC, Gopal S, Hu N, Kaimila B, Khoshnia M, Malekzadeh R, Menya D, Mmbaga BT, Moody S, Mulima G, Mushi BP, Mwaiselage J, Mwanga A, Newton Y, Ng DL, Radenbaugh A, Rwakatema DS, Selekwa M, Schüz J, Taylor PR, Vaske C, Goldstein A, Stratton MR, McCormack V, Brennan P, DeCaprio JA, Meyerson M, Mmbaga EJ, Van Loon K. An international report on bacterial communities in esophageal squamous cell carcinoma. Int J Cancer 2022; 151:1947-1959. [PMID: 35837755 DOI: 10.1002/ijc.34212] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/23/2022] [Accepted: 04/11/2022] [Indexed: 11/09/2022]
Abstract
The incidence of esophageal squamous cell carcinoma (ESCC) is disproportionately high in the eastern corridor of Africa and parts of Asia. Emerging research has identified a potential association between poor oral health and ESCC. One possible link between poor oral health and ESCC involves the alteration of the microbiome. We performed an integrated analysis of four independent sequencing efforts of ESCC tumors from patients from high- and low-incidence regions of the world. Using whole genome sequencing (WGS) and RNA sequencing (RNAseq) of ESCC tumors from 61 patients in Tanzania, we identified a community of bacteria, including members of the genera Fusobacterium, Selenomonas, Prevotella, Streptococcus, Porphyromonas, Veillonella and Campylobacter, present at high abundance in ESCC tumors. We then characterized the microbiome of 238 ESCC tumor specimens collected in two additional independent sequencing efforts consisting of patients from other high-ESCC incidence regions (Tanzania, Malawi, Kenya, Iran, China). This analysis revealed similar ESCC-associated bacterial communities in these cancers. Because these genera are traditionally considered members of the oral microbiota, we next explored whether there was a relationship between the synchronous saliva and tumor microbiomes of ESCC patients in Tanzania. Comparative analyses revealed that paired saliva and tumor microbiomes were significantly similar with a specific enrichment of Fusobacterium and Prevotella in the tumor microbiome. Together, these data indicate that cancer-associated oral bacteria are associated with ESCC tumors at the time of diagnosis and support a model in which oral bacteria are present in high abundance in both saliva and tumors of some ESCC patients.
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Affiliation(s)
- Jason Nomburg
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Harvard Program in Virology, Harvard Medical School, Boston, Massachusetts, USA
| | - Susan Bullman
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Dariush Nasrollahzadeh
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Shariati Hospital, Tehran, Iran
- International Agency for Research on Cancer (IARC), Genomic Epidemiology Branch, Lyon, France
| | - Eric A Collisson
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (UCSF), San Francisco, California, USA
- Division of Hematology/Oncology, Department of Medicine, UCSF, San Francisco, California, USA
| | - Behnoush Abedi-Ardekani
- International Agency for Research on Cancer (IARC), Genomic Epidemiology Branch, Lyon, France
| | - Larry O Akoko
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Joshua R Atkins
- International Agency for Research on Cancer (IARC), Genomic Epidemiology Branch, Lyon, France
| | - Geoffrey C Buckle
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (UCSF), San Francisco, California, USA
- Division of Hematology/Oncology, Department of Medicine, UCSF, San Francisco, California, USA
| | - Satish Gopal
- University of North Carolina (UNC), Chapel Hill, North Carolina, USA
| | - Nan Hu
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | | | - Masoud Khoshnia
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Shariati Hospital, Tehran, Iran
| | - Reza Malekzadeh
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Shariati Hospital, Tehran, Iran
| | - Diana Menya
- School of Public Health, Moi University, Eldoret, Kenya
| | - Blandina T Mmbaga
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Center, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Sarah Moody
- The Cancer, Ageing and Somatic Mutation Programme, Wellcome Trust Sanger Institute, Cambridgeshire, UK
| | | | - Beatrice P Mushi
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Ally Mwanga
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Yulia Newton
- NantOmics/NantHealth, Inc., El Segundo, California, USA
| | - Dianna L Ng
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (UCSF), San Francisco, California, USA
- Department of Pathology, UCSF, San Francisco, California, USA
| | | | - Deogratias S Rwakatema
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Center, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Msiba Selekwa
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Joachim Schüz
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, Lyon, France
| | - Philip R Taylor
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Charles Vaske
- NantOmics/NantHealth, Inc., El Segundo, California, USA
| | - Alisa Goldstein
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Michael R Stratton
- The Cancer, Ageing and Somatic Mutation Programme, Wellcome Trust Sanger Institute, Cambridgeshire, UK
| | - Valerie McCormack
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, Lyon, France
| | - Paul Brennan
- International Agency for Research on Cancer (IARC), Genomic Epidemiology Branch, Lyon, France
| | - James A DeCaprio
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Harvard Program in Virology, Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Matthew Meyerson
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Genetics, Harvard Medical School, Boston, Massachusetts, USA
| | - Elia J Mmbaga
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway
| | - Katherine Van Loon
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (UCSF), San Francisco, California, USA
- Division of Hematology/Oncology, Department of Medicine, UCSF, San Francisco, California, USA
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7
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Kaimila B, Mulima G, Kajombo C, Salima A, Nietschke P, Pritchett N, Chen Y, Murphy G, Dawsey SM, Gopal S, Phiri KS, Abnet CC. Tobacco and other risk factors for esophageal squamous cell carcinoma in Lilongwe Malawi: Results from the Lilongwe esophageal cancer case: Control study. PLOS Glob Public Health 2022; 2:e0000135. [PMID: 36962303 PMCID: PMC10021825 DOI: 10.1371/journal.pgph.0000135] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 05/11/2022] [Indexed: 06/18/2023]
Abstract
OBJECTIVE Esophageal cancer is the second commonest cancer in Malawi, and 95% of all cases are esophageal squamous cell carcinoma (ESCC). Very little is known about the epidemiology of ESCC in Malawi including risk factors. The main objective of the study was to evaluate and describe risk factors of ESCC in Malawi. METHODS We conducted a case-control study from 2017 to 2020 at two hospitals in Lilongwe, Malawi and consenting adults were eligible for inclusion. Endoscopy was conducted on all cases and biopsies were obtained for histological confirmation. Controls were selected from patients or their guardians in orthopedic, dental and ophthalmology wards and they were frequency matched by sex, age, and region of origin to cases. An electronic structured questionnaire was delivered by a trained interviewer. Multivariate conditional logistic regression models were used to assess the associations between subject characteristics, habits, and medical history and risk of ESCC. RESULTS During the study period, 300 cases and 300 controls were enrolled into the study. Median age of cases and controls was 56 years and 62% of the cases were male. Among cases, 30% were ever cigarette smokers as were 22% of controls. Smoking cigarettes had an adjusted odds ratio of 2.4 (95% CI 1.4-4.2 p = 0.003). HIV+ status was present in 11% of cases and 4% controls, which resulted in an adjusted odds ratio was 4.0 (95% CI 1.8-9.0 p = 0.001). Drinking hot tea was associated with an adjusted odd ratio of 2.9 (95% CI 1.3-6.3 p = 0.007). Mold on stored grain has an adjusted odd ratio of 1.6 (95% CI 1.1-2.5 p = 0.021). CONCLUSION Reducing smoking cigarettes, consumption of scalding hot tea, and consumption of contaminated grain, could potentially help reduce the burden of ESCC in Malawi. Further investigation of the association between HIV status and ESCC are warranted.
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Affiliation(s)
- Bongani Kaimila
- UNC Project, Department of Cancer Research, Lilongwe, Malawi
| | - Gift Mulima
- Kamuzu Central Hospital, Department of Surgery, Lilongwe, Malawi
| | - Chifundo Kajombo
- Kamuzu Central Hospital, Department of Surgery, Lilongwe, Malawi
| | - Ande Salima
- UNC Project, Department of Cancer Research, Lilongwe, Malawi
| | - Peter Nietschke
- St. Gabriel Hospital, Department of Medicine, Lilongwe, Malawi
| | - Natalie Pritchett
- National Cancer Institute, Department of Cancer Epidemiology and Genetics, Metabolic Epidemiology Branch, Rockville, Maryland, United States of America
| | - Yingxi Chen
- National Cancer Institute, Department of Cancer Epidemiology and Genetics, Metabolic Epidemiology Branch, Rockville, Maryland, United States of America
| | - Gwen Murphy
- National Cancer Institute, Department of Cancer Epidemiology and Genetics, Metabolic Epidemiology Branch, Rockville, Maryland, United States of America
| | - Sanford M. Dawsey
- National Cancer Institute, Department of Cancer Epidemiology and Genetics, Metabolic Epidemiology Branch, Rockville, Maryland, United States of America
| | - Satish Gopal
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Kamija S. Phiri
- Kamuzu University of Health Sciences, School of Public Health, Blantyre, Malawi
| | - Christian C. Abnet
- National Cancer Institute, Department of Cancer Epidemiology and Genetics, Metabolic Epidemiology Branch, Rockville, Maryland, United States of America
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8
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Lando JO, Mwachiro MM, Parker RK, Albert PS, White RE, Burgert SL, Chepkwony R, Abnet CC, Githanga J, Topazian MD, Dawsey SM. Prevalence of esophageal squamous dysplasia in relatives of patients with esophageal cancer in Southwestern Kenya. Cancer Epidemiol 2022; 78:102141. [PMID: 35299153 DOI: 10.1016/j.canep.2022.102141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 02/19/2022] [Accepted: 03/09/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Esophageal squamous cell carcinoma (ESCC) and its asymptomatic precursor lesion, esophageal squamous dysplasia (ESD), are common in East Africa. It is unknown whether family history of esophageal cancer is a risk factor for both ESD and ESCC in Africa, and whether family members of affected persons should be screened. METHODS We recruited 296 asymptomatic adult first-degree relatives of ESCC patients residing in southwestern Kenya. Participants completed questionnaires and underwent endoscopy with Lugol's iodine staining and biopsy to determine the prevalence of ESD. Prevalence comparisons were made with a prior population-based cohort from the same catchment area who also underwent Lugol's chromoendoscopy. RESULTS Mean age was 40.7 years, compared to 62.7 years in the prior population study. The overall prevalence of ESD/ESCC among first-degree relatives was 14.7%, comparable to the background population prevalence of 14.4%, and this comparability remained even after adjusting for the different age distributions of the studies. Post-primary education was the only measured variable that was associated with a decreased risk of ESD/ESCC (adjusted OR=0.31, 95% CI: 0.11, 0.83). There was heterogeneity in the ESD prevalence across families, even after adjustments for varying age and other measured factors. CONCLUSIONS The prevalence of esophageal squamous dysplasia among first-degree relatives of persons with ESCC was similar to that of the background population of southwestern Kenya; however, there was heterogeneity in ESD prevalence between families, suggesting other genetic or environmental factors may influence family prevalence. Further study of families with a high prevalence of ESD or ESCC is justified.
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Ismail M, Mondlane L, Loforte M, Dimande L, Machatine S, Carrilho C, Sacarlal J. Demographic, endoscopic and histological profile of esophageal cancer at the Gastroenterology Department of Maputo Central Hospital from January 2016 to December 2018. Pan Afr Med J 2022; 41:100. [PMID: 35465369 PMCID: PMC8994464 DOI: 10.11604/pamj.2022.41.100.30941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 01/14/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION esophageal cancer is a major public health problem in Mozambique. It is the nineth most common cancer worldwide in terms of incidence (604.000 new cases/year), and sixth in overall mortality (544.076 deaths/year). In Mozambique esophageal cancer was the seventh most common cancer in males and the fifth in females between 1991 and 2008. METHODS it was done a cross-sectional hospital-based epidemiological study, using secondary demographics endoscopic and pathologic features data. A retrospective analysis of the existing information of patients classified as esophageal cancer diagnosed with upper gastrointestinal endoscopy observed from January 1st, 2016 to December 31st, 2018 at the Gastroenterology Service of Maputo Central Hospital. A coding sheet was created a priori, and data analysed in SPSS version 20. RESULTS of the 205 cases with complete records where included in the analysis, there was a higher frequency of females with 56.6% (116/205). The average age was 59.5 years with standard deviation of ± 12.9 years. Most of the patients were native of southern Mozambique, with 92.7% (190/205), of which Maputo made up 53.2% (109/205). Regarding race, 99.5% (204/205) were black. The most affected endoscopic location was the middle third with 48.8% (100/205), followed by the lower third with 29.8% (61/205) and the upper third with 21.5% (44/205). Squamous cell carcinoma was the most frequent, with 92.7% (190/205), followed by adenocarcinoma with 4.9% (10/205). CONCLUSION due to the high number of observed cases of esophageal cancer, a high degree of clinical suspicion is needed for timely diagnosis and more effective treatment. Updated prevalent studies are needed throughout the country to understand the true impact of esophageal cancer on the Mozambican population.
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Affiliation(s)
- Muhammad Ismail
- Serviço de Gastroenterologia, Hospital Central de Maputo, Maputo, Mozambique,,Corresponding author: Muhammad Ismail, Serviço de Gastroenterologia, Hospital Central de Maputo, Maputo, Mozambique.
| | - Liana Mondlane
- Serviço de Gastroenterologia, Hospital Central de Maputo, Maputo, Mozambique
| | - Michella Loforte
- Serviço de Gastroenterologia, Hospital Central de Maputo, Maputo, Mozambique
| | - Luzmira Dimande
- Serviço de Gastroenterologia, Hospital Central de Maputo, Maputo, Mozambique
| | - Sheila Machatine
- Serviço de Gastroenterologia, Hospital Central de Maputo, Maputo, Mozambique
| | - Carla Carrilho
- Serviço de Anatomia Patológica, Hospital Central de Maputo, Maputo, Mozambique,,Departamento de Patologia, Faculdade de Medicina, UEM, Maputo, Mozambique
| | - Jahit Sacarlal
- Departamento de Patologia, Faculdade de Medicina, UEM, Maputo, Mozambique
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10
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Buckle GC, Mmbaga EJ, Paciorek A, Akoko L, Deardorff K, Mgisha W, Mushi BP, Mwaiselage J, Hiatt RA, Zhang L, Van Loon K. Risk Factors Associated With Early-Onset Esophageal Cancer in Tanzania. JCO Glob Oncol 2022; 8:e2100256. [PMID: 35113655 PMCID: PMC8853620 DOI: 10.1200/go.21.00256] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Eastern Africa is one of several regions affected by high incidence rates of esophageal squamous cell carcinoma (ESCC). A unique epidemiologic feature of ESCC in Eastern Africa is the high incidence in young people, with one-third of cases diagnosed at age < 45 years. This study aimed to investigate risk factors for early-onset ESCC in Tanzania through a secondary analysis of a matched case-control study. Data from Tanzania show esophageal cancer risk factors in East Africa may differ across age groups.![]()
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Affiliation(s)
- Geoffrey C Buckle
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA.,UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Elia J Mmbaga
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Alan Paciorek
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA.,Department of Epidemiology and Biostatistics, UCSF, San Francisco, CA
| | - Larry Akoko
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Katrina Deardorff
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - William Mgisha
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Beatrice P Mushi
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Robert A Hiatt
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA.,Department of Epidemiology and Biostatistics, UCSF, San Francisco, CA
| | - Li Zhang
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA.,UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA.,Department of Epidemiology and Biostatistics, UCSF, San Francisco, CA
| | - Katherine Van Loon
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA.,UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
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11
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Buckle GC, Mrema A, Mwachiro M, Ringo Y, Selekwa M, Mulima G, Some FF, Mmbaga BT, Mody GN, Zhang L, Paciorek A, Akoko L, Ayuo P, Burgert S, Bukusi E, Charles A, Chepkemoi W, Chesumbai G, Kaimila B, Kenseko A, Kibwana KS, Koech D, Macharia C, Moirana EN, Mushi BP, Mremi A, Mwaiselage J, Mwanga A, Ndumbalo J, Nvakunga G, Ngoma M, Oduor M, Oloo M, Opakas J, Parker R, Seno S, Salima A, Servent F, Wandera A, Westmoreland KD, White RE, Williams B, Mmbaga EJ, Van Loon K. Treatment outcomes of esophageal cancer in Eastern Africa: protocol of a multi-center, prospective, observational, open cohort study. BMC Cancer 2022; 22:82. [PMID: 35045815 PMCID: PMC8772224 DOI: 10.1186/s12885-021-09124-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 12/18/2021] [Indexed: 11/19/2022] Open
Abstract
Background Esophageal squamous cell carcinoma (ESCC) is a major cause of cancer morbidity and mortality in Eastern Africa. The majority of patients with ESCC in Eastern Africa present with advanced disease at the time of diagnosis. Several palliative interventions for ESCC are currently in use within the region, including chemotherapy, radiation therapy with and without chemotherapy, and esophageal stenting with self-expandable metallic stents; however, the comparative effectiveness of these interventions in a low resource setting has yet to be examined. Methods This prospective, observational, multi-center, open cohort study aims to describe the therapeutic landscape of ESCC in Eastern Africa and investigate the outcomes of different treatment strategies within the region. The 4.5-year study will recruit at a total of six sites in Kenya, Malawi and Tanzania (Ocean Road Cancer Institute and Muhimbili National Hospital in Dar es Salaam, Tanzania; Kilimanjaro Christian Medical Center in Moshi, Tanzania; Tenwek Hospital in Bomet, Kenya; Moi Teaching and Referral Hospital in Eldoret, Kenya; and Kamuzu Central Hospital in Lilongwe, Malawi). Treatment outcomes that will be evaluated include overall survival, quality of life (QOL) and safety. All patients (≥18 years old) who present to participating sites with a histopathologically-confirmed or presumptive clinical diagnosis of ESCC based on endoscopy or barium swallow will be recruited to participate. Key clinical and treatment-related data including standardized QOL metrics will be collected at study enrollment, 1 month following treatment, 3 months following treatment, and thereafter at 3-month intervals until death. Vital status and QOL data will be collected through mobile phone outreach. Discussion This study will be the first study to prospectively compare ESCC treatment strategies in Eastern Africa, and the first to investigate QOL benefits associated with different treatments in sub-Saharan Africa. Findings from this study will help define optimal management strategies for ESCC in Eastern Africa and other resource-limited settings and will serve as a benchmark for future research. Trial registration This study was retrospectively registered with the ClinicalTrials.gov database on December 15, 2021, NCT05177393. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-09124-5.
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Affiliation(s)
- Geoffrey C Buckle
- UCSF Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, 505 Parnassus Ave, M1296, San Francsico, CA, 94143, USA.
| | - Alita Mrema
- Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | | | - Yona Ringo
- Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Msiba Selekwa
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Fatma F Some
- Moi University School of Medicine, Eldoret, Kenya
| | - Blandina T Mmbaga
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Gita N Mody
- University of North Carolina, Chapel Hill, USA
| | - Li Zhang
- UCSF Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, 505 Parnassus Ave, M1296, San Francsico, CA, 94143, USA
| | - Alan Paciorek
- UCSF Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, 505 Parnassus Ave, M1296, San Francsico, CA, 94143, USA
| | - Larry Akoko
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Paul Ayuo
- Moi University School of Medicine, Eldoret, Kenya
| | | | | | | | | | | | | | - Aida Kenseko
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | | | - David Koech
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | | | | | | | - Alex Mremi
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | | | - Ally Mwanga
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Gissela Nvakunga
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Mamsau Ngoma
- Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | | | - Mark Oloo
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Jesse Opakas
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Robert Parker
- Tenwek Hospital, Bomet, Kenya.,Warren Alpert School of Medicine at Brown University, Providence, RI, USA
| | - Saruni Seno
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | | | - Furaha Servent
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | | | - Kate D Westmoreland
- University of North Carolina, Chapel Hill, USA.,UNC-Project Malawi, Lilongwe, Malawi
| | - Russell E White
- Tenwek Hospital, Bomet, Kenya.,Warren Alpert School of Medicine at Brown University, Providence, RI, USA
| | | | - Elia J Mmbaga
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Katherine Van Loon
- UCSF Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, 505 Parnassus Ave, M1296, San Francsico, CA, 94143, USA
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12
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Geßner AL, Borkowetz A, Wilhelm TJ, Ludzu E, Baier M, Mastala Y, Nyirenda S, Mothes H. Risk factors for esophageal cancer in a high-incidence area of Malawi. Cancer Causes Control 2021. [PMID: 34342770 DOI: 10.1007/s10552-021-01482-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 07/12/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To explore associations of nutritional, infectious, and lifestyle factors with esophageal cancer (EC) occurrence in a high-risk area of Malawi. METHODS This case-control study was performed with 227 patients undergoing endoscopy for dysphagia or other upper gastrointestinal complaints. Data on clinicopathological characteristics and risk factors were collected using a questionnaire developed for this study specifically. Ninety-eight blood samples were collected and the prevalence of antibodies against human immunodeficiency virus, herpes simplex virus, cytomegalovirus, Epstein-Barr virus, varicella-zoster virus, and Helicobacter pylori were determined serologically. RESULTS The tumor and control groups comprised 157 (69.2%) and 70 (31.8%) patients, respectively. Patients with tumors were significantly older than controls (55.5 vs. 43.5 years, p < 0.001). The male/female ratio did not differ between groups (59% and 54% male, respectively; p = 0.469). EC was associated with smoking (p < 0.001), and alcohol consumption (p = 0.020), but 43% of patients with tumors did not smoke or drink. EC was associated with the consumption of hot food and tea (p = 0.003) and smoked fish (p = 0.011). EC was not associated with any serologically investigated infectious agents. In an age adjusted binary logistic regression analysis of all nutritive factors, only locally made alcohol was significant [odds ratio (OR), 9.252; 95% confidence interval (CI), 1.455-58.822; p = 0.018]. CONCLUSIONS Apart from alcohol consumption and smoking, the consumption of hot food or tea and smoked fish are associated with EC. Locally distilled alcohol consumption increases the EC risk in Malawi.
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13
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Lyimo EP, Rumisha SF, Mremi IR, Mangu CD, Kishamawe C, Chiduo MG, Matemba LE, Bwana VM, Massawe IS, Mboera LEG. Cancer Mortality Patterns in Tanzania: A Retrospective Hospital-Based Study, 2006-2015. JCO Glob Oncol 2021; 6:224-232. [PMID: 32073912 PMCID: PMC7051795 DOI: 10.1200/jgo.19.00270] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE This retrospective study sought to determine the type, burden, and pattern of cancer deaths in public hospitals in Tanzania from 2006 to 2015. METHODS This study analyzed data on cancer mortality in 39 hospitals in Tanzania. Data on the age and sex of the deceased and type of cancer were extracted from hospital death registers and report forms. Cancer types were grouped according to the 10th revision of the International Classification of Diseases. Age-standardized mortality rates and cancer mortality patterns were analyzed. A χ2 test was used to examine the association between common cancers and selected covariates. RESULTS A total of 12,621 cancer-related deaths occurred during the 10-year period, which translates to an age-standardized hospital-based mortality rate of 47.8 per 100,000 population. Overall, the number of deaths was notably higher (56.5%) among individuals in the 15- to 59-year-old age category and disproportionately higher among females than males (P = .0017). Cancers of the cervix, esophagus, and liver were the 3 major causes of death across all study hospitals in Tanzania. Cancers of the cervix, esophagus, and liver were the largest contributors to mortality burden among females. Among males, cancers of the esophagus, liver, and prostate were the leading cause of mortality. CONCLUSION There is an increasing trend in cancer mortality over recent years in Tanzania, which differs with respect to age, sex, and geographic zones. These findings provide a basis for additional studies to ascertain incidence rates and survival probabilities, and highlight the need to strengthen awareness campaigns for early detection, access to care, and improved diagnostic capabilities.
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Affiliation(s)
- Emanuel P Lyimo
- National Institute for Medical Research, Headquarters, Dar es Salaam, Tanzania
| | - Susan F Rumisha
- National Institute for Medical Research, Headquarters, Dar es Salaam, Tanzania.,Southern African Centre for Infectious Disease Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Irene R Mremi
- National Institute for Medical Research, Headquarters, Dar es Salaam, Tanzania.,Southern African Centre for Infectious Disease Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Chacha D Mangu
- National Institute for Medical Research, Mbeya Research Centre, Mbeya, Tanzania
| | - Coleman Kishamawe
- National Institute for Medical Research, Mwanza Research Centre, Mwanza, Tanzania
| | - Mercy G Chiduo
- National Institute for Medical Research, Tanga Research Centre, Tanga, Tanzania
| | - Lucas E Matemba
- National Institute for Medical Research, Headquarters, Dar es Salaam, Tanzania.,Malaria Atlas Project, Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, United Kingdom
| | - Veneranda M Bwana
- National Institute for Medical Research, Amani Research Centre, Muheza, Tanzania
| | - Isolide S Massawe
- National Institute for Medical Research, Tanga Research Centre, Tanga, Tanzania
| | - Leonard E G Mboera
- National Institute for Medical Research, Headquarters, Dar es Salaam, Tanzania.,Southern African Centre for Infectious Disease Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania
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14
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Mwachiro MM, Pritchett N, Calafat AM, Parker RK, Lando JO, Murphy G, Chepkwony R, Burgert SL, Abnet CC, Topazian MD, White RE, Dawsey SM, Etemadi A. Indoor wood combustion, carcinogenic exposure and esophageal cancer in southwest Kenya. Environ Int 2021; 152:106485. [PMID: 33689906 PMCID: PMC8832867 DOI: 10.1016/j.envint.2021.106485] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/20/2021] [Accepted: 02/23/2021] [Indexed: 05/05/2023]
Abstract
BACKGROUND Exposure to polycyclic aromatic hydrocarbons (PAHs) is a risk factor for esophageal squamous cell carcinoma (ESCC) in high-incidence areas of China, Iran and Brazil, but PAH assessments have not been conducted in East Africa, another ESCC hot spot. OBJECTIVE To evaluate demographic or lifestyle factors associated with the PAH biomarker concentrations in the study population, and whether PAH metabolite concentrations showed any associations with esophageal precancerous lesions. METHODS We recruited a community-based sample of 289 asymptomatic adults from a rural area of Kenya and performed Lugol's chromoendoscopy to detect esophageal squamous dysplasia (ESD); participants completed a questionnaire and provided a spot urine specimen. We analyzed urine for seven hydroxylated metabolites of naphthalene, fluorene, phenanthrene, and pyrene at the U.S. National Center for Environmental Health, and compared creatinine-corrected PAH metabolite concentrations with questionnaire data and the presence of ESD. RESULTS PAH metabolite concentrations among never tobacco users in these rural Kenya residents were 2.4-28.1 times higher than those reported from never tobacco users in Iran, Brazil and the USA. Female sex, cooking indoors, having no post-primary education, and age <50, but not tobacco use, were positively and significantly associated with PAH metabolite concentrations. Almost all participants used wood as cooking fuel. Nine participants had advanced ESD. Adjusted logistic regression showed a significant association between 2-hydroxynaphthalene (OR = 4.19, 95%CI: 1.01-17.47) and advanced ESD. All other PAH metabolites had positive but non-significant associations with advanced ESD. CONCLUSIONS Urinary PAH metabolite concentrations among never tobacco users are markedly higher in this group from Kenya than in other populations and are associated with indoor cooking with wood on open, unvented stoves. These metabolite concentrations were also associated with the presence of advanced esophageal dysplasia. Our findings underline the importance of assessing alternative cooking conditions to reduce PAH exposure in this population.
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Affiliation(s)
| | - Natalie Pritchett
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Antonia M Calafat
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Robert K Parker
- Tenwek Hospital, Bomet, Kenya; Department of Surgery, Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Gwen Murphy
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | | | - Christian C Abnet
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Russell E White
- Tenwek Hospital, Bomet, Kenya; Department of Surgery, Alpert Medical School of Brown University, Providence, RI, USA
| | - Sanford M Dawsey
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Arash Etemadi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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15
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Bukirwa P, Wabinga H, Nambooze S, Amulen PM, Joko WY, Liu B, Parkin DM. Trends in the incidence of cancer in Kampala, Uganda, 1991 to 2015. Int J Cancer 2021; 148:2129-2138. [PMID: 33129228 DOI: 10.1002/ijc.33373] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 09/27/2020] [Accepted: 10/06/2020] [Indexed: 01/01/2023]
Abstract
Trends in the incidence of cancer in the population of Kyadondo County, Uganda-which comprises the city of Kampala and a peri-urban hinterland-are presented for a period of 25 years (1991-2015) based on data collected by the Kampala Cancer Registry. Incidence rates have risen overall-age-adjusted rates are some 25% higher in 2011 to 2015 compared with 1991 to 1995. The biggest absolute increases have been in cancers of the prostate, breast and cervix, with rates of some 100% (prostate), 70% (breast) and 45% (cervix) higher in 2010 to 2015 than in 1991 to 1995. There were also increases in the incidence of cancers of the esophagus and colon-rectum (statistically significant in men), while the incidence of liver cancer-the fifth most common in this population-increased until 2007, and subsequently declined. By far the most commonly registered cancer over the 25-year period was Kaposi sarcoma, but the incidence has declined, consistent with the decreasing population-prevalence of HIV. Non-Hodgkin lymphomas, also AIDS-related, increased in incidence until 2006/2007 and then declined-possibly as a result of availability of antiretroviral therapy. The trends reflect the changing lifestyles of this urban African population, as well as the consequences of the epidemic of HIV/AIDS and the availability of treatment with ARVs. At the same time, it highlights the fact that the decreases in cancer of the cervix observed in high and upper-middle income countries are not a consequence of changes in lifestyle, but demand active intervention through screening (and, in the longer term, vaccination).
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Affiliation(s)
- Phiona Bukirwa
- Department of Pathology, Makerere University Medical School, Kampala, Uganda
- Kampala Cancer Registry, Makerere University Medical School, Kampala, Uganda
| | - Henry Wabinga
- Department of Pathology, Makerere University Medical School, Kampala, Uganda
- Kampala Cancer Registry, Makerere University Medical School, Kampala, Uganda
| | - Sarah Nambooze
- Kampala Cancer Registry, Makerere University Medical School, Kampala, Uganda
| | - Phoebe Mary Amulen
- Kampala Cancer Registry, Makerere University Medical School, Kampala, Uganda
| | | | - Biying Liu
- African Cancer Registry Network, Oxford, UK
| | - Donald Maxwell Parkin
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Cancer Surveillance Unit, International Agency for Research on Cancer, Lyon, France
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16
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Parkin DM, Chingonzoh T, Vuma S, Liu B, Chokunonga E, Ndlovu N, Borok M. Changes in the Incidence of Cancer in Bulawayo, Zimbabwe over a 50-Year Period. Cancer Epidemiol Biomarkers Prev 2021; 30:867-873. [PMID: 33619023 DOI: 10.1158/1055-9965.epi-20-0669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 11/14/2020] [Accepted: 02/02/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The cancer registry of Bulawayo (Zimbabwe) operated for 15 years in the preindependence period (1963-77), and was restarted in 2011. This allows comparison of incidence of cancers over a period of almost 50 years. METHODS Age-standardized rates, with SEs, were calculated for 1963-1972 and 2011-2015. Detailed results are presented for those cancers for which there was a significant (P < 0.05) change in the rates between the two periods. RESULTS There were declines in the rates of those cancers previously known to be common in East and Southern Africa (esophagus, liver, bladder), and the emergence of cancers associated with "westernization" of lifestyles (breast, prostate, large bowel). Cancers related to infection with HIV-AIDS (Kaposi sarcoma, non-Hodgkin lymphoma, eye cancers) have come to comprise a much larger proportion of the total burden, and cancer of the cervix (also AIDS-related) has shown a large increase in incidence-as elsewhere in sub-Saharan Africa (SSA). More surprising is the decline in cancer of the lung-formerly very high, but by 2011-2015, despite little change in the prevalence of smoking, rates were low-close to the average for SSA. This may relate, in part, to a decline in the numbers of miners, and ex-miners, residing in the city. CONCLUSIONS The changes in incidence are largely explained by differences in past exposure to environmental risk factors. IMPACT Few datasets from SSA can document temporal changes in the cancer epidemic on the continent. There are some anticipated observations, as well as unexpected findings meriting further investigation.
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Affiliation(s)
- Donald Maxwell Parkin
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
- African Cancer Registry Network, Prama House, Oxford, United Kingdom
- International Agency for Research on Cancer, Lyon, France
| | | | - Samkeliso Vuma
- Radiotherapy Centre, Mpilo Central Hospital, Bulawayo, Zimbabwe
| | - Biying Liu
- African Cancer Registry Network, Prama House, Oxford, United Kingdom
| | - Eric Chokunonga
- Zimbabwe National Cancer Registry, Parirenyatwa Group of Hospitals, Harare, Zimbabwe
| | - Ntokozo Ndlovu
- Zimbabwe National Cancer Registry, Parirenyatwa Group of Hospitals, Harare, Zimbabwe
- Radiotherapy Centre, Parirenyatwa Group of Hospitals, Harare, Zimbabwe
| | - Margaret Borok
- Zimbabwe National Cancer Registry, Parirenyatwa Group of Hospitals, Harare, Zimbabwe
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Kamita M, Mweni S, Nzioka A, Figueroa JD, Makokha F. Analysis of cancer diagnoses from 2015-2019 within Machakos County, Kenya, support establishment of Cancer Centre in 2019 likely changing referral patterns. Wellcome Open Res 2020. [DOI: 10.12688/wellcomeopenres.16340.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: In Kenya, cancer is an increasing public health challenge, with an estimated 48,000 new cancer cases and over 33,000 deaths recorded each year. Machakos County, Kenya, recently opened a cancer centre with an aim of bringing cancer services such as surgical oncology, chemotherapy, radiotherapy, and pathological services closer to the residents of Machakos County. The county is also one of four counties selected for the universal health coverage pilot programme making it uniquely poised to inform cancer control programs at the local, national, and international levels. Methods: This study aimed to build a cancer database to enable future population-based cancer studies by reviewing cancer diagnosis records for selected major public hospitals in Machakos County from 2015-2019. Medical records data were retrieved from Machakos Level 5 Hospital and Kangundo, Matuu, Kathiani and Mwala Level 4 Hospitals. Results: A total of 522 cancer cases were recorded across the study period with more than a third (N=172, 33%) diagnosed August-December of 2019 when the Machakos Cancer Centre opened. Among the cancers diagnosed, the majority were in women (59.2%), with cervix uteri (n=106, 34.3%) followed by breast (n=62, 20.1%) as the most common cancers. For males, oesophagus (n=52, 24.4%) followed by prostate (n=43, 20.2%) were the most common cancer types. The highest crude rates per 100,000 persons were for Kangundo 67.4 and Matungulu 53.2 subcounties. Conclusion: It is clear that access to cancer care treatment will change referral patterns for residents in Machakos County and with the establishment of this database we expect to enable future population-based surveillance of the cancer burden and research studies, to inform cancer control programs.
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Mmbaga EJ, Mushi BP, Deardorff K, Mgisha W, Akoko LO, Paciorek A, Hiatt RA, Buckle GC, Mwaiselage J, Zhang L, Van Loon K. A Case–Control Study to Evaluate Environmental and Lifestyle Risk Factors for Esophageal Cancer in Tanzania. Cancer Epidemiol Biomarkers Prev 2020; 30:305-316. [DOI: 10.1158/1055-9965.epi-20-0660] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/03/2020] [Accepted: 10/22/2020] [Indexed: 12/24/2022] Open
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Omonisi AE, Liu B, Parkin DM. Population-Based Cancer Registration in Sub-Saharan Africa: Its Role in Research and Cancer Control. JCO Glob Oncol 2020; 6:1721-1728. [PMID: 33180635 PMCID: PMC7713579 DOI: 10.1200/go.20.00294] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2020] [Indexed: 12/24/2022] Open
Affiliation(s)
- Abidemi Emmanuel Omonisi
- Department of Anatomic Pathology, Ekiti State University, Ado-Ekiti, Nigeria
- Ekiti Cancer Registry, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Biying Liu
- African Cancer Registry Network, Oxford, United Kingdom
| | - Donald Maxwell Parkin
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- International Agency for Research on Cancer, Lyon, France
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Buckle GC, Mahapatra R, Mwachiro M, Akoko L, Mmbaga EJ, White RE, Bent S, Van Loon K. Optimal management of esophageal cancer in Africa: A systemic review of treatment strategies. Int J Cancer 2020; 148:1115-1131. [PMID: 32930395 DOI: 10.1002/ijc.33299] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/05/2020] [Accepted: 08/13/2020] [Indexed: 12/24/2022]
Abstract
Esophageal cancer (EC) is a leading cause of cancer morbidity and mortality in Africa. Despite the high burden of disease, optimal management strategies for EC in resource-constrained settings have yet to be established. This systematic review evaluates the literature on treatments for EC throughout Africa and compares the efficacy and safety of varying treatment strategies in this context (PROSPERO CRD42017071546). PubMed, Embase and African Index Medicus were searched for studies published on treatment strategies for EC in Africa from 1980 to 2020. Searches were supplemented by examining bibliographies of included studies and relevant conference proceedings. Methodological quality/risk of bias was assessed using the Cochrane Risk-of-Bias tool and the Newcastle-Ottawa Scale. Forty-six studies were included. Case series constituted the majority of studies: 13 were case series reporting on outcomes of esophagectomies, 17 on palliative luminal or surgical interventions, four on radiotherapy and three on concurrent chemoradiation. Nine randomized controlled trials were identified, of which four prospectively compared different treatment modalities (one investigating radiotherapy vs chemoradiation, three evaluating rigid plastic stents vs other treatments). This review summarizes the research on EC treatments in Africa published over the last four decades and outlines critical gaps in knowledge related to management in this context. Areas in need of further research include (a) evaluation of the safety and efficacy of neoadjuvant therapy in patients with locally advanced disease; (b) strategies to improve long-term survival in patients treated with definitive chemoradiation; and (c) the comparative effectiveness of modern palliative interventions, focusing on quality of life and survival as outcome measures.
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Affiliation(s)
- Geoffrey C Buckle
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, California, USA.,Global Cancer Program, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California, USA
| | - Ruchika Mahapatra
- Global Cancer Program, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California, USA
| | | | - Larry Akoko
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Elia J Mmbaga
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Russell E White
- Department of Surgery, Tenwek Hospital, Bomet, Kenya.,Department of Surgery, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island, USA
| | - Stephen Bent
- Division of General Internal Medicine, Department of Medicine, UCSF, San Francisco, California, USA
| | - Katherine Van Loon
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, California, USA.,Global Cancer Program, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California, USA
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Tahtabasi M, Mohamud Abdullahi I, Kalayci M, Gedi Ibrahim I, Er S. Cancer Incidence and Distribution at a Tertiary Care Hospital in Somalia from 2017 to 2020: An Initial Report of 1306 Cases. Cancer Manag Res 2020; 12:8599-8611. [PMID: 33061565 PMCID: PMC7534047 DOI: 10.2147/cmar.s277202] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 09/02/2020] [Indexed: 12/12/2022] Open
Abstract
Purpose To determine the type, frequency and distribution of all cancers in Somalia from 2017 to 2020. Patients and Methods This retrospective and descriptive study included the review of a total of 5238 pathology reports obtained from the medical records of the Somalia Turkey Recep Tayyip Erdogan Education and Research Hospital. Patient characteristics, lesion localization, and histopathology were recorded. Patients with an unconfirmed cancer diagnosis, borderline tumors, intraepithelial neoplasms and metastatic cancers were excluded from the study. The cases were classified according to gender, age, and organ involvement. Results Of the 1306 patients included in the study, 50.9% (n=666) were female and 49.1% (n=640) were male, and the mean age was 51.1±19.4 years. Of the cases, 5.1% (n=67) were pediatric (0–17 years) and 35.8% (n=468) were in the 18–50 years range. The most common cancer was esophageal cancer (EC) for the overall data (n=284; 21.7%) and in both genders. EC peaked in the fifth decade, and the most common histological type was squamous cell carcinoma (n=256; 91.1%). Liver cancer was the second most common cancer overall (n=99; 7.6%) and in men (n=67; 10.5%). Cervical cancer was the second most common cancer among women (n=88; 13.3%) and ranked fourth in terms of overall incidence (n=88; 6.7%). Breast cancer was the third most common overall (n=95; 7.3%) and in women (n= 87; 13.1%). Conclusion This study shows that in Somalia, EC is the most common cancer in both genders. These high rates in Somalia suggest that environmental factors and dietary habits may have an effect. To reduce the incidence of EC and prevent its development, the population of Somalia should be educated and effective planning should be undertaken.
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Affiliation(s)
- Mehmet Tahtabasi
- Department of Radiology, University of Health Sciences- Somalia Turkey Recep Tayyip Erdogan Education and Research Hospital, Mogadishu, Somalia
| | - Ismail Mohamud Abdullahi
- Department of Pathology, University of Health Sciences- Somalia Turkey Recep Tayyip Erdogan Education and Research Hospital, Mogadishu, Somalia
| | - Mustafa Kalayci
- Department of Ophthalmology, University of Health Sciences- Somalia Turkey Recep Tayyip Erdogan Education and Research Hospital, Mogadishu, Somalia
| | - Ismail Gedi Ibrahim
- Department of Radiology, University of Health Sciences- Somalia Turkey Recep Tayyip Erdogan Education and Research Hospital, Mogadishu, Somalia
| | - Sadettin Er
- Department of General Surgery, University of Health Sciences- Somalia Turkey Recep Tayyip Erdogan Education and Research Hospital, Mogadishu, Somalia
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Horner MJ, Salima A, Chilima C, Mukatipa M, Kumwenda W, Kampani C, Chimzimu F, Mukunda B, Tomoka T, Mulenga M, Nyasosela R, Chasimpha S, Dzamalala C, Gopal S. Frequent HIV and Young Age Among Individuals With Diverse Cancers at a National Teaching Hospital in Malawi. J Glob Oncol 2019; 4:1-11. [PMID: 30085887 PMCID: PMC6223526 DOI: 10.1200/jgo.17.00174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Purpose Cancer surveillance provides a critical evidence base to guide cancer control efforts, yet population-based coverage in Africa is sparse. Hospital-based registries may help fill this need by providing local epidemiologic data to guide policy and forecast local health care needs. We report the epidemiology of patients with cancer recorded by a de novo hospital-based cancer registry at Kamuzu Central Hospital, Malawi, the sole provider of comprehensive oncology services for half the country and location of a high-volume pathology laboratory. Methods We conducted active case finding across all hospital departments and the pathology laboratory from June 2014 to March 2016. Patient demographics, tumor characteristics, treatment, and HIV status were collected. We describe epidemiology of the cancer caseload, registry design, and costs associated with registry operations. Results Among 1,446 registered patients, Kaposi sarcoma and cervical cancer were the most common cancers among men and women, respectively. Burkitt lymphoma was most common cancer among children. The current rate of pathology confirmation is 65%, a vast improvement in the diagnostic capacity for cancer through the hospital’s pathology laboratory. Among leading cancer types, an alarming proportion occurred at young ages; 50% of Kaposi sarcoma and 25% of esophageal, breast, and cervical cancers were diagnosed among those younger than 40 years of age. A systematic, cross-sectional assessment of HIV status reveals a prevalence of 58% among adults and 18% among children. Conclusion We report a high caseload among typically young patients and a significant burden of HIV infection among patients with cancer. In low- and middle-income countries with intermittent, sparse, or nonexistent cancer surveillance, hospital-based cancer registries can provide important local epidemiologic data while efforts to expand population-based registration continue.
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Affiliation(s)
- Marie-Josèphe Horner
- Marie-Josèphe Horner and Satish Gopal, University of North Carolina at Chapel Hill, Chapel Hill, NC; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, Coxcilly Kampani, Fred Chimzimu, Bal Mukunda, Tamiwe Tomoka, Maurice Mulenga, Richard Nyasosela, and Satish Gopal, University of North Carolina Project-Malawi; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, and Satish Gopal, Kamuzu Central Hospital Cancer Registry; Satish Gopal, Malawi Cancer Consortium & Regional Center of Research Excellence for Non-Communicable Diseases, Lilongwe; Steady Chasimpha and Charles Dzamalala, Malawi Cancer Registry; and Charles Dzamalala and Satish Gopal, University of Malawi College of Medicine, Blantyre, Malawi
| | - Ande Salima
- Marie-Josèphe Horner and Satish Gopal, University of North Carolina at Chapel Hill, Chapel Hill, NC; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, Coxcilly Kampani, Fred Chimzimu, Bal Mukunda, Tamiwe Tomoka, Maurice Mulenga, Richard Nyasosela, and Satish Gopal, University of North Carolina Project-Malawi; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, and Satish Gopal, Kamuzu Central Hospital Cancer Registry; Satish Gopal, Malawi Cancer Consortium & Regional Center of Research Excellence for Non-Communicable Diseases, Lilongwe; Steady Chasimpha and Charles Dzamalala, Malawi Cancer Registry; and Charles Dzamalala and Satish Gopal, University of Malawi College of Medicine, Blantyre, Malawi
| | - Chrissie Chilima
- Marie-Josèphe Horner and Satish Gopal, University of North Carolina at Chapel Hill, Chapel Hill, NC; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, Coxcilly Kampani, Fred Chimzimu, Bal Mukunda, Tamiwe Tomoka, Maurice Mulenga, Richard Nyasosela, and Satish Gopal, University of North Carolina Project-Malawi; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, and Satish Gopal, Kamuzu Central Hospital Cancer Registry; Satish Gopal, Malawi Cancer Consortium & Regional Center of Research Excellence for Non-Communicable Diseases, Lilongwe; Steady Chasimpha and Charles Dzamalala, Malawi Cancer Registry; and Charles Dzamalala and Satish Gopal, University of Malawi College of Medicine, Blantyre, Malawi
| | - Matthews Mukatipa
- Marie-Josèphe Horner and Satish Gopal, University of North Carolina at Chapel Hill, Chapel Hill, NC; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, Coxcilly Kampani, Fred Chimzimu, Bal Mukunda, Tamiwe Tomoka, Maurice Mulenga, Richard Nyasosela, and Satish Gopal, University of North Carolina Project-Malawi; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, and Satish Gopal, Kamuzu Central Hospital Cancer Registry; Satish Gopal, Malawi Cancer Consortium & Regional Center of Research Excellence for Non-Communicable Diseases, Lilongwe; Steady Chasimpha and Charles Dzamalala, Malawi Cancer Registry; and Charles Dzamalala and Satish Gopal, University of Malawi College of Medicine, Blantyre, Malawi
| | - Wiza Kumwenda
- Marie-Josèphe Horner and Satish Gopal, University of North Carolina at Chapel Hill, Chapel Hill, NC; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, Coxcilly Kampani, Fred Chimzimu, Bal Mukunda, Tamiwe Tomoka, Maurice Mulenga, Richard Nyasosela, and Satish Gopal, University of North Carolina Project-Malawi; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, and Satish Gopal, Kamuzu Central Hospital Cancer Registry; Satish Gopal, Malawi Cancer Consortium & Regional Center of Research Excellence for Non-Communicable Diseases, Lilongwe; Steady Chasimpha and Charles Dzamalala, Malawi Cancer Registry; and Charles Dzamalala and Satish Gopal, University of Malawi College of Medicine, Blantyre, Malawi
| | - Coxcilly Kampani
- Marie-Josèphe Horner and Satish Gopal, University of North Carolina at Chapel Hill, Chapel Hill, NC; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, Coxcilly Kampani, Fred Chimzimu, Bal Mukunda, Tamiwe Tomoka, Maurice Mulenga, Richard Nyasosela, and Satish Gopal, University of North Carolina Project-Malawi; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, and Satish Gopal, Kamuzu Central Hospital Cancer Registry; Satish Gopal, Malawi Cancer Consortium & Regional Center of Research Excellence for Non-Communicable Diseases, Lilongwe; Steady Chasimpha and Charles Dzamalala, Malawi Cancer Registry; and Charles Dzamalala and Satish Gopal, University of Malawi College of Medicine, Blantyre, Malawi
| | - Fred Chimzimu
- Marie-Josèphe Horner and Satish Gopal, University of North Carolina at Chapel Hill, Chapel Hill, NC; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, Coxcilly Kampani, Fred Chimzimu, Bal Mukunda, Tamiwe Tomoka, Maurice Mulenga, Richard Nyasosela, and Satish Gopal, University of North Carolina Project-Malawi; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, and Satish Gopal, Kamuzu Central Hospital Cancer Registry; Satish Gopal, Malawi Cancer Consortium & Regional Center of Research Excellence for Non-Communicable Diseases, Lilongwe; Steady Chasimpha and Charles Dzamalala, Malawi Cancer Registry; and Charles Dzamalala and Satish Gopal, University of Malawi College of Medicine, Blantyre, Malawi
| | - Bal Mukunda
- Marie-Josèphe Horner and Satish Gopal, University of North Carolina at Chapel Hill, Chapel Hill, NC; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, Coxcilly Kampani, Fred Chimzimu, Bal Mukunda, Tamiwe Tomoka, Maurice Mulenga, Richard Nyasosela, and Satish Gopal, University of North Carolina Project-Malawi; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, and Satish Gopal, Kamuzu Central Hospital Cancer Registry; Satish Gopal, Malawi Cancer Consortium & Regional Center of Research Excellence for Non-Communicable Diseases, Lilongwe; Steady Chasimpha and Charles Dzamalala, Malawi Cancer Registry; and Charles Dzamalala and Satish Gopal, University of Malawi College of Medicine, Blantyre, Malawi
| | - Tamiwe Tomoka
- Marie-Josèphe Horner and Satish Gopal, University of North Carolina at Chapel Hill, Chapel Hill, NC; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, Coxcilly Kampani, Fred Chimzimu, Bal Mukunda, Tamiwe Tomoka, Maurice Mulenga, Richard Nyasosela, and Satish Gopal, University of North Carolina Project-Malawi; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, and Satish Gopal, Kamuzu Central Hospital Cancer Registry; Satish Gopal, Malawi Cancer Consortium & Regional Center of Research Excellence for Non-Communicable Diseases, Lilongwe; Steady Chasimpha and Charles Dzamalala, Malawi Cancer Registry; and Charles Dzamalala and Satish Gopal, University of Malawi College of Medicine, Blantyre, Malawi
| | - Maurice Mulenga
- Marie-Josèphe Horner and Satish Gopal, University of North Carolina at Chapel Hill, Chapel Hill, NC; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, Coxcilly Kampani, Fred Chimzimu, Bal Mukunda, Tamiwe Tomoka, Maurice Mulenga, Richard Nyasosela, and Satish Gopal, University of North Carolina Project-Malawi; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, and Satish Gopal, Kamuzu Central Hospital Cancer Registry; Satish Gopal, Malawi Cancer Consortium & Regional Center of Research Excellence for Non-Communicable Diseases, Lilongwe; Steady Chasimpha and Charles Dzamalala, Malawi Cancer Registry; and Charles Dzamalala and Satish Gopal, University of Malawi College of Medicine, Blantyre, Malawi
| | - Richard Nyasosela
- Marie-Josèphe Horner and Satish Gopal, University of North Carolina at Chapel Hill, Chapel Hill, NC; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, Coxcilly Kampani, Fred Chimzimu, Bal Mukunda, Tamiwe Tomoka, Maurice Mulenga, Richard Nyasosela, and Satish Gopal, University of North Carolina Project-Malawi; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, and Satish Gopal, Kamuzu Central Hospital Cancer Registry; Satish Gopal, Malawi Cancer Consortium & Regional Center of Research Excellence for Non-Communicable Diseases, Lilongwe; Steady Chasimpha and Charles Dzamalala, Malawi Cancer Registry; and Charles Dzamalala and Satish Gopal, University of Malawi College of Medicine, Blantyre, Malawi
| | - Steady Chasimpha
- Marie-Josèphe Horner and Satish Gopal, University of North Carolina at Chapel Hill, Chapel Hill, NC; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, Coxcilly Kampani, Fred Chimzimu, Bal Mukunda, Tamiwe Tomoka, Maurice Mulenga, Richard Nyasosela, and Satish Gopal, University of North Carolina Project-Malawi; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, and Satish Gopal, Kamuzu Central Hospital Cancer Registry; Satish Gopal, Malawi Cancer Consortium & Regional Center of Research Excellence for Non-Communicable Diseases, Lilongwe; Steady Chasimpha and Charles Dzamalala, Malawi Cancer Registry; and Charles Dzamalala and Satish Gopal, University of Malawi College of Medicine, Blantyre, Malawi
| | - Charles Dzamalala
- Marie-Josèphe Horner and Satish Gopal, University of North Carolina at Chapel Hill, Chapel Hill, NC; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, Coxcilly Kampani, Fred Chimzimu, Bal Mukunda, Tamiwe Tomoka, Maurice Mulenga, Richard Nyasosela, and Satish Gopal, University of North Carolina Project-Malawi; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, and Satish Gopal, Kamuzu Central Hospital Cancer Registry; Satish Gopal, Malawi Cancer Consortium & Regional Center of Research Excellence for Non-Communicable Diseases, Lilongwe; Steady Chasimpha and Charles Dzamalala, Malawi Cancer Registry; and Charles Dzamalala and Satish Gopal, University of Malawi College of Medicine, Blantyre, Malawi
| | - Satish Gopal
- Marie-Josèphe Horner and Satish Gopal, University of North Carolina at Chapel Hill, Chapel Hill, NC; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, Coxcilly Kampani, Fred Chimzimu, Bal Mukunda, Tamiwe Tomoka, Maurice Mulenga, Richard Nyasosela, and Satish Gopal, University of North Carolina Project-Malawi; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, and Satish Gopal, Kamuzu Central Hospital Cancer Registry; Satish Gopal, Malawi Cancer Consortium & Regional Center of Research Excellence for Non-Communicable Diseases, Lilongwe; Steady Chasimpha and Charles Dzamalala, Malawi Cancer Registry; and Charles Dzamalala and Satish Gopal, University of Malawi College of Medicine, Blantyre, Malawi
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Affiliation(s)
- Violet Kayamba
- Tropical Gastroenterology & Nutrition Group, Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia.
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Asombang AW, Chishinga N, Nkhoma A, Chipaila J, Nsokolo B, Manda-Mapalo M, Montiero JFG, Banda L, Dua KS. Systematic review and meta-analysis of esophageal cancer in Africa: Epidemiology, risk factors, management and outcomes. World J Gastroenterol 2019; 25:4512-4533. [PMID: 31496629 PMCID: PMC6710188 DOI: 10.3748/wjg.v25.i31.4512] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 07/05/2019] [Accepted: 07/19/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Esophageal cancer (EC) is associated with a poor prognosis, particularly so in Africa where an alarmingly high mortality to incidence ratio prevails for this disease. AIM To provide further understanding of EC in the context of the unique cultural and genetic diversity, and socio-economic challenges faced on the African continent. METHODS We performed a systematic review of studies from Africa to obtain data on epidemiology, risk factors, management and outcomes of EC. A non-systematic review was used to obtain incidence data from the International Agency for Research on Cancer, and the Cancer in Sub-Saharan reports. We searched EMBASE, PubMed, Web of Science, and Cochrane Central from inception to March 2019 and reviewed the list of articles retrieved. Random effects meta-analyses were used to assess heterogeneity between studies and to obtain odds ratio (OR) of the associations between EC and risk factors; and incidence rate ratios for EC between sexes with their respective 95% confidence intervals (CI). RESULTS The incidence of EC is higher in males than females, except in North Africa where it is similar for both sexes. The highest age-standardized rate is from Malawi (30.3 and 19.4 cases/year/100000 population for males and females, respectively) followed by Kenya (28.7 cases/year/100000 population for both sexes). The incidence of EC rises sharply after the age of 40 years and reaches a peak at 75 years old. Meta-analysis shows a strong association with tobacco (OR 3.15, 95%CI: 2.83-3.50). There was significant heterogeneity between studies on alcohol consumption (OR 2.28, 95%CI: 1.94-2.65) and on low socioeconomic status (OR 139, 95%CI: 1.25-1.54) as risk factors, but these could also contribute to increasing the incidence of EC. The best treatment outcomes were with esophagectomy with survival rates of 76.6% at 3 years, and chemo-radiotherapy with an overall combined survival time of 267.50 d. CONCLUSION Africa has high incidence and mortality rates of EC, with preventable and non-modifiable risk factors. Men in this setting are at increased risk due to their higher prevalence of tobacco and alcohol consumption. Management requires a multidisciplinary approach, and survival is significantly improved in the setting of esophagectomy and chemoradiation therapy.
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Affiliation(s)
- Akwi W Asombang
- Division of Gastroenterology/Hepatology, Warren Alpert Medical School of Brown University, Providence, RI 02903, United States
| | - Nathaniel Chishinga
- Department for HIV Elimination, Fulton County Government, Atlanta, GA 30303, United States
| | - Alick Nkhoma
- Department of Gastroenterology, Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Staffordshire ST4 6QG, United Kingdom
| | - Jackson Chipaila
- Department of Surgery, University Teaching Hospital-Adult Hospital, Lusaka 10101, Zambia
| | - Bright Nsokolo
- Department of Medicine, Levy Mwanawasa University Teaching Hospital, Tropical Gastroenterology and Nutrition Group (TROPGAN), Lusaka 10101, Zambia
| | - Martha Manda-Mapalo
- Department of Medicine, The University of New Mexico, Albuquerque, NM 87106, United States
| | | | - Lewis Banda
- Hematology/Oncology, Cancer Disease Hospital, Lusaka 10101, Zambia
| | - Kulwinder S Dua
- Department of Medicine and Pediatrics, Medical College of Wisconsin, Milwaukee, WI 53226, United States
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Come J, Cambaza E, Ferreira R, da Costa JMC, Carrilho C, Santos LL. Esophageal cancer in Mozambique: should mycotoxins be a concern? Pan Afr Med J 2019; 33:187. [PMID: 31565147 PMCID: PMC6756822 DOI: 10.11604/pamj.2019.33.187.18295] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 05/04/2019] [Indexed: 01/01/2023] Open
Abstract
Fumonisin B1 (FB1) is a mycotoxin frequently found in agricultural commodities. The toxin poses a considerable risk for human and animal health. FB1 is among several mycotoxins produced by Fusarium spp. contaminating virtually any cereal and other Poaceae. Their intracellular action includes the promotion of oxidative stress through the generation of reactive oxygen species (ROS) that damage biomolecules such as DNA. These toxic effects were observed in vivo and in vitro. However, the association between esophageal lesions and oxidative stress induced by FB1. Studies in China, Iran and South Africa showed higher exposure to fumonisins in areas with higher risk of esophageal cancer (EC). Exposure to mycotoxins may be inevitable in Mozambique. How mycotoxins, particularly fumonisins from the contaminated food, can be associated with the emergence of EC in Mozambique? Herein, we revise the literature and present some pieces of evidence in order to highlight the burden of mycotoxins and to provide evidence-based considerations for the stakeholders involved in the management of the EC agenda in Mozambique. The information presented herein supports the need to implement novel and/or to revisit the existent detoxification methods to reduce the global burden of mycotoxins and its outcomes in health management.
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Affiliation(s)
- Jotamo Come
- Department of Surgery, Maputo Central Hospital, Maputo, Mozambique
| | - Edgar Cambaza
- Department of Biological Sciences, Faculty of Sciences, Eduardo Mondlane University, Maputo, Mozambique
| | - Rita Ferreira
- QOPNA-Química Orgânica, Produtos Naturais e Agroalimentares, Departamento de Química, Aveiro University, Aveiro, Portugal
| | - José Manuel Correia da Costa
- Center for the Study of Animal Science, ICETA, University of Porto and INSA-National Health Institute Dr. Ricardo Jorge, Porto, Portugal
| | - Carla Carrilho
- Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo Central Hospital, Maputo, Mozambique
| | - Lúcio Lara Santos
- Experimental Pathology and Therapeutics Research Group, Surgical Oncology Department, Portuguese Oncology Institute, Porto, Portugal
- ONCOCIR, Education and Care in Oncology, Lusophone Africa
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Pilleron S, Soerjomataram I, Charvat H, Chokunonga E, Somdyala NIM, Wabinga H, Korir A, Bray F, Jemal A, Maxwell Parkin D. Cancer incidence in older adults in selected regions of sub-Saharan Africa, 2008-2012. Int J Cancer 2019; 144:1824-1833. [PMID: 30238972 DOI: 10.1002/ijc.31880] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 08/03/2018] [Accepted: 08/06/2018] [Indexed: 12/15/2022]
Abstract
Although the countries of Sub-Sharan Africa represent among the most rapidly growing and aging populations worldwide, no previous studies have examined the cancer patterns in older adults in the region as a means to inform cancer policies. Using data from Cancer Incidence in Five Continents, we describe recent patterns and trends in incidence rates for the major cancer sites in adults aged ≥60 years and in people aged 0-59 for comparison in four selected population-based cancer registries in Kenya (Nairobi), the Republic of South Africa (Eastern Cape Province), Uganda (Kyadondo country), and Zimbabwe (Harare blacks). Over the period 2008-2012, almost 9,000 new cancer cases were registered in older adults in the four populations, representing one-third of all cancer cases. Prostate and esophageal cancers were the leading cancer sites in older males, while breast, cervical and esophageal cancers were the most common among older females. Among younger people, Kaposi sarcoma and non-Hodgkin lymphoma were common. Over the past 20 years, incidence rates among older adults have increased in both sexes in Uganda and Zimbabwe while rates have stabilized among the younger age group. Among older adults, the largest rate increase was observed for breast cancer (estimated annual percentage change: 5% in each country) in females and for prostate cancer (6-7%) in males. Due to the specific needs of older adults, tailored considerations should be given to geriatric oncology when developing, funding and implementing national and regional cancer programmes.
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Affiliation(s)
- Sophie Pilleron
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Isabelle Soerjomataram
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Hadrien Charvat
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | | | - Nontuthuzelo I M Somdyala
- South African Medical Research Council, Burden of Disease Research Unit; Eastern Cape Cancer Registry, Tygerberg, South Africa
| | - Henry Wabinga
- Department of Pathology Kampala Cancer Registry, Makerere University, Kampala, Uganda
| | - Anne Korir
- Nairobi Cancer Registry, Kenya Medical Research Institute, Nairobi, Kenya
| | - Freddie Bray
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Ahmedin Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - D Maxwell Parkin
- Nuffield Department of Public Health, University of Oxford, Oxford, United Kingdom
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Mwachiro MM, Parker RK, Pritchett NR, Lando JO, Ranketi S, Murphy G, Chepkwony R, Burgert SL, Abnet CC, Topazian MD, Dawsey SM, White RE. Investigating tea temperature and content as risk factors for esophageal cancer in an endemic region of Western Kenya: Validation of a questionnaire and analysis of polycyclic aromatic hydrocarbon content. Cancer Epidemiol 2019; 60:60-6. [PMID: 30925281 DOI: 10.1016/j.canep.2019.03.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/15/2019] [Accepted: 03/18/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Esophageal squamous cell carcinoma (ESCC) is common in certain areas worldwide. One area, western Kenya, has a high risk of ESCC, including many young cases (<30 years old), but has limited prior study of potential risk factors. Thermal injury from hot food and beverages and exposure to polycyclic aromatic hydrocarbons (PAHs) have been proposed as important risk factors for ESCC in other settings. The beverage of choice in western Kenya is milky tea (chai). METHODS Healthy individuals >18 years of age who were accompanying relatives to an endoscopy unit were recruited to participate. The preferred initial temperature of chai consumption in these adults was measured by questionnaire and digital thermometer. Comparisons of these results were assessed by kappa statistics. Concentrations of 26 selected PAHs were determined by gas chromatography/mass spectrometry in samples of 11 brands of commercial tea leaves commonly consumed in Kenya. RESULTS Kappa values demonstrated moderate agreement between questionnaire responses and measured temperatures. The mean preferred chai temperatures were 72.1 °C overall, 72.6 °C in men (n = 78), and 70.2 °C in women (n = 22; p < 0.05). Chai temperature did not significantly differ by age or ethnic group. The PAH levels in the commercial Kenyan tea leaves were uniformly low (total PAH < 300 ng/g of leaves). CONCLUSIONS Study participants drink chai at higher temperatures than previously reported in other high-risk ESCC regions. Chai is not, however, a source of significant PAH exposure. Very hot chai consumption should be further evaluated as a risk factor for ESCC in Kenya with the proposed questionnaire.
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Come J, Castro C, Morais A, Cossa M, Modcoicar P, Tulsidâs S, Cunha L, Lobo V, Morais AG, Cotton S, Lunet N, Carrilho C, Santos LL. Clinical and Pathologic Profiles of Esophageal Cancer in Mozambique: A Study of Consecutive Patients Admitted to Maputo Central Hospital. J Glob Oncol 2018; 4:1-9. [PMID: 30398947 PMCID: PMC7010456 DOI: 10.1200/jgo.18.00147] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Eastern Africa was recently described as a high-incidence geographic area for esophageal cancer. Mozambique is included in this region. This study aimed to characterize this malignant disease at Maputo Central Hospital (MCH) to develop a global program for esophageal cancer management in Mozambique. METHODS MCH records from between 2012 and 2016 were used to assess the clinical, pathologic, and outcome profiles of esophageal tumors. A descriptive analysis of data collected was performed. Overall survival was evaluated using Kaplan-Meier curves. RESULTS In the study, 522 consecutive patient cases of esophageal cancer were recorded. The median patient age was 56.1 years (range, 27 to 97 years); 291 (55.7%) patients were women, and 230 (44.1%) were men. Regarding tumor site, 113 patients (21.6%) had a tumor in the lower third, 154 (29.5%) in the middle, and 50 (9.6%) in the upper third of the esophagus; in the remaining 196 (37.5%), tumor site was unknown. Squamous cell carcinoma comprised 94.4% of cases with documented histopathology (74.9% of the sample). Surgical treatment was possible in 32 patients (6.1%). Disease stage was documented only in these 32 surgical patients; 28.1%, 53.1%, and 18.8% had stage I, II, and III disease, respectively. The remaining patient cases seemed to involve clinically advanced tumors. The median follow-up time was of 1.6 months. The median survival time was of 3.5 months for all patients; for patients treated with curative intent, it was of 8.7 months. CONCLUSION Esophageal carcinoma is a common malignant tumor at MCH and is diagnosed in the advanced stages resulting in poor prognosis. Therefore, implementation of an Esophageal Cancer Program in Mozambique is essential.
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Affiliation(s)
- Jotamo Come
- Jotamo Come, Atílio Morais, Matchecane Cossa, Prassad Modcoicar, Satish Tulsidás, Lina Cunha, Vitória Lobo, Alberto Gudo Morais, and Carla Carrilho, Hospital Central de Maputo; Carla Carrilho, Universidade Eduardo Mondlane, Maputo, Moçambique; Clara Castro, Sofia Cotton, and Lúcio Lara Santos, Instituto Português de Oncologia; Clara Castro and Nuno Lunet, Universidade do Porto; Sofia Cotton, Project ESTIMA-01-0145-FEDER-000027; Sofia Cotton and Lúcio Lara Santos, Grupo de Patologia e Terapêutica Experimental; Lúcio Lara Santos Universidade Fernando Pessoa, Porto, Portugal
| | - Clara Castro
- Jotamo Come, Atílio Morais, Matchecane Cossa, Prassad Modcoicar, Satish Tulsidás, Lina Cunha, Vitória Lobo, Alberto Gudo Morais, and Carla Carrilho, Hospital Central de Maputo; Carla Carrilho, Universidade Eduardo Mondlane, Maputo, Moçambique; Clara Castro, Sofia Cotton, and Lúcio Lara Santos, Instituto Português de Oncologia; Clara Castro and Nuno Lunet, Universidade do Porto; Sofia Cotton, Project ESTIMA-01-0145-FEDER-000027; Sofia Cotton and Lúcio Lara Santos, Grupo de Patologia e Terapêutica Experimental; Lúcio Lara Santos Universidade Fernando Pessoa, Porto, Portugal
| | - Atílio Morais
- Jotamo Come, Atílio Morais, Matchecane Cossa, Prassad Modcoicar, Satish Tulsidás, Lina Cunha, Vitória Lobo, Alberto Gudo Morais, and Carla Carrilho, Hospital Central de Maputo; Carla Carrilho, Universidade Eduardo Mondlane, Maputo, Moçambique; Clara Castro, Sofia Cotton, and Lúcio Lara Santos, Instituto Português de Oncologia; Clara Castro and Nuno Lunet, Universidade do Porto; Sofia Cotton, Project ESTIMA-01-0145-FEDER-000027; Sofia Cotton and Lúcio Lara Santos, Grupo de Patologia e Terapêutica Experimental; Lúcio Lara Santos Universidade Fernando Pessoa, Porto, Portugal
| | - Matchecane Cossa
- Jotamo Come, Atílio Morais, Matchecane Cossa, Prassad Modcoicar, Satish Tulsidás, Lina Cunha, Vitória Lobo, Alberto Gudo Morais, and Carla Carrilho, Hospital Central de Maputo; Carla Carrilho, Universidade Eduardo Mondlane, Maputo, Moçambique; Clara Castro, Sofia Cotton, and Lúcio Lara Santos, Instituto Português de Oncologia; Clara Castro and Nuno Lunet, Universidade do Porto; Sofia Cotton, Project ESTIMA-01-0145-FEDER-000027; Sofia Cotton and Lúcio Lara Santos, Grupo de Patologia e Terapêutica Experimental; Lúcio Lara Santos Universidade Fernando Pessoa, Porto, Portugal
| | - Prassad Modcoicar
- Jotamo Come, Atílio Morais, Matchecane Cossa, Prassad Modcoicar, Satish Tulsidás, Lina Cunha, Vitória Lobo, Alberto Gudo Morais, and Carla Carrilho, Hospital Central de Maputo; Carla Carrilho, Universidade Eduardo Mondlane, Maputo, Moçambique; Clara Castro, Sofia Cotton, and Lúcio Lara Santos, Instituto Português de Oncologia; Clara Castro and Nuno Lunet, Universidade do Porto; Sofia Cotton, Project ESTIMA-01-0145-FEDER-000027; Sofia Cotton and Lúcio Lara Santos, Grupo de Patologia e Terapêutica Experimental; Lúcio Lara Santos Universidade Fernando Pessoa, Porto, Portugal
| | - Satish Tulsidâs
- Jotamo Come, Atílio Morais, Matchecane Cossa, Prassad Modcoicar, Satish Tulsidás, Lina Cunha, Vitória Lobo, Alberto Gudo Morais, and Carla Carrilho, Hospital Central de Maputo; Carla Carrilho, Universidade Eduardo Mondlane, Maputo, Moçambique; Clara Castro, Sofia Cotton, and Lúcio Lara Santos, Instituto Português de Oncologia; Clara Castro and Nuno Lunet, Universidade do Porto; Sofia Cotton, Project ESTIMA-01-0145-FEDER-000027; Sofia Cotton and Lúcio Lara Santos, Grupo de Patologia e Terapêutica Experimental; Lúcio Lara Santos Universidade Fernando Pessoa, Porto, Portugal
| | - Lina Cunha
- Jotamo Come, Atílio Morais, Matchecane Cossa, Prassad Modcoicar, Satish Tulsidás, Lina Cunha, Vitória Lobo, Alberto Gudo Morais, and Carla Carrilho, Hospital Central de Maputo; Carla Carrilho, Universidade Eduardo Mondlane, Maputo, Moçambique; Clara Castro, Sofia Cotton, and Lúcio Lara Santos, Instituto Português de Oncologia; Clara Castro and Nuno Lunet, Universidade do Porto; Sofia Cotton, Project ESTIMA-01-0145-FEDER-000027; Sofia Cotton and Lúcio Lara Santos, Grupo de Patologia e Terapêutica Experimental; Lúcio Lara Santos Universidade Fernando Pessoa, Porto, Portugal
| | - Vitória Lobo
- Jotamo Come, Atílio Morais, Matchecane Cossa, Prassad Modcoicar, Satish Tulsidás, Lina Cunha, Vitória Lobo, Alberto Gudo Morais, and Carla Carrilho, Hospital Central de Maputo; Carla Carrilho, Universidade Eduardo Mondlane, Maputo, Moçambique; Clara Castro, Sofia Cotton, and Lúcio Lara Santos, Instituto Português de Oncologia; Clara Castro and Nuno Lunet, Universidade do Porto; Sofia Cotton, Project ESTIMA-01-0145-FEDER-000027; Sofia Cotton and Lúcio Lara Santos, Grupo de Patologia e Terapêutica Experimental; Lúcio Lara Santos Universidade Fernando Pessoa, Porto, Portugal
| | - Alberto Gudo Morais
- Jotamo Come, Atílio Morais, Matchecane Cossa, Prassad Modcoicar, Satish Tulsidás, Lina Cunha, Vitória Lobo, Alberto Gudo Morais, and Carla Carrilho, Hospital Central de Maputo; Carla Carrilho, Universidade Eduardo Mondlane, Maputo, Moçambique; Clara Castro, Sofia Cotton, and Lúcio Lara Santos, Instituto Português de Oncologia; Clara Castro and Nuno Lunet, Universidade do Porto; Sofia Cotton, Project ESTIMA-01-0145-FEDER-000027; Sofia Cotton and Lúcio Lara Santos, Grupo de Patologia e Terapêutica Experimental; Lúcio Lara Santos Universidade Fernando Pessoa, Porto, Portugal
| | - Sofia Cotton
- Jotamo Come, Atílio Morais, Matchecane Cossa, Prassad Modcoicar, Satish Tulsidás, Lina Cunha, Vitória Lobo, Alberto Gudo Morais, and Carla Carrilho, Hospital Central de Maputo; Carla Carrilho, Universidade Eduardo Mondlane, Maputo, Moçambique; Clara Castro, Sofia Cotton, and Lúcio Lara Santos, Instituto Português de Oncologia; Clara Castro and Nuno Lunet, Universidade do Porto; Sofia Cotton, Project ESTIMA-01-0145-FEDER-000027; Sofia Cotton and Lúcio Lara Santos, Grupo de Patologia e Terapêutica Experimental; Lúcio Lara Santos Universidade Fernando Pessoa, Porto, Portugal
| | - Nuno Lunet
- Jotamo Come, Atílio Morais, Matchecane Cossa, Prassad Modcoicar, Satish Tulsidás, Lina Cunha, Vitória Lobo, Alberto Gudo Morais, and Carla Carrilho, Hospital Central de Maputo; Carla Carrilho, Universidade Eduardo Mondlane, Maputo, Moçambique; Clara Castro, Sofia Cotton, and Lúcio Lara Santos, Instituto Português de Oncologia; Clara Castro and Nuno Lunet, Universidade do Porto; Sofia Cotton, Project ESTIMA-01-0145-FEDER-000027; Sofia Cotton and Lúcio Lara Santos, Grupo de Patologia e Terapêutica Experimental; Lúcio Lara Santos Universidade Fernando Pessoa, Porto, Portugal
| | - Carla Carrilho
- Jotamo Come, Atílio Morais, Matchecane Cossa, Prassad Modcoicar, Satish Tulsidás, Lina Cunha, Vitória Lobo, Alberto Gudo Morais, and Carla Carrilho, Hospital Central de Maputo; Carla Carrilho, Universidade Eduardo Mondlane, Maputo, Moçambique; Clara Castro, Sofia Cotton, and Lúcio Lara Santos, Instituto Português de Oncologia; Clara Castro and Nuno Lunet, Universidade do Porto; Sofia Cotton, Project ESTIMA-01-0145-FEDER-000027; Sofia Cotton and Lúcio Lara Santos, Grupo de Patologia e Terapêutica Experimental; Lúcio Lara Santos Universidade Fernando Pessoa, Porto, Portugal
| | - Lúcio Lara Santos
- Jotamo Come, Atílio Morais, Matchecane Cossa, Prassad Modcoicar, Satish Tulsidás, Lina Cunha, Vitória Lobo, Alberto Gudo Morais, and Carla Carrilho, Hospital Central de Maputo; Carla Carrilho, Universidade Eduardo Mondlane, Maputo, Moçambique; Clara Castro, Sofia Cotton, and Lúcio Lara Santos, Instituto Português de Oncologia; Clara Castro and Nuno Lunet, Universidade do Porto; Sofia Cotton, Project ESTIMA-01-0145-FEDER-000027; Sofia Cotton and Lúcio Lara Santos, Grupo de Patologia e Terapêutica Experimental; Lúcio Lara Santos Universidade Fernando Pessoa, Porto, Portugal
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Chetwood JD, Finch PJ, Kankwatira A, Mallewa J, Gordon MA, Masamba L. Five-year single-centre experience of carcinoma of the oesophagus from Blantyre, Malawi. BMJ Open Gastroenterol 2018; 5:e000232. [PMID: 30397505 PMCID: PMC6203015 DOI: 10.1136/bmjgast-2018-000232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 08/20/2018] [Accepted: 09/02/2018] [Indexed: 01/12/2023] Open
Abstract
Background Oesophageal squamous cell carcinoma (OSCC) is increasing worldwide and has an exceptionally high prevalence in certain distinct geographical locations such as the African oesophageal SCC corridor. Despite this, there is a paucity of evidence to characterise the disease particularly in the Malawian context. Method We retrospectively audited our endoscopy database over 5 years, including for patient demographics, endoscopy findings, therapeutic intervention and recommendations for treatment. Results 1586 patients with oesophageal cancer were identified from a total of 5882 endoscopy records from 2013 to 2017. Our cohort showed a larger proportion of oesophageal cancers found higher in the oesophagus compared with other African studies and a female preponderance in this upper-oesophagus disease subset though a male preponderance overall. 39% of patients with oesophageal cancer underwent bougie dilatation and 11% underwent palliative stent placement, which likely reflects local availability of resources. Conclusion This study validates the observation that OSCC predominates in sub-Saharan Africa in Malawi over other forms of oesophageal carcinoma, though our cohort appears to have subtly distinct demographics and disease-specific data. This highlights the need to prioritise preventative and therapeutic strategies for OSCC in this and similar settings.
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Affiliation(s)
- John David Chetwood
- Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Peter J Finch
- Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Anstead Kankwatira
- Malawi-Liverpool-Wellcome Trust Major Overseas Programme, Blantyre, Malawi
| | - Jane Mallewa
- Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Melita A Gordon
- Malawi-Liverpool-Wellcome Trust Major Overseas Programme, Blantyre, Malawi.,Institute of Infection and Global Health, University of Liverpool, Liverpool, UK.,World Gastroenterology Organisation International Training Centre, Blantyre, Malawi
| | - Leo Masamba
- Department of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
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Van Loon K, Mwachiro MM, Abnet CC, Akoko L, Assefa M, Burgert SL, Chasimpha S, Dzamalala C, Fleischer DE, Gopal S, Iyer PG, Kaimila B, Kayamba V, Kelly P, Leon ME, Mathew CG, Menya D, Middleton D, Mlombe Y, Mmbaga BT, Mmbaga E, Mulima G, Murphy G, Mushi B, Mwanga A, Mwasamwaja A, Parker MI, Pritchett N, Schüz J, Topazian MD, White RE, McCormack V, Dawsey SM. The African Esophageal Cancer Consortium: A Call to Action. J Glob Oncol 2018; 4:1-9. [PMID: 30241229 PMCID: PMC6223465 DOI: 10.1200/jgo.17.00163] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Esophageal cancer is the eighth most common cancer worldwide and the sixth most common cause of cancer-related death; however, worldwide incidence and mortality rates do not reflect the geographic variations in the occurrence of this disease. In recent years, increased attention has been focused on the high incidence of esophageal squamous cell carcinoma (ESCC) throughout the eastern corridor of Africa, extending from Ethiopia to South Africa. Nascent investigations are underway at a number of sites throughout the region in an effort to improve our understanding of the etiology behind the high incidence of ESCC in this region. In 2017, these sites established the African Esophageal Cancer Consortium. Here, we summarize the priorities of this newly established consortium: to implement coordinated multisite investigations into etiology and identify targets for primary prevention; to address the impact of the clinical burden of ESCC via capacity building and shared resources in treatment and palliative care; and to heighten awareness of ESCC among physicians, at-risk populations, policy makers, and funding agencies.
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Affiliation(s)
- Katherine Van Loon
- Katherine Van Loon, University of California, San Francisco, San Francisco, CA; Michael M. Mwachiro, Stephen L. Burgert, and Russell E. White, Tenwek Hospital, Bomet; Diana Menya, Moi University, Eldoret, Kenya; Christian C. Abnet, Gwen Murphy, Natalie Pritchett, and Sanford M. Dawsey, National Cancer Institute, Bethesda, MD; Larry Akoko, Elia Mmbaga, Beatrice Mushi, and Ally Mwanga, Muhimbili University of Health and Allied Sciences, Dar es Salaam; Blandina T. Mmbaga and Amos Mwasamwaja, Kilimanjaro Clinical Research Institute, Moshi, Tanzania; Mathewos Assefa, Addis Ababa University, Addis Ababa, Ethiopia; Steady Chasimpha and Charles Dzamalala, Queen Elizabeth Central Hospital; Charles Dzamalala, Satish Gopal, Bongani Kaimila, and Yohannie Mlombe, University of Malawi College of Medicine, Blantyre; Gift Mulima, Kamuzu Central Hospital, Lilongwe, Malawi; David E. Fleischer, Mayo Clinic, Phoenix, AZ; Satish Gopal, University of North Carolina, Chapel Hill, NC; Prasad G. Iyer and Mark D. Topazian, Mayo Clinic, Rochester, MN; Violet Kayamba and Paul Kelly, University of Zambia, Lusaka, Zambia; Paul Kelly, Queen Mary University of London; Christopher G. Mathew, King’s College London, London, United Kingdom; Maria E. Leon, Daniel Middleton, Joachim Schüz, and Valerie McCormack, International Agency for Research on Cancer, Lyon, France; Christopher G. Mathew, University of the Witwatersrand, Johannesburg; and M. Iqbal Parker, University of Cape Town, Cape Town, South Africa
| | - Michael M. Mwachiro
- Katherine Van Loon, University of California, San Francisco, San Francisco, CA; Michael M. Mwachiro, Stephen L. Burgert, and Russell E. White, Tenwek Hospital, Bomet; Diana Menya, Moi University, Eldoret, Kenya; Christian C. Abnet, Gwen Murphy, Natalie Pritchett, and Sanford M. Dawsey, National Cancer Institute, Bethesda, MD; Larry Akoko, Elia Mmbaga, Beatrice Mushi, and Ally Mwanga, Muhimbili University of Health and Allied Sciences, Dar es Salaam; Blandina T. Mmbaga and Amos Mwasamwaja, Kilimanjaro Clinical Research Institute, Moshi, Tanzania; Mathewos Assefa, Addis Ababa University, Addis Ababa, Ethiopia; Steady Chasimpha and Charles Dzamalala, Queen Elizabeth Central Hospital; Charles Dzamalala, Satish Gopal, Bongani Kaimila, and Yohannie Mlombe, University of Malawi College of Medicine, Blantyre; Gift Mulima, Kamuzu Central Hospital, Lilongwe, Malawi; David E. Fleischer, Mayo Clinic, Phoenix, AZ; Satish Gopal, University of North Carolina, Chapel Hill, NC; Prasad G. Iyer and Mark D. Topazian, Mayo Clinic, Rochester, MN; Violet Kayamba and Paul Kelly, University of Zambia, Lusaka, Zambia; Paul Kelly, Queen Mary University of London; Christopher G. Mathew, King’s College London, London, United Kingdom; Maria E. Leon, Daniel Middleton, Joachim Schüz, and Valerie McCormack, International Agency for Research on Cancer, Lyon, France; Christopher G. Mathew, University of the Witwatersrand, Johannesburg; and M. Iqbal Parker, University of Cape Town, Cape Town, South Africa
| | - Christian C. Abnet
- Katherine Van Loon, University of California, San Francisco, San Francisco, CA; Michael M. Mwachiro, Stephen L. Burgert, and Russell E. White, Tenwek Hospital, Bomet; Diana Menya, Moi University, Eldoret, Kenya; Christian C. Abnet, Gwen Murphy, Natalie Pritchett, and Sanford M. Dawsey, National Cancer Institute, Bethesda, MD; Larry Akoko, Elia Mmbaga, Beatrice Mushi, and Ally Mwanga, Muhimbili University of Health and Allied Sciences, Dar es Salaam; Blandina T. Mmbaga and Amos Mwasamwaja, Kilimanjaro Clinical Research Institute, Moshi, Tanzania; Mathewos Assefa, Addis Ababa University, Addis Ababa, Ethiopia; Steady Chasimpha and Charles Dzamalala, Queen Elizabeth Central Hospital; Charles Dzamalala, Satish Gopal, Bongani Kaimila, and Yohannie Mlombe, University of Malawi College of Medicine, Blantyre; Gift Mulima, Kamuzu Central Hospital, Lilongwe, Malawi; David E. Fleischer, Mayo Clinic, Phoenix, AZ; Satish Gopal, University of North Carolina, Chapel Hill, NC; Prasad G. Iyer and Mark D. Topazian, Mayo Clinic, Rochester, MN; Violet Kayamba and Paul Kelly, University of Zambia, Lusaka, Zambia; Paul Kelly, Queen Mary University of London; Christopher G. Mathew, King’s College London, London, United Kingdom; Maria E. Leon, Daniel Middleton, Joachim Schüz, and Valerie McCormack, International Agency for Research on Cancer, Lyon, France; Christopher G. Mathew, University of the Witwatersrand, Johannesburg; and M. Iqbal Parker, University of Cape Town, Cape Town, South Africa
| | - Larry Akoko
- Katherine Van Loon, University of California, San Francisco, San Francisco, CA; Michael M. Mwachiro, Stephen L. Burgert, and Russell E. White, Tenwek Hospital, Bomet; Diana Menya, Moi University, Eldoret, Kenya; Christian C. Abnet, Gwen Murphy, Natalie Pritchett, and Sanford M. Dawsey, National Cancer Institute, Bethesda, MD; Larry Akoko, Elia Mmbaga, Beatrice Mushi, and Ally Mwanga, Muhimbili University of Health and Allied Sciences, Dar es Salaam; Blandina T. Mmbaga and Amos Mwasamwaja, Kilimanjaro Clinical Research Institute, Moshi, Tanzania; Mathewos Assefa, Addis Ababa University, Addis Ababa, Ethiopia; Steady Chasimpha and Charles Dzamalala, Queen Elizabeth Central Hospital; Charles Dzamalala, Satish Gopal, Bongani Kaimila, and Yohannie Mlombe, University of Malawi College of Medicine, Blantyre; Gift Mulima, Kamuzu Central Hospital, Lilongwe, Malawi; David E. Fleischer, Mayo Clinic, Phoenix, AZ; Satish Gopal, University of North Carolina, Chapel Hill, NC; Prasad G. Iyer and Mark D. Topazian, Mayo Clinic, Rochester, MN; Violet Kayamba and Paul Kelly, University of Zambia, Lusaka, Zambia; Paul Kelly, Queen Mary University of London; Christopher G. Mathew, King’s College London, London, United Kingdom; Maria E. Leon, Daniel Middleton, Joachim Schüz, and Valerie McCormack, International Agency for Research on Cancer, Lyon, France; Christopher G. Mathew, University of the Witwatersrand, Johannesburg; and M. Iqbal Parker, University of Cape Town, Cape Town, South Africa
| | - Mathewos Assefa
- Katherine Van Loon, University of California, San Francisco, San Francisco, CA; Michael M. Mwachiro, Stephen L. Burgert, and Russell E. White, Tenwek Hospital, Bomet; Diana Menya, Moi University, Eldoret, Kenya; Christian C. Abnet, Gwen Murphy, Natalie Pritchett, and Sanford M. Dawsey, National Cancer Institute, Bethesda, MD; Larry Akoko, Elia Mmbaga, Beatrice Mushi, and Ally Mwanga, Muhimbili University of Health and Allied Sciences, Dar es Salaam; Blandina T. Mmbaga and Amos Mwasamwaja, Kilimanjaro Clinical Research Institute, Moshi, Tanzania; Mathewos Assefa, Addis Ababa University, Addis Ababa, Ethiopia; Steady Chasimpha and Charles Dzamalala, Queen Elizabeth Central Hospital; Charles Dzamalala, Satish Gopal, Bongani Kaimila, and Yohannie Mlombe, University of Malawi College of Medicine, Blantyre; Gift Mulima, Kamuzu Central Hospital, Lilongwe, Malawi; David E. Fleischer, Mayo Clinic, Phoenix, AZ; Satish Gopal, University of North Carolina, Chapel Hill, NC; Prasad G. Iyer and Mark D. Topazian, Mayo Clinic, Rochester, MN; Violet Kayamba and Paul Kelly, University of Zambia, Lusaka, Zambia; Paul Kelly, Queen Mary University of London; Christopher G. Mathew, King’s College London, London, United Kingdom; Maria E. Leon, Daniel Middleton, Joachim Schüz, and Valerie McCormack, International Agency for Research on Cancer, Lyon, France; Christopher G. Mathew, University of the Witwatersrand, Johannesburg; and M. Iqbal Parker, University of Cape Town, Cape Town, South Africa
| | - Stephen L. Burgert
- Katherine Van Loon, University of California, San Francisco, San Francisco, CA; Michael M. Mwachiro, Stephen L. Burgert, and Russell E. White, Tenwek Hospital, Bomet; Diana Menya, Moi University, Eldoret, Kenya; Christian C. Abnet, Gwen Murphy, Natalie Pritchett, and Sanford M. Dawsey, National Cancer Institute, Bethesda, MD; Larry Akoko, Elia Mmbaga, Beatrice Mushi, and Ally Mwanga, Muhimbili University of Health and Allied Sciences, Dar es Salaam; Blandina T. Mmbaga and Amos Mwasamwaja, Kilimanjaro Clinical Research Institute, Moshi, Tanzania; Mathewos Assefa, Addis Ababa University, Addis Ababa, Ethiopia; Steady Chasimpha and Charles Dzamalala, Queen Elizabeth Central Hospital; Charles Dzamalala, Satish Gopal, Bongani Kaimila, and Yohannie Mlombe, University of Malawi College of Medicine, Blantyre; Gift Mulima, Kamuzu Central Hospital, Lilongwe, Malawi; David E. Fleischer, Mayo Clinic, Phoenix, AZ; Satish Gopal, University of North Carolina, Chapel Hill, NC; Prasad G. Iyer and Mark D. Topazian, Mayo Clinic, Rochester, MN; Violet Kayamba and Paul Kelly, University of Zambia, Lusaka, Zambia; Paul Kelly, Queen Mary University of London; Christopher G. Mathew, King’s College London, London, United Kingdom; Maria E. Leon, Daniel Middleton, Joachim Schüz, and Valerie McCormack, International Agency for Research on Cancer, Lyon, France; Christopher G. Mathew, University of the Witwatersrand, Johannesburg; and M. Iqbal Parker, University of Cape Town, Cape Town, South Africa
| | - Steady Chasimpha
- Katherine Van Loon, University of California, San Francisco, San Francisco, CA; Michael M. Mwachiro, Stephen L. Burgert, and Russell E. White, Tenwek Hospital, Bomet; Diana Menya, Moi University, Eldoret, Kenya; Christian C. Abnet, Gwen Murphy, Natalie Pritchett, and Sanford M. Dawsey, National Cancer Institute, Bethesda, MD; Larry Akoko, Elia Mmbaga, Beatrice Mushi, and Ally Mwanga, Muhimbili University of Health and Allied Sciences, Dar es Salaam; Blandina T. Mmbaga and Amos Mwasamwaja, Kilimanjaro Clinical Research Institute, Moshi, Tanzania; Mathewos Assefa, Addis Ababa University, Addis Ababa, Ethiopia; Steady Chasimpha and Charles Dzamalala, Queen Elizabeth Central Hospital; Charles Dzamalala, Satish Gopal, Bongani Kaimila, and Yohannie Mlombe, University of Malawi College of Medicine, Blantyre; Gift Mulima, Kamuzu Central Hospital, Lilongwe, Malawi; David E. Fleischer, Mayo Clinic, Phoenix, AZ; Satish Gopal, University of North Carolina, Chapel Hill, NC; Prasad G. Iyer and Mark D. Topazian, Mayo Clinic, Rochester, MN; Violet Kayamba and Paul Kelly, University of Zambia, Lusaka, Zambia; Paul Kelly, Queen Mary University of London; Christopher G. Mathew, King’s College London, London, United Kingdom; Maria E. Leon, Daniel Middleton, Joachim Schüz, and Valerie McCormack, International Agency for Research on Cancer, Lyon, France; Christopher G. Mathew, University of the Witwatersrand, Johannesburg; and M. Iqbal Parker, University of Cape Town, Cape Town, South Africa
| | - Charles Dzamalala
- Katherine Van Loon, University of California, San Francisco, San Francisco, CA; Michael M. Mwachiro, Stephen L. Burgert, and Russell E. White, Tenwek Hospital, Bomet; Diana Menya, Moi University, Eldoret, Kenya; Christian C. Abnet, Gwen Murphy, Natalie Pritchett, and Sanford M. Dawsey, National Cancer Institute, Bethesda, MD; Larry Akoko, Elia Mmbaga, Beatrice Mushi, and Ally Mwanga, Muhimbili University of Health and Allied Sciences, Dar es Salaam; Blandina T. Mmbaga and Amos Mwasamwaja, Kilimanjaro Clinical Research Institute, Moshi, Tanzania; Mathewos Assefa, Addis Ababa University, Addis Ababa, Ethiopia; Steady Chasimpha and Charles Dzamalala, Queen Elizabeth Central Hospital; Charles Dzamalala, Satish Gopal, Bongani Kaimila, and Yohannie Mlombe, University of Malawi College of Medicine, Blantyre; Gift Mulima, Kamuzu Central Hospital, Lilongwe, Malawi; David E. Fleischer, Mayo Clinic, Phoenix, AZ; Satish Gopal, University of North Carolina, Chapel Hill, NC; Prasad G. Iyer and Mark D. Topazian, Mayo Clinic, Rochester, MN; Violet Kayamba and Paul Kelly, University of Zambia, Lusaka, Zambia; Paul Kelly, Queen Mary University of London; Christopher G. Mathew, King’s College London, London, United Kingdom; Maria E. Leon, Daniel Middleton, Joachim Schüz, and Valerie McCormack, International Agency for Research on Cancer, Lyon, France; Christopher G. Mathew, University of the Witwatersrand, Johannesburg; and M. Iqbal Parker, University of Cape Town, Cape Town, South Africa
| | - David E. Fleischer
- Katherine Van Loon, University of California, San Francisco, San Francisco, CA; Michael M. Mwachiro, Stephen L. Burgert, and Russell E. White, Tenwek Hospital, Bomet; Diana Menya, Moi University, Eldoret, Kenya; Christian C. Abnet, Gwen Murphy, Natalie Pritchett, and Sanford M. Dawsey, National Cancer Institute, Bethesda, MD; Larry Akoko, Elia Mmbaga, Beatrice Mushi, and Ally Mwanga, Muhimbili University of Health and Allied Sciences, Dar es Salaam; Blandina T. Mmbaga and Amos Mwasamwaja, Kilimanjaro Clinical Research Institute, Moshi, Tanzania; Mathewos Assefa, Addis Ababa University, Addis Ababa, Ethiopia; Steady Chasimpha and Charles Dzamalala, Queen Elizabeth Central Hospital; Charles Dzamalala, Satish Gopal, Bongani Kaimila, and Yohannie Mlombe, University of Malawi College of Medicine, Blantyre; Gift Mulima, Kamuzu Central Hospital, Lilongwe, Malawi; David E. Fleischer, Mayo Clinic, Phoenix, AZ; Satish Gopal, University of North Carolina, Chapel Hill, NC; Prasad G. Iyer and Mark D. Topazian, Mayo Clinic, Rochester, MN; Violet Kayamba and Paul Kelly, University of Zambia, Lusaka, Zambia; Paul Kelly, Queen Mary University of London; Christopher G. Mathew, King’s College London, London, United Kingdom; Maria E. Leon, Daniel Middleton, Joachim Schüz, and Valerie McCormack, International Agency for Research on Cancer, Lyon, France; Christopher G. Mathew, University of the Witwatersrand, Johannesburg; and M. Iqbal Parker, University of Cape Town, Cape Town, South Africa
| | - Satish Gopal
- Katherine Van Loon, University of California, San Francisco, San Francisco, CA; Michael M. Mwachiro, Stephen L. Burgert, and Russell E. White, Tenwek Hospital, Bomet; Diana Menya, Moi University, Eldoret, Kenya; Christian C. Abnet, Gwen Murphy, Natalie Pritchett, and Sanford M. Dawsey, National Cancer Institute, Bethesda, MD; Larry Akoko, Elia Mmbaga, Beatrice Mushi, and Ally Mwanga, Muhimbili University of Health and Allied Sciences, Dar es Salaam; Blandina T. Mmbaga and Amos Mwasamwaja, Kilimanjaro Clinical Research Institute, Moshi, Tanzania; Mathewos Assefa, Addis Ababa University, Addis Ababa, Ethiopia; Steady Chasimpha and Charles Dzamalala, Queen Elizabeth Central Hospital; Charles Dzamalala, Satish Gopal, Bongani Kaimila, and Yohannie Mlombe, University of Malawi College of Medicine, Blantyre; Gift Mulima, Kamuzu Central Hospital, Lilongwe, Malawi; David E. Fleischer, Mayo Clinic, Phoenix, AZ; Satish Gopal, University of North Carolina, Chapel Hill, NC; Prasad G. Iyer and Mark D. Topazian, Mayo Clinic, Rochester, MN; Violet Kayamba and Paul Kelly, University of Zambia, Lusaka, Zambia; Paul Kelly, Queen Mary University of London; Christopher G. Mathew, King’s College London, London, United Kingdom; Maria E. Leon, Daniel Middleton, Joachim Schüz, and Valerie McCormack, International Agency for Research on Cancer, Lyon, France; Christopher G. Mathew, University of the Witwatersrand, Johannesburg; and M. Iqbal Parker, University of Cape Town, Cape Town, South Africa
| | - Prasad G. Iyer
- Katherine Van Loon, University of California, San Francisco, San Francisco, CA; Michael M. Mwachiro, Stephen L. Burgert, and Russell E. White, Tenwek Hospital, Bomet; Diana Menya, Moi University, Eldoret, Kenya; Christian C. Abnet, Gwen Murphy, Natalie Pritchett, and Sanford M. Dawsey, National Cancer Institute, Bethesda, MD; Larry Akoko, Elia Mmbaga, Beatrice Mushi, and Ally Mwanga, Muhimbili University of Health and Allied Sciences, Dar es Salaam; Blandina T. Mmbaga and Amos Mwasamwaja, Kilimanjaro Clinical Research Institute, Moshi, Tanzania; Mathewos Assefa, Addis Ababa University, Addis Ababa, Ethiopia; Steady Chasimpha and Charles Dzamalala, Queen Elizabeth Central Hospital; Charles Dzamalala, Satish Gopal, Bongani Kaimila, and Yohannie Mlombe, University of Malawi College of Medicine, Blantyre; Gift Mulima, Kamuzu Central Hospital, Lilongwe, Malawi; David E. Fleischer, Mayo Clinic, Phoenix, AZ; Satish Gopal, University of North Carolina, Chapel Hill, NC; Prasad G. Iyer and Mark D. Topazian, Mayo Clinic, Rochester, MN; Violet Kayamba and Paul Kelly, University of Zambia, Lusaka, Zambia; Paul Kelly, Queen Mary University of London; Christopher G. Mathew, King’s College London, London, United Kingdom; Maria E. Leon, Daniel Middleton, Joachim Schüz, and Valerie McCormack, International Agency for Research on Cancer, Lyon, France; Christopher G. Mathew, University of the Witwatersrand, Johannesburg; and M. Iqbal Parker, University of Cape Town, Cape Town, South Africa
| | - Bongani Kaimila
- Katherine Van Loon, University of California, San Francisco, San Francisco, CA; Michael M. Mwachiro, Stephen L. Burgert, and Russell E. White, Tenwek Hospital, Bomet; Diana Menya, Moi University, Eldoret, Kenya; Christian C. Abnet, Gwen Murphy, Natalie Pritchett, and Sanford M. Dawsey, National Cancer Institute, Bethesda, MD; Larry Akoko, Elia Mmbaga, Beatrice Mushi, and Ally Mwanga, Muhimbili University of Health and Allied Sciences, Dar es Salaam; Blandina T. Mmbaga and Amos Mwasamwaja, Kilimanjaro Clinical Research Institute, Moshi, Tanzania; Mathewos Assefa, Addis Ababa University, Addis Ababa, Ethiopia; Steady Chasimpha and Charles Dzamalala, Queen Elizabeth Central Hospital; Charles Dzamalala, Satish Gopal, Bongani Kaimila, and Yohannie Mlombe, University of Malawi College of Medicine, Blantyre; Gift Mulima, Kamuzu Central Hospital, Lilongwe, Malawi; David E. Fleischer, Mayo Clinic, Phoenix, AZ; Satish Gopal, University of North Carolina, Chapel Hill, NC; Prasad G. Iyer and Mark D. Topazian, Mayo Clinic, Rochester, MN; Violet Kayamba and Paul Kelly, University of Zambia, Lusaka, Zambia; Paul Kelly, Queen Mary University of London; Christopher G. Mathew, King’s College London, London, United Kingdom; Maria E. Leon, Daniel Middleton, Joachim Schüz, and Valerie McCormack, International Agency for Research on Cancer, Lyon, France; Christopher G. Mathew, University of the Witwatersrand, Johannesburg; and M. Iqbal Parker, University of Cape Town, Cape Town, South Africa
| | - Violet Kayamba
- Katherine Van Loon, University of California, San Francisco, San Francisco, CA; Michael M. Mwachiro, Stephen L. Burgert, and Russell E. White, Tenwek Hospital, Bomet; Diana Menya, Moi University, Eldoret, Kenya; Christian C. Abnet, Gwen Murphy, Natalie Pritchett, and Sanford M. Dawsey, National Cancer Institute, Bethesda, MD; Larry Akoko, Elia Mmbaga, Beatrice Mushi, and Ally Mwanga, Muhimbili University of Health and Allied Sciences, Dar es Salaam; Blandina T. Mmbaga and Amos Mwasamwaja, Kilimanjaro Clinical Research Institute, Moshi, Tanzania; Mathewos Assefa, Addis Ababa University, Addis Ababa, Ethiopia; Steady Chasimpha and Charles Dzamalala, Queen Elizabeth Central Hospital; Charles Dzamalala, Satish Gopal, Bongani Kaimila, and Yohannie Mlombe, University of Malawi College of Medicine, Blantyre; Gift Mulima, Kamuzu Central Hospital, Lilongwe, Malawi; David E. Fleischer, Mayo Clinic, Phoenix, AZ; Satish Gopal, University of North Carolina, Chapel Hill, NC; Prasad G. Iyer and Mark D. Topazian, Mayo Clinic, Rochester, MN; Violet Kayamba and Paul Kelly, University of Zambia, Lusaka, Zambia; Paul Kelly, Queen Mary University of London; Christopher G. Mathew, King’s College London, London, United Kingdom; Maria E. Leon, Daniel Middleton, Joachim Schüz, and Valerie McCormack, International Agency for Research on Cancer, Lyon, France; Christopher G. Mathew, University of the Witwatersrand, Johannesburg; and M. Iqbal Parker, University of Cape Town, Cape Town, South Africa
| | - Paul Kelly
- Katherine Van Loon, University of California, San Francisco, San Francisco, CA; Michael M. Mwachiro, Stephen L. Burgert, and Russell E. White, Tenwek Hospital, Bomet; Diana Menya, Moi University, Eldoret, Kenya; Christian C. Abnet, Gwen Murphy, Natalie Pritchett, and Sanford M. Dawsey, National Cancer Institute, Bethesda, MD; Larry Akoko, Elia Mmbaga, Beatrice Mushi, and Ally Mwanga, Muhimbili University of Health and Allied Sciences, Dar es Salaam; Blandina T. Mmbaga and Amos Mwasamwaja, Kilimanjaro Clinical Research Institute, Moshi, Tanzania; Mathewos Assefa, Addis Ababa University, Addis Ababa, Ethiopia; Steady Chasimpha and Charles Dzamalala, Queen Elizabeth Central Hospital; Charles Dzamalala, Satish Gopal, Bongani Kaimila, and Yohannie Mlombe, University of Malawi College of Medicine, Blantyre; Gift Mulima, Kamuzu Central Hospital, Lilongwe, Malawi; David E. Fleischer, Mayo Clinic, Phoenix, AZ; Satish Gopal, University of North Carolina, Chapel Hill, NC; Prasad G. Iyer and Mark D. Topazian, Mayo Clinic, Rochester, MN; Violet Kayamba and Paul Kelly, University of Zambia, Lusaka, Zambia; Paul Kelly, Queen Mary University of London; Christopher G. Mathew, King’s College London, London, United Kingdom; Maria E. Leon, Daniel Middleton, Joachim Schüz, and Valerie McCormack, International Agency for Research on Cancer, Lyon, France; Christopher G. Mathew, University of the Witwatersrand, Johannesburg; and M. Iqbal Parker, University of Cape Town, Cape Town, South Africa
| | - Maria E. Leon
- Katherine Van Loon, University of California, San Francisco, San Francisco, CA; Michael M. Mwachiro, Stephen L. Burgert, and Russell E. White, Tenwek Hospital, Bomet; Diana Menya, Moi University, Eldoret, Kenya; Christian C. Abnet, Gwen Murphy, Natalie Pritchett, and Sanford M. Dawsey, National Cancer Institute, Bethesda, MD; Larry Akoko, Elia Mmbaga, Beatrice Mushi, and Ally Mwanga, Muhimbili University of Health and Allied Sciences, Dar es Salaam; Blandina T. Mmbaga and Amos Mwasamwaja, Kilimanjaro Clinical Research Institute, Moshi, Tanzania; Mathewos Assefa, Addis Ababa University, Addis Ababa, Ethiopia; Steady Chasimpha and Charles Dzamalala, Queen Elizabeth Central Hospital; Charles Dzamalala, Satish Gopal, Bongani Kaimila, and Yohannie Mlombe, University of Malawi College of Medicine, Blantyre; Gift Mulima, Kamuzu Central Hospital, Lilongwe, Malawi; David E. Fleischer, Mayo Clinic, Phoenix, AZ; Satish Gopal, University of North Carolina, Chapel Hill, NC; Prasad G. Iyer and Mark D. Topazian, Mayo Clinic, Rochester, MN; Violet Kayamba and Paul Kelly, University of Zambia, Lusaka, Zambia; Paul Kelly, Queen Mary University of London; Christopher G. Mathew, King’s College London, London, United Kingdom; Maria E. Leon, Daniel Middleton, Joachim Schüz, and Valerie McCormack, International Agency for Research on Cancer, Lyon, France; Christopher G. Mathew, University of the Witwatersrand, Johannesburg; and M. Iqbal Parker, University of Cape Town, Cape Town, South Africa
| | - Christopher G. Mathew
- Katherine Van Loon, University of California, San Francisco, San Francisco, CA; Michael M. Mwachiro, Stephen L. Burgert, and Russell E. White, Tenwek Hospital, Bomet; Diana Menya, Moi University, Eldoret, Kenya; Christian C. Abnet, Gwen Murphy, Natalie Pritchett, and Sanford M. Dawsey, National Cancer Institute, Bethesda, MD; Larry Akoko, Elia Mmbaga, Beatrice Mushi, and Ally Mwanga, Muhimbili University of Health and Allied Sciences, Dar es Salaam; Blandina T. Mmbaga and Amos Mwasamwaja, Kilimanjaro Clinical Research Institute, Moshi, Tanzania; Mathewos Assefa, Addis Ababa University, Addis Ababa, Ethiopia; Steady Chasimpha and Charles Dzamalala, Queen Elizabeth Central Hospital; Charles Dzamalala, Satish Gopal, Bongani Kaimila, and Yohannie Mlombe, University of Malawi College of Medicine, Blantyre; Gift Mulima, Kamuzu Central Hospital, Lilongwe, Malawi; David E. Fleischer, Mayo Clinic, Phoenix, AZ; Satish Gopal, University of North Carolina, Chapel Hill, NC; Prasad G. Iyer and Mark D. Topazian, Mayo Clinic, Rochester, MN; Violet Kayamba and Paul Kelly, University of Zambia, Lusaka, Zambia; Paul Kelly, Queen Mary University of London; Christopher G. Mathew, King’s College London, London, United Kingdom; Maria E. Leon, Daniel Middleton, Joachim Schüz, and Valerie McCormack, International Agency for Research on Cancer, Lyon, France; Christopher G. Mathew, University of the Witwatersrand, Johannesburg; and M. Iqbal Parker, University of Cape Town, Cape Town, South Africa
| | - Diana Menya
- Katherine Van Loon, University of California, San Francisco, San Francisco, CA; Michael M. Mwachiro, Stephen L. Burgert, and Russell E. White, Tenwek Hospital, Bomet; Diana Menya, Moi University, Eldoret, Kenya; Christian C. Abnet, Gwen Murphy, Natalie Pritchett, and Sanford M. Dawsey, National Cancer Institute, Bethesda, MD; Larry Akoko, Elia Mmbaga, Beatrice Mushi, and Ally Mwanga, Muhimbili University of Health and Allied Sciences, Dar es Salaam; Blandina T. Mmbaga and Amos Mwasamwaja, Kilimanjaro Clinical Research Institute, Moshi, Tanzania; Mathewos Assefa, Addis Ababa University, Addis Ababa, Ethiopia; Steady Chasimpha and Charles Dzamalala, Queen Elizabeth Central Hospital; Charles Dzamalala, Satish Gopal, Bongani Kaimila, and Yohannie Mlombe, University of Malawi College of Medicine, Blantyre; Gift Mulima, Kamuzu Central Hospital, Lilongwe, Malawi; David E. Fleischer, Mayo Clinic, Phoenix, AZ; Satish Gopal, University of North Carolina, Chapel Hill, NC; Prasad G. Iyer and Mark D. Topazian, Mayo Clinic, Rochester, MN; Violet Kayamba and Paul Kelly, University of Zambia, Lusaka, Zambia; Paul Kelly, Queen Mary University of London; Christopher G. Mathew, King’s College London, London, United Kingdom; Maria E. Leon, Daniel Middleton, Joachim Schüz, and Valerie McCormack, International Agency for Research on Cancer, Lyon, France; Christopher G. Mathew, University of the Witwatersrand, Johannesburg; and M. Iqbal Parker, University of Cape Town, Cape Town, South Africa
| | - Daniel Middleton
- Katherine Van Loon, University of California, San Francisco, San Francisco, CA; Michael M. Mwachiro, Stephen L. Burgert, and Russell E. White, Tenwek Hospital, Bomet; Diana Menya, Moi University, Eldoret, Kenya; Christian C. Abnet, Gwen Murphy, Natalie Pritchett, and Sanford M. Dawsey, National Cancer Institute, Bethesda, MD; Larry Akoko, Elia Mmbaga, Beatrice Mushi, and Ally Mwanga, Muhimbili University of Health and Allied Sciences, Dar es Salaam; Blandina T. Mmbaga and Amos Mwasamwaja, Kilimanjaro Clinical Research Institute, Moshi, Tanzania; Mathewos Assefa, Addis Ababa University, Addis Ababa, Ethiopia; Steady Chasimpha and Charles Dzamalala, Queen Elizabeth Central Hospital; Charles Dzamalala, Satish Gopal, Bongani Kaimila, and Yohannie Mlombe, University of Malawi College of Medicine, Blantyre; Gift Mulima, Kamuzu Central Hospital, Lilongwe, Malawi; David E. Fleischer, Mayo Clinic, Phoenix, AZ; Satish Gopal, University of North Carolina, Chapel Hill, NC; Prasad G. Iyer and Mark D. Topazian, Mayo Clinic, Rochester, MN; Violet Kayamba and Paul Kelly, University of Zambia, Lusaka, Zambia; Paul Kelly, Queen Mary University of London; Christopher G. Mathew, King’s College London, London, United Kingdom; Maria E. Leon, Daniel Middleton, Joachim Schüz, and Valerie McCormack, International Agency for Research on Cancer, Lyon, France; Christopher G. Mathew, University of the Witwatersrand, Johannesburg; and M. Iqbal Parker, University of Cape Town, Cape Town, South Africa
| | - Yohannie Mlombe
- Katherine Van Loon, University of California, San Francisco, San Francisco, CA; Michael M. Mwachiro, Stephen L. Burgert, and Russell E. White, Tenwek Hospital, Bomet; Diana Menya, Moi University, Eldoret, Kenya; Christian C. Abnet, Gwen Murphy, Natalie Pritchett, and Sanford M. Dawsey, National Cancer Institute, Bethesda, MD; Larry Akoko, Elia Mmbaga, Beatrice Mushi, and Ally Mwanga, Muhimbili University of Health and Allied Sciences, Dar es Salaam; Blandina T. Mmbaga and Amos Mwasamwaja, Kilimanjaro Clinical Research Institute, Moshi, Tanzania; Mathewos Assefa, Addis Ababa University, Addis Ababa, Ethiopia; Steady Chasimpha and Charles Dzamalala, Queen Elizabeth Central Hospital; Charles Dzamalala, Satish Gopal, Bongani Kaimila, and Yohannie Mlombe, University of Malawi College of Medicine, Blantyre; Gift Mulima, Kamuzu Central Hospital, Lilongwe, Malawi; David E. Fleischer, Mayo Clinic, Phoenix, AZ; Satish Gopal, University of North Carolina, Chapel Hill, NC; Prasad G. Iyer and Mark D. Topazian, Mayo Clinic, Rochester, MN; Violet Kayamba and Paul Kelly, University of Zambia, Lusaka, Zambia; Paul Kelly, Queen Mary University of London; Christopher G. Mathew, King’s College London, London, United Kingdom; Maria E. Leon, Daniel Middleton, Joachim Schüz, and Valerie McCormack, International Agency for Research on Cancer, Lyon, France; Christopher G. Mathew, University of the Witwatersrand, Johannesburg; and M. Iqbal Parker, University of Cape Town, Cape Town, South Africa
| | - Blandina T. Mmbaga
- Katherine Van Loon, University of California, San Francisco, San Francisco, CA; Michael M. Mwachiro, Stephen L. Burgert, and Russell E. White, Tenwek Hospital, Bomet; Diana Menya, Moi University, Eldoret, Kenya; Christian C. Abnet, Gwen Murphy, Natalie Pritchett, and Sanford M. Dawsey, National Cancer Institute, Bethesda, MD; Larry Akoko, Elia Mmbaga, Beatrice Mushi, and Ally Mwanga, Muhimbili University of Health and Allied Sciences, Dar es Salaam; Blandina T. Mmbaga and Amos Mwasamwaja, Kilimanjaro Clinical Research Institute, Moshi, Tanzania; Mathewos Assefa, Addis Ababa University, Addis Ababa, Ethiopia; Steady Chasimpha and Charles Dzamalala, Queen Elizabeth Central Hospital; Charles Dzamalala, Satish Gopal, Bongani Kaimila, and Yohannie Mlombe, University of Malawi College of Medicine, Blantyre; Gift Mulima, Kamuzu Central Hospital, Lilongwe, Malawi; David E. Fleischer, Mayo Clinic, Phoenix, AZ; Satish Gopal, University of North Carolina, Chapel Hill, NC; Prasad G. Iyer and Mark D. Topazian, Mayo Clinic, Rochester, MN; Violet Kayamba and Paul Kelly, University of Zambia, Lusaka, Zambia; Paul Kelly, Queen Mary University of London; Christopher G. Mathew, King’s College London, London, United Kingdom; Maria E. Leon, Daniel Middleton, Joachim Schüz, and Valerie McCormack, International Agency for Research on Cancer, Lyon, France; Christopher G. Mathew, University of the Witwatersrand, Johannesburg; and M. Iqbal Parker, University of Cape Town, Cape Town, South Africa
| | - Elia Mmbaga
- Katherine Van Loon, University of California, San Francisco, San Francisco, CA; Michael M. Mwachiro, Stephen L. Burgert, and Russell E. White, Tenwek Hospital, Bomet; Diana Menya, Moi University, Eldoret, Kenya; Christian C. Abnet, Gwen Murphy, Natalie Pritchett, and Sanford M. Dawsey, National Cancer Institute, Bethesda, MD; Larry Akoko, Elia Mmbaga, Beatrice Mushi, and Ally Mwanga, Muhimbili University of Health and Allied Sciences, Dar es Salaam; Blandina T. Mmbaga and Amos Mwasamwaja, Kilimanjaro Clinical Research Institute, Moshi, Tanzania; Mathewos Assefa, Addis Ababa University, Addis Ababa, Ethiopia; Steady Chasimpha and Charles Dzamalala, Queen Elizabeth Central Hospital; Charles Dzamalala, Satish Gopal, Bongani Kaimila, and Yohannie Mlombe, University of Malawi College of Medicine, Blantyre; Gift Mulima, Kamuzu Central Hospital, Lilongwe, Malawi; David E. Fleischer, Mayo Clinic, Phoenix, AZ; Satish Gopal, University of North Carolina, Chapel Hill, NC; Prasad G. Iyer and Mark D. Topazian, Mayo Clinic, Rochester, MN; Violet Kayamba and Paul Kelly, University of Zambia, Lusaka, Zambia; Paul Kelly, Queen Mary University of London; Christopher G. Mathew, King’s College London, London, United Kingdom; Maria E. Leon, Daniel Middleton, Joachim Schüz, and Valerie McCormack, International Agency for Research on Cancer, Lyon, France; Christopher G. Mathew, University of the Witwatersrand, Johannesburg; and M. Iqbal Parker, University of Cape Town, Cape Town, South Africa
| | - Gift Mulima
- Katherine Van Loon, University of California, San Francisco, San Francisco, CA; Michael M. Mwachiro, Stephen L. Burgert, and Russell E. White, Tenwek Hospital, Bomet; Diana Menya, Moi University, Eldoret, Kenya; Christian C. Abnet, Gwen Murphy, Natalie Pritchett, and Sanford M. Dawsey, National Cancer Institute, Bethesda, MD; Larry Akoko, Elia Mmbaga, Beatrice Mushi, and Ally Mwanga, Muhimbili University of Health and Allied Sciences, Dar es Salaam; Blandina T. Mmbaga and Amos Mwasamwaja, Kilimanjaro Clinical Research Institute, Moshi, Tanzania; Mathewos Assefa, Addis Ababa University, Addis Ababa, Ethiopia; Steady Chasimpha and Charles Dzamalala, Queen Elizabeth Central Hospital; Charles Dzamalala, Satish Gopal, Bongani Kaimila, and Yohannie Mlombe, University of Malawi College of Medicine, Blantyre; Gift Mulima, Kamuzu Central Hospital, Lilongwe, Malawi; David E. Fleischer, Mayo Clinic, Phoenix, AZ; Satish Gopal, University of North Carolina, Chapel Hill, NC; Prasad G. Iyer and Mark D. Topazian, Mayo Clinic, Rochester, MN; Violet Kayamba and Paul Kelly, University of Zambia, Lusaka, Zambia; Paul Kelly, Queen Mary University of London; Christopher G. Mathew, King’s College London, London, United Kingdom; Maria E. Leon, Daniel Middleton, Joachim Schüz, and Valerie McCormack, International Agency for Research on Cancer, Lyon, France; Christopher G. Mathew, University of the Witwatersrand, Johannesburg; and M. Iqbal Parker, University of Cape Town, Cape Town, South Africa
| | - Gwen Murphy
- Katherine Van Loon, University of California, San Francisco, San Francisco, CA; Michael M. Mwachiro, Stephen L. Burgert, and Russell E. White, Tenwek Hospital, Bomet; Diana Menya, Moi University, Eldoret, Kenya; Christian C. Abnet, Gwen Murphy, Natalie Pritchett, and Sanford M. Dawsey, National Cancer Institute, Bethesda, MD; Larry Akoko, Elia Mmbaga, Beatrice Mushi, and Ally Mwanga, Muhimbili University of Health and Allied Sciences, Dar es Salaam; Blandina T. Mmbaga and Amos Mwasamwaja, Kilimanjaro Clinical Research Institute, Moshi, Tanzania; Mathewos Assefa, Addis Ababa University, Addis Ababa, Ethiopia; Steady Chasimpha and Charles Dzamalala, Queen Elizabeth Central Hospital; Charles Dzamalala, Satish Gopal, Bongani Kaimila, and Yohannie Mlombe, University of Malawi College of Medicine, Blantyre; Gift Mulima, Kamuzu Central Hospital, Lilongwe, Malawi; David E. Fleischer, Mayo Clinic, Phoenix, AZ; Satish Gopal, University of North Carolina, Chapel Hill, NC; Prasad G. Iyer and Mark D. Topazian, Mayo Clinic, Rochester, MN; Violet Kayamba and Paul Kelly, University of Zambia, Lusaka, Zambia; Paul Kelly, Queen Mary University of London; Christopher G. Mathew, King’s College London, London, United Kingdom; Maria E. Leon, Daniel Middleton, Joachim Schüz, and Valerie McCormack, International Agency for Research on Cancer, Lyon, France; Christopher G. Mathew, University of the Witwatersrand, Johannesburg; and M. Iqbal Parker, University of Cape Town, Cape Town, South Africa
| | - Beatrice Mushi
- Katherine Van Loon, University of California, San Francisco, San Francisco, CA; Michael M. Mwachiro, Stephen L. Burgert, and Russell E. White, Tenwek Hospital, Bomet; Diana Menya, Moi University, Eldoret, Kenya; Christian C. Abnet, Gwen Murphy, Natalie Pritchett, and Sanford M. Dawsey, National Cancer Institute, Bethesda, MD; Larry Akoko, Elia Mmbaga, Beatrice Mushi, and Ally Mwanga, Muhimbili University of Health and Allied Sciences, Dar es Salaam; Blandina T. Mmbaga and Amos Mwasamwaja, Kilimanjaro Clinical Research Institute, Moshi, Tanzania; Mathewos Assefa, Addis Ababa University, Addis Ababa, Ethiopia; Steady Chasimpha and Charles Dzamalala, Queen Elizabeth Central Hospital; Charles Dzamalala, Satish Gopal, Bongani Kaimila, and Yohannie Mlombe, University of Malawi College of Medicine, Blantyre; Gift Mulima, Kamuzu Central Hospital, Lilongwe, Malawi; David E. Fleischer, Mayo Clinic, Phoenix, AZ; Satish Gopal, University of North Carolina, Chapel Hill, NC; Prasad G. Iyer and Mark D. Topazian, Mayo Clinic, Rochester, MN; Violet Kayamba and Paul Kelly, University of Zambia, Lusaka, Zambia; Paul Kelly, Queen Mary University of London; Christopher G. Mathew, King’s College London, London, United Kingdom; Maria E. Leon, Daniel Middleton, Joachim Schüz, and Valerie McCormack, International Agency for Research on Cancer, Lyon, France; Christopher G. Mathew, University of the Witwatersrand, Johannesburg; and M. Iqbal Parker, University of Cape Town, Cape Town, South Africa
| | - Ally Mwanga
- Katherine Van Loon, University of California, San Francisco, San Francisco, CA; Michael M. Mwachiro, Stephen L. Burgert, and Russell E. White, Tenwek Hospital, Bomet; Diana Menya, Moi University, Eldoret, Kenya; Christian C. Abnet, Gwen Murphy, Natalie Pritchett, and Sanford M. Dawsey, National Cancer Institute, Bethesda, MD; Larry Akoko, Elia Mmbaga, Beatrice Mushi, and Ally Mwanga, Muhimbili University of Health and Allied Sciences, Dar es Salaam; Blandina T. Mmbaga and Amos Mwasamwaja, Kilimanjaro Clinical Research Institute, Moshi, Tanzania; Mathewos Assefa, Addis Ababa University, Addis Ababa, Ethiopia; Steady Chasimpha and Charles Dzamalala, Queen Elizabeth Central Hospital; Charles Dzamalala, Satish Gopal, Bongani Kaimila, and Yohannie Mlombe, University of Malawi College of Medicine, Blantyre; Gift Mulima, Kamuzu Central Hospital, Lilongwe, Malawi; David E. Fleischer, Mayo Clinic, Phoenix, AZ; Satish Gopal, University of North Carolina, Chapel Hill, NC; Prasad G. Iyer and Mark D. Topazian, Mayo Clinic, Rochester, MN; Violet Kayamba and Paul Kelly, University of Zambia, Lusaka, Zambia; Paul Kelly, Queen Mary University of London; Christopher G. Mathew, King’s College London, London, United Kingdom; Maria E. Leon, Daniel Middleton, Joachim Schüz, and Valerie McCormack, International Agency for Research on Cancer, Lyon, France; Christopher G. Mathew, University of the Witwatersrand, Johannesburg; and M. Iqbal Parker, University of Cape Town, Cape Town, South Africa
| | - Amos Mwasamwaja
- Katherine Van Loon, University of California, San Francisco, San Francisco, CA; Michael M. Mwachiro, Stephen L. Burgert, and Russell E. White, Tenwek Hospital, Bomet; Diana Menya, Moi University, Eldoret, Kenya; Christian C. Abnet, Gwen Murphy, Natalie Pritchett, and Sanford M. Dawsey, National Cancer Institute, Bethesda, MD; Larry Akoko, Elia Mmbaga, Beatrice Mushi, and Ally Mwanga, Muhimbili University of Health and Allied Sciences, Dar es Salaam; Blandina T. Mmbaga and Amos Mwasamwaja, Kilimanjaro Clinical Research Institute, Moshi, Tanzania; Mathewos Assefa, Addis Ababa University, Addis Ababa, Ethiopia; Steady Chasimpha and Charles Dzamalala, Queen Elizabeth Central Hospital; Charles Dzamalala, Satish Gopal, Bongani Kaimila, and Yohannie Mlombe, University of Malawi College of Medicine, Blantyre; Gift Mulima, Kamuzu Central Hospital, Lilongwe, Malawi; David E. Fleischer, Mayo Clinic, Phoenix, AZ; Satish Gopal, University of North Carolina, Chapel Hill, NC; Prasad G. Iyer and Mark D. Topazian, Mayo Clinic, Rochester, MN; Violet Kayamba and Paul Kelly, University of Zambia, Lusaka, Zambia; Paul Kelly, Queen Mary University of London; Christopher G. Mathew, King’s College London, London, United Kingdom; Maria E. Leon, Daniel Middleton, Joachim Schüz, and Valerie McCormack, International Agency for Research on Cancer, Lyon, France; Christopher G. Mathew, University of the Witwatersrand, Johannesburg; and M. Iqbal Parker, University of Cape Town, Cape Town, South Africa
| | - M. Iqbal Parker
- Katherine Van Loon, University of California, San Francisco, San Francisco, CA; Michael M. Mwachiro, Stephen L. Burgert, and Russell E. White, Tenwek Hospital, Bomet; Diana Menya, Moi University, Eldoret, Kenya; Christian C. Abnet, Gwen Murphy, Natalie Pritchett, and Sanford M. Dawsey, National Cancer Institute, Bethesda, MD; Larry Akoko, Elia Mmbaga, Beatrice Mushi, and Ally Mwanga, Muhimbili University of Health and Allied Sciences, Dar es Salaam; Blandina T. Mmbaga and Amos Mwasamwaja, Kilimanjaro Clinical Research Institute, Moshi, Tanzania; Mathewos Assefa, Addis Ababa University, Addis Ababa, Ethiopia; Steady Chasimpha and Charles Dzamalala, Queen Elizabeth Central Hospital; Charles Dzamalala, Satish Gopal, Bongani Kaimila, and Yohannie Mlombe, University of Malawi College of Medicine, Blantyre; Gift Mulima, Kamuzu Central Hospital, Lilongwe, Malawi; David E. Fleischer, Mayo Clinic, Phoenix, AZ; Satish Gopal, University of North Carolina, Chapel Hill, NC; Prasad G. Iyer and Mark D. Topazian, Mayo Clinic, Rochester, MN; Violet Kayamba and Paul Kelly, University of Zambia, Lusaka, Zambia; Paul Kelly, Queen Mary University of London; Christopher G. Mathew, King’s College London, London, United Kingdom; Maria E. Leon, Daniel Middleton, Joachim Schüz, and Valerie McCormack, International Agency for Research on Cancer, Lyon, France; Christopher G. Mathew, University of the Witwatersrand, Johannesburg; and M. Iqbal Parker, University of Cape Town, Cape Town, South Africa
| | - Natalie Pritchett
- Katherine Van Loon, University of California, San Francisco, San Francisco, CA; Michael M. Mwachiro, Stephen L. Burgert, and Russell E. White, Tenwek Hospital, Bomet; Diana Menya, Moi University, Eldoret, Kenya; Christian C. Abnet, Gwen Murphy, Natalie Pritchett, and Sanford M. Dawsey, National Cancer Institute, Bethesda, MD; Larry Akoko, Elia Mmbaga, Beatrice Mushi, and Ally Mwanga, Muhimbili University of Health and Allied Sciences, Dar es Salaam; Blandina T. Mmbaga and Amos Mwasamwaja, Kilimanjaro Clinical Research Institute, Moshi, Tanzania; Mathewos Assefa, Addis Ababa University, Addis Ababa, Ethiopia; Steady Chasimpha and Charles Dzamalala, Queen Elizabeth Central Hospital; Charles Dzamalala, Satish Gopal, Bongani Kaimila, and Yohannie Mlombe, University of Malawi College of Medicine, Blantyre; Gift Mulima, Kamuzu Central Hospital, Lilongwe, Malawi; David E. Fleischer, Mayo Clinic, Phoenix, AZ; Satish Gopal, University of North Carolina, Chapel Hill, NC; Prasad G. Iyer and Mark D. Topazian, Mayo Clinic, Rochester, MN; Violet Kayamba and Paul Kelly, University of Zambia, Lusaka, Zambia; Paul Kelly, Queen Mary University of London; Christopher G. Mathew, King’s College London, London, United Kingdom; Maria E. Leon, Daniel Middleton, Joachim Schüz, and Valerie McCormack, International Agency for Research on Cancer, Lyon, France; Christopher G. Mathew, University of the Witwatersrand, Johannesburg; and M. Iqbal Parker, University of Cape Town, Cape Town, South Africa
| | - Joachim Schüz
- Katherine Van Loon, University of California, San Francisco, San Francisco, CA; Michael M. Mwachiro, Stephen L. Burgert, and Russell E. White, Tenwek Hospital, Bomet; Diana Menya, Moi University, Eldoret, Kenya; Christian C. Abnet, Gwen Murphy, Natalie Pritchett, and Sanford M. Dawsey, National Cancer Institute, Bethesda, MD; Larry Akoko, Elia Mmbaga, Beatrice Mushi, and Ally Mwanga, Muhimbili University of Health and Allied Sciences, Dar es Salaam; Blandina T. Mmbaga and Amos Mwasamwaja, Kilimanjaro Clinical Research Institute, Moshi, Tanzania; Mathewos Assefa, Addis Ababa University, Addis Ababa, Ethiopia; Steady Chasimpha and Charles Dzamalala, Queen Elizabeth Central Hospital; Charles Dzamalala, Satish Gopal, Bongani Kaimila, and Yohannie Mlombe, University of Malawi College of Medicine, Blantyre; Gift Mulima, Kamuzu Central Hospital, Lilongwe, Malawi; David E. Fleischer, Mayo Clinic, Phoenix, AZ; Satish Gopal, University of North Carolina, Chapel Hill, NC; Prasad G. Iyer and Mark D. Topazian, Mayo Clinic, Rochester, MN; Violet Kayamba and Paul Kelly, University of Zambia, Lusaka, Zambia; Paul Kelly, Queen Mary University of London; Christopher G. Mathew, King’s College London, London, United Kingdom; Maria E. Leon, Daniel Middleton, Joachim Schüz, and Valerie McCormack, International Agency for Research on Cancer, Lyon, France; Christopher G. Mathew, University of the Witwatersrand, Johannesburg; and M. Iqbal Parker, University of Cape Town, Cape Town, South Africa
| | - Mark D. Topazian
- Katherine Van Loon, University of California, San Francisco, San Francisco, CA; Michael M. Mwachiro, Stephen L. Burgert, and Russell E. White, Tenwek Hospital, Bomet; Diana Menya, Moi University, Eldoret, Kenya; Christian C. Abnet, Gwen Murphy, Natalie Pritchett, and Sanford M. Dawsey, National Cancer Institute, Bethesda, MD; Larry Akoko, Elia Mmbaga, Beatrice Mushi, and Ally Mwanga, Muhimbili University of Health and Allied Sciences, Dar es Salaam; Blandina T. Mmbaga and Amos Mwasamwaja, Kilimanjaro Clinical Research Institute, Moshi, Tanzania; Mathewos Assefa, Addis Ababa University, Addis Ababa, Ethiopia; Steady Chasimpha and Charles Dzamalala, Queen Elizabeth Central Hospital; Charles Dzamalala, Satish Gopal, Bongani Kaimila, and Yohannie Mlombe, University of Malawi College of Medicine, Blantyre; Gift Mulima, Kamuzu Central Hospital, Lilongwe, Malawi; David E. Fleischer, Mayo Clinic, Phoenix, AZ; Satish Gopal, University of North Carolina, Chapel Hill, NC; Prasad G. Iyer and Mark D. Topazian, Mayo Clinic, Rochester, MN; Violet Kayamba and Paul Kelly, University of Zambia, Lusaka, Zambia; Paul Kelly, Queen Mary University of London; Christopher G. Mathew, King’s College London, London, United Kingdom; Maria E. Leon, Daniel Middleton, Joachim Schüz, and Valerie McCormack, International Agency for Research on Cancer, Lyon, France; Christopher G. Mathew, University of the Witwatersrand, Johannesburg; and M. Iqbal Parker, University of Cape Town, Cape Town, South Africa
| | - Russell E. White
- Katherine Van Loon, University of California, San Francisco, San Francisco, CA; Michael M. Mwachiro, Stephen L. Burgert, and Russell E. White, Tenwek Hospital, Bomet; Diana Menya, Moi University, Eldoret, Kenya; Christian C. Abnet, Gwen Murphy, Natalie Pritchett, and Sanford M. Dawsey, National Cancer Institute, Bethesda, MD; Larry Akoko, Elia Mmbaga, Beatrice Mushi, and Ally Mwanga, Muhimbili University of Health and Allied Sciences, Dar es Salaam; Blandina T. Mmbaga and Amos Mwasamwaja, Kilimanjaro Clinical Research Institute, Moshi, Tanzania; Mathewos Assefa, Addis Ababa University, Addis Ababa, Ethiopia; Steady Chasimpha and Charles Dzamalala, Queen Elizabeth Central Hospital; Charles Dzamalala, Satish Gopal, Bongani Kaimila, and Yohannie Mlombe, University of Malawi College of Medicine, Blantyre; Gift Mulima, Kamuzu Central Hospital, Lilongwe, Malawi; David E. Fleischer, Mayo Clinic, Phoenix, AZ; Satish Gopal, University of North Carolina, Chapel Hill, NC; Prasad G. Iyer and Mark D. Topazian, Mayo Clinic, Rochester, MN; Violet Kayamba and Paul Kelly, University of Zambia, Lusaka, Zambia; Paul Kelly, Queen Mary University of London; Christopher G. Mathew, King’s College London, London, United Kingdom; Maria E. Leon, Daniel Middleton, Joachim Schüz, and Valerie McCormack, International Agency for Research on Cancer, Lyon, France; Christopher G. Mathew, University of the Witwatersrand, Johannesburg; and M. Iqbal Parker, University of Cape Town, Cape Town, South Africa
| | - Valerie McCormack
- Katherine Van Loon, University of California, San Francisco, San Francisco, CA; Michael M. Mwachiro, Stephen L. Burgert, and Russell E. White, Tenwek Hospital, Bomet; Diana Menya, Moi University, Eldoret, Kenya; Christian C. Abnet, Gwen Murphy, Natalie Pritchett, and Sanford M. Dawsey, National Cancer Institute, Bethesda, MD; Larry Akoko, Elia Mmbaga, Beatrice Mushi, and Ally Mwanga, Muhimbili University of Health and Allied Sciences, Dar es Salaam; Blandina T. Mmbaga and Amos Mwasamwaja, Kilimanjaro Clinical Research Institute, Moshi, Tanzania; Mathewos Assefa, Addis Ababa University, Addis Ababa, Ethiopia; Steady Chasimpha and Charles Dzamalala, Queen Elizabeth Central Hospital; Charles Dzamalala, Satish Gopal, Bongani Kaimila, and Yohannie Mlombe, University of Malawi College of Medicine, Blantyre; Gift Mulima, Kamuzu Central Hospital, Lilongwe, Malawi; David E. Fleischer, Mayo Clinic, Phoenix, AZ; Satish Gopal, University of North Carolina, Chapel Hill, NC; Prasad G. Iyer and Mark D. Topazian, Mayo Clinic, Rochester, MN; Violet Kayamba and Paul Kelly, University of Zambia, Lusaka, Zambia; Paul Kelly, Queen Mary University of London; Christopher G. Mathew, King’s College London, London, United Kingdom; Maria E. Leon, Daniel Middleton, Joachim Schüz, and Valerie McCormack, International Agency for Research on Cancer, Lyon, France; Christopher G. Mathew, University of the Witwatersrand, Johannesburg; and M. Iqbal Parker, University of Cape Town, Cape Town, South Africa
| | - Sanford M. Dawsey
- Katherine Van Loon, University of California, San Francisco, San Francisco, CA; Michael M. Mwachiro, Stephen L. Burgert, and Russell E. White, Tenwek Hospital, Bomet; Diana Menya, Moi University, Eldoret, Kenya; Christian C. Abnet, Gwen Murphy, Natalie Pritchett, and Sanford M. Dawsey, National Cancer Institute, Bethesda, MD; Larry Akoko, Elia Mmbaga, Beatrice Mushi, and Ally Mwanga, Muhimbili University of Health and Allied Sciences, Dar es Salaam; Blandina T. Mmbaga and Amos Mwasamwaja, Kilimanjaro Clinical Research Institute, Moshi, Tanzania; Mathewos Assefa, Addis Ababa University, Addis Ababa, Ethiopia; Steady Chasimpha and Charles Dzamalala, Queen Elizabeth Central Hospital; Charles Dzamalala, Satish Gopal, Bongani Kaimila, and Yohannie Mlombe, University of Malawi College of Medicine, Blantyre; Gift Mulima, Kamuzu Central Hospital, Lilongwe, Malawi; David E. Fleischer, Mayo Clinic, Phoenix, AZ; Satish Gopal, University of North Carolina, Chapel Hill, NC; Prasad G. Iyer and Mark D. Topazian, Mayo Clinic, Rochester, MN; Violet Kayamba and Paul Kelly, University of Zambia, Lusaka, Zambia; Paul Kelly, Queen Mary University of London; Christopher G. Mathew, King’s College London, London, United Kingdom; Maria E. Leon, Daniel Middleton, Joachim Schüz, and Valerie McCormack, International Agency for Research on Cancer, Lyon, France; Christopher G. Mathew, University of the Witwatersrand, Johannesburg; and M. Iqbal Parker, University of Cape Town, Cape Town, South Africa
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Khazaei S, Soheylizad M, Veisani Y, Rezaeian S, Biderafsh A, Ahmadi-pishkuhi M, Khazaei S. Global Inequality in the Incidence and Mortality Rates of Esophageal Cancer: A Country-Level Analysis. Int J Cancer Manag 2018; 11. [DOI: 10.5812/ijcm.10059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Moses A, Mwafongo A, Chikasema M, Kafantenganji L, Stanely C, Chimzukira E, Kampani C, Krysiak R, Gopal S, Rosenberg NE, Shores CG, Hosseinipour MC. Risk factors for common cancers among patients at Kamuzu Central Hospital in Lilongwe, Malawi: A retrospective cohort study. Malawi Med J 2018; 29:136-141. [PMID: 28955421 PMCID: PMC5610284 DOI: 10.4314/mmj.v29i2.11] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background Little is known about risk factors for different cancers in Malawi. This study aimed to assess risk factors for and epidemiologic patterns of common cancers among patients treated at Kamuzu Central Hospital (KCH) in Lilongwe, and to determine the prevalence of Human Immunodeficiency Virus (HIV) infection in the same population. Methods We analysed data from the hospital-based KCH cancer registry, from June 2009 to September 2012, including data from a nested substudy on coinfections among cancer patients. Demographics and behavioural variables, including smoking and alcohol use, were collected through personal interviews with patients. We assessed HIV prevalence across cancer types. The distribution of cancer types was reported overall and by gender. Logistic regression was used to assess risk factors associated with common cancer types. Results Data from 504 registered cancer patients were included—300 (59.5%) were female and 204 (40.5%) were male. Mean age was 49 years (standard deviation, SD = 16). There were 343 HIV-negative patients (71.2%), and 139 (28.8%) were HIV-positive. The commonest cancers were oesophageal (n = 172; 34.5%), cervical (n = 109; 21.9%), and Kaposi's sarcoma (KS) (n = 52; 10.4%). Only 18% of cancer cases were histologically confirmed. Patients with oesophageal cancer were likely to be older than 50 years (odds ratio, OR = 2.22), male (OR = 1.47), and smokers (OR = 2.02). Kaposi's sarcoma patients had the highest odds (OR = 54.4) of being HIV-positive and were also more likely to be male (OR = 6.02) and smokers. Cervical cancer patients were more likely to be HIV-positive (OR = 2.2) and less than 50 years of age. Conclusions Age, smoking, and HIV are important risk factors for the 3 commonest cancer types (oesophageal, KS, and cervical) at this teaching hospital in Malawi. HIV is the single most important risk factor for Kaposi's sarcoma and cervical cancer.
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Affiliation(s)
- Agnes Moses
- UNC Project-Malawi, Lilongwe, Malawi.,College of Medicine, University of Malawi, Blantyre, Malawi.,Kamuzu Central Hospital, Lilongwe, Malawi
| | | | | | | | | | | | | | | | - Satish Gopal
- UNC Project-Malawi, Lilongwe, Malawi.,University of North Carolina, Chapel Hill, North Carolina, USA.,College of Medicine, University of Malawi, Blantyre, Malawi.,Kamuzu Central Hospital, Lilongwe, Malawi
| | - Nora E Rosenberg
- UNC Project-Malawi, Lilongwe, Malawi.,University of North Carolina, Chapel Hill, North Carolina, USA
| | - Carol G Shores
- UNC Project-Malawi, Lilongwe, Malawi.,University of North Carolina, Chapel Hill, North Carolina, USA
| | - Mina C Hosseinipour
- UNC Project-Malawi, Lilongwe, Malawi.,University of North Carolina, Chapel Hill, North Carolina, USA.,College of Medicine, University of Malawi, Blantyre, Malawi
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Pritchett NR, Burgert SL, Murphy GA, Brockman JD, White RE, Lando J, Chepkwony R, Topazian MD, Abnet CC, Dawsey SM, Mwachiro MM. Cross sectional study of serum selenium concentration and esophageal squamous dysplasia in western Kenya. BMC Cancer 2017; 17:835. [PMID: 29216866 PMCID: PMC5721656 DOI: 10.1186/s12885-017-3837-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 11/23/2017] [Indexed: 12/13/2022] Open
Abstract
Background Low serum selenium status has been associated with increased risk of esophageal squamous cell carcinoma (ESCC). East Africa is a region of high ESCC incidence and is known to have low soil selenium levels, but this association has not previously been evaluated. In this study we assessed the association of serum selenium concentration and the prevalence of esophageal squamous dysplasia (ESD), the precursor lesion of ESCC, in a cross-sectional study of subjects from Bomet, Kenya. Methods 294 asymptomatic adult residents of Bomet, Kenya completed questionnaires and underwent endoscopy with Lugol’s iodine staining and biopsy for detection of ESD. Serum selenium concentrations were measured by instrumental neutron activation analysis. Odds ratios (OR) and confidence intervals (95% CI) for associations between serum selenium and ESD were calculated using unconditional logistic regression. Results The mean serum selenium concentration was 85.5 (±28.3) μg/L. Forty-two ESD cases were identified (14% of those screened), including 5 (12%) in selenium quartile 1 (Q1), 5 (12%) in Q2, 15 (36%) in Q3, and 17 (40%) in Q4. Higher serum selenium was associated with prevalence of ESD (Q4 vs Q1: OR: 3.03; 95% CI: 1.05–8.74) and this association remained after adjusting for potential confounders (Q4 vs Q1: OR: 3.87; 95% CI: 1.06–14.19). Conclusion This is the first study to evaluate the association of serum selenium concentration and esophageal squamous dysplasia in an African population at high risk for ESCC. We found a positive association between higher serum selenium concentration and prevalence of ESD, an association contrary to our original hypothesis. Further work is needed to better understand the role of selenium in the etiology of ESCC in this region, and to develop effective ESCC prevention and control strategies.
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Affiliation(s)
| | | | | | - John D Brockman
- University of Missouri Research Reactor Center, Columbia, MO, USA
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Kigen G, Busakhala N, Kamuren Z, Rono H, Kimalat W, Njiru E. Factors associated with the high prevalence of oesophageal cancer in Western Kenya: a review. Infect Agent Cancer 2017; 12:59. [PMID: 29142587 PMCID: PMC5670732 DOI: 10.1186/s13027-017-0169-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 10/25/2017] [Indexed: 12/19/2022] Open
Abstract
Oesophageal carcinoma (OC) is highly prevalent in Western Kenya especially among the members of the Kalenjin community who reside in the Northern and Southern areas of the Rift Valley. Previous authors have suggested potential association of environmental and genetic risk factors with this high prevalence. The environmental factors that have been suggested include contamination of food by mycotoxins and/or pesticides, consumption of traditional alcohol (locally referred to “Busaa” and “Chan’gaa”), use of fermented milk (“Mursik”), poor diet, tobacco use and genetic predisposition. The aim of this paper is to critically examine the potential contribution of each of the factors that have been postulated to be associated with the high prevalence of the disease in order to establish the most likely cause. We have done this by analyzing the trends, characteristics and behaviours that are specifically unique in the region, and corroborated this with the available literature. From our findings, the most plausible cause of the high incidence of OC among the Kalenjin community is mycotoxins, particularly fumonisins from the food chain resulting from poor handling of cereals; particularly maize combined with traditional alcohol laced with the toxins interacting synergistically with other high-risk factors such as dietary deficiencies associated alcoholism and viral infections, especially HPV. Urgent mitigating strategies should be developed in order to minimize the levels of mycotoxins in the food chain.
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Affiliation(s)
- Gabriel Kigen
- Department of Pharmacology & Toxicology; Department of Hematology & Oncology, Moi University School of Medicine, P.O. Box 4606-30100, Eldoret, Kenya
| | - Naftali Busakhala
- Department of Pharmacology & Toxicology; Department of Hematology & Oncology, Moi University School of Medicine, P. O. Box 4606-30100, Eldoret, Kenya
| | - Zipporah Kamuren
- Department of Pharmacology & Toxicology, Moi University School of Medicine, P.O. Box 4606-30100, Eldoret, Kenya
| | - Hillary Rono
- Kitale County Hospital; London School of Tropical Medicine & Hygiene, P.O. Box 98-30200, Kitale, Kenya
| | - Wilfred Kimalat
- Retired Permanent Secretary, Ministry of Education, Science & Technology, Provisional Administration & Internal Security, Office of the President, P. O. Box 28467-00200, Nairobi, Kenya
| | - Evangeline Njiru
- Department of Internal Medicine; Department of Hematology and Oncology, Moi University School of Medicine, P.O. Box 4606, Eldoret, 30100 Kenya
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Abstract
Oesophageal cancer (OC) is responsible for the second highest number of cancer-related deaths in South Africa (SA). Squamous cell carcinoma is the most prevalent type with an incidence of 46.7/100,000 and 19.2/100,000 for males and females. This is a systematic review of the clinical diagnosis and management of OC within the South African context. This protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) (registration number CRD42016034053) with adherence to PRISMA guidelines. An online search was performed using MEDLINE, EBSCOHost and PubMed. Eligibility criteria for articles included published, original peer-reviewed research addressing clinical management of oesophageal cancer in South Africa. Review articles, case reports, scientific letters and studies published in languages other than English or Afrikaans were excluded. The research terms were 'etiology', 'human', 'esophageal cancer', 'esophageal carcinoma', 'oesophageal cancer', and 'oesophageal carcinoma', 'squamous cell carcinoma', 'Africa' and 'South Africa'. A total of 336 articles were identified. Of these, 146 were immediately excluded and a further 159 were excluded after review. A total of 31 appropriate articles, i.e. 9.2% of searched articles, were included. Thirteen articles addressed chemotherapy and/or radiotherapy, 9 oesophageal luminal therapy, 7 oesophageal surgery and 2 screening. OC research of in SA over the last two decades has mainly been in the form of reviews and opinion papers. Clinical research, auditing and prospectively analysing OC management and outcomes in SA hospitals are sorely needed and should be promoted by both healthcare workers and policy makers alike.
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Affiliation(s)
- E Loots
- Department of Surgery, Inkosi Albert Luthuli Central Hospital, Durban, South Africa.
- Department of Surgery, University of KwaZulu-Natal, Private Bag 7, Congella, Durban, 4013, South Africa.
| | - B Sartorius
- Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
- Gastrointestinal Cancer Research Centre, University of KwaZulu-Natal, Durban, South Africa
| | - T E Madiba
- Department of Surgery, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
- Department of Surgery, University of KwaZulu-Natal, Private Bag 7, Congella, Durban, 4013, South Africa
- Gastrointestinal Cancer Research Centre, University of KwaZulu-Natal, Durban, South Africa
| | - C J J Mulder
- Department of Hepatogastroenterology, VU University Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - D L Clarke
- Department of Surgery, University of KwaZulu-Natal, Private Bag 7, Congella, Durban, 4013, South Africa
- Department of General Surgery, Grey's Hospital, Pietermaritzburg, South Africa
- Department of General Surgery, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
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Murphy G, McCormack V, Abedi-Ardekani B, Arnold M, Camargo MC, Dar NA, Dawsey SM, Etemadi A, Fitzgerald RC, Fleischer DE, Freedman ND, Goldstein AM, Gopal S, Hashemian M, Hu N, Hyland PL, Kaimila B, Kamangar F, Malekzadeh R, Mathew CG, Menya D, Mulima G, Mwachiro MM, Mwasamwaja A, Pritchett N, Qiao YL, Ribeiro-Pinto LF, Ricciardone M, Schüz J, Sitas F, Taylor PR, Van Loon K, Wang SM, Wei WQ, Wild CP, Wu C, Abnet CC, Chanock SJ, Brennan P. International cancer seminars: a focus on esophageal squamous cell carcinoma. Ann Oncol 2017; 28:2086-2093. [PMID: 28911061 PMCID: PMC5834011 DOI: 10.1093/annonc/mdx279] [Citation(s) in RCA: 133] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The International Agency for Research on Cancer (IARC) and the US National Cancer Institute (NCI) have initiated a series of cancer-focused seminars [Scelo G, Hofmann JN, Banks RE et al. International cancer seminars: a focus on kidney cancer. Ann Oncol 2016; 27(8): 1382-1385]. In this, the second seminar, IARC and NCI convened a workshop in order to examine the state of the current science on esophageal squamous cell carcinoma etiology, genetics, early detection, treatment, and palliation, was reviewed to identify the most critical open research questions. The results of these discussions were summarized by formulating a series of 'difficult questions', which should inform and prioritize future research efforts.
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Affiliation(s)
- G. Murphy
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda Maryland, USA
| | | | | | - M. Arnold
- Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - M. C. Camargo
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda Maryland, USA
| | - N. A. Dar
- Department of Biochemistry, University of Kashmir, Hazratbal, Srinagar, Jammu and Kashmir, India
| | - S. M. Dawsey
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda Maryland, USA
| | - A. Etemadi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda Maryland, USA
| | - R. C. Fitzgerald
- MRC Cancer Unit, Hutchison-MRC Research Centre, University of Cambridge, Cambridge, UK
| | - D. E. Fleischer
- Department of Internal Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | - N. D. Freedman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda Maryland, USA
| | - A. M. Goldstein
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda Maryland, USA
| | - S. Gopal
- University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - M. Hashemian
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda Maryland, USA
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - N. Hu
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda Maryland, USA
| | - P. L. Hyland
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda Maryland, USA
| | - B. Kaimila
- University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - F. Kamangar
- Department of Public Health Analysis, School of Community Health and Policy, Morgan State University, Baltimore, Maryland, USA
| | - R. Malekzadeh
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - C. G. Mathew
- Department of Medical and Molecular Genetics, Kings College London
- Sydney Brenner Institute for Molecular Bioscience, University of Witwatersrand, Johannesburg, South Africa
| | - D. Menya
- School of Public Health, Moi University, Eldoret, Kenya
| | - G. Mulima
- University of North Carolina Project-Malawi, Lilongwe, Malawi
| | | | - A. Mwasamwaja
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - N. Pritchett
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda Maryland, USA
| | - Y.-L. Qiao
- Department of Etiology and Carcinogenesis & Department of Cancer Epidemiology, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - L. F. Ribeiro-Pinto
- Molecular Carcinogenesis Program, Institute Nacional de Cancer, Sao Paulo, Brazil
| | - M. Ricciardone
- National Cancer Institute, Center for Global Health, National Institutes of Health, Bethesda, Maryland, USA
| | - J. Schüz
- Section of Environment and Radiation
| | - F. Sitas
- School of Public Health, University of Sydney, New South Wales, Australia
- School of Public Health & Community Medicine, University of New South Wales, Sydney, Australia
| | - P. R. Taylor
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda Maryland, USA
| | - K. Van Loon
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California, USA
| | - S.-M. Wang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda Maryland, USA
- Department of Etiology and Carcinogenesis & Department of Cancer Epidemiology, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - W.-Q. Wei
- Department of Etiology and Carcinogenesis & Department of Cancer Epidemiology, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - C. P. Wild
- Director's office, International Agency for Research on Cancer, Lyon, France
| | - C. Wu
- Department of Etiology and Carcinogenesis & Department of Cancer Epidemiology, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - C. C. Abnet
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda Maryland, USA
| | - S. J. Chanock
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda Maryland, USA
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Chasimpha SJ, Parkin DM, Masamba L, Dzamalala CP. Three-year cancer incidence in Blantyre, Malawi (2008-2010). Int J Cancer 2017; 141:694-700. [PMID: 28493322 PMCID: PMC5999322 DOI: 10.1002/ijc.30777] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 03/30/2017] [Accepted: 04/26/2017] [Indexed: 12/11/2022]
Abstract
In this paper, we present incidence rates of different cancers calculated for the population of Blantyre, Malawi for the period 2008-2010, using data from the Malawi Cancer Registry. Active methods were used for case finding, with standard checks for accuracy and validity performed in CanReg 4. During this 3-year period, a total of 3,711 cases were registered comprising 1,643 men (an estimated age-standardized incidence rate (ASR) of 169.8 per 100,000) and 2,068 women (ASR 238.7 per 105 ). Kaposi sarcoma (KS) was the most common cancer in men (40.5% of all cancers in men; ASR 54.0 per 105 ) while cervical cancer was the commonest in women (33.3%; ASR 88.6 per 105 ). The incidence rates for esophageal cancer remain one of the highest in the world (ASR 30.9 per 100,000 in men, 22.1 per 100,000 in women). Incidence of cancer of the prostate is relatively low in Blantyre (5.1%; ASR 16.4 per 105 ), compared with elsewhere in Africa. In childhood, the cancer spectrum is dominated by Burkitt lymphoma (32.5% ASR 90.9 per 106 ) followed by Wilms tumor (11.3%; ASR 35.9 per 106 ) and pediatric KS (11.0%; ASR 31.1 per 106 ). The overall percentage of cases with histological verification was 47.5%, a slight improvement from 42.4% in late 1990s also indicating successful case finding outside laboratories.
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Affiliation(s)
| | | | - Leo Masamba
- Cancer Unit, Queen Elizabeth Hospital, Blantyre, Malawi
| | - Charles P. Dzamalala
- Malawi Cancer Registry, Queen Elizabeth Hospital, Blantyre, Malawi
- Department of Pathology, College of Medicine, Blantyre, Malawi
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Odera JO, Odera E, Githang’a J, Walong EO, Li F, Xiong Z, Chen XL. Esophageal cancer in Kenya. Am J Dig Dis (Madison) 2017; 4:23-33. [PMID: 29082268 PMCID: PMC5659304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Kenya belongs to a high incidence region known as Africa's esophageal cancer (EC) corridor. It has one of the highest incidence rates of EC worldwide, but research on EC in Kenya has gone highly unnoticed. EC in Kenya is unique in its high percentage of young cases (< 30 years of age). In this review, we show the current status of EC in the country. We mainly focus on significant risk factors such as alcohol drinking, genetic factors, malnutrition and hot food/drink. Future directions in the study and prevention of EC in Kenya are also discussed.
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Affiliation(s)
- Joab Otieno Odera
- Cancer Research Program, JLC-BBRI, North Carolina Central University, Durham 27707, NC, USA
- Integrated Biosciences PhD Program, North Carolina Central University, Durham 27707, NC, USA
| | - Elizabeth Odera
- Department of Human Pathology, University of Nairobi, P. O. Box 19676, Kenyatta National Hospital, Nairobi 00202, Kenya
| | - Jessie Githang’a
- Department of Human Pathology, University of Nairobi, P. O. Box 19676, Kenyatta National Hospital, Nairobi 00202, Kenya
| | - Edwin Oloo Walong
- Department of Human Pathology, University of Nairobi, P. O. Box 19676, Kenyatta National Hospital, Nairobi 00202, Kenya
| | - Fang Li
- Cancer Research Program, JLC-BBRI, North Carolina Central University, Durham 27707, NC, USA
- Department of Dentistry, Dalian University Affiliated Zhongshan Hospital, 6 Jiefang Street, Zhongshan District, Dalian 116001, Liaoning Province, China
| | - Zhaohui Xiong
- Cancer Research Program, JLC-BBRI, North Carolina Central University, Durham 27707, NC, USA
| | - Xiaoxin Luke Chen
- Cancer Research Program, JLC-BBRI, North Carolina Central University, Durham 27707, NC, USA
- Center for Esophageal Disease and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill 27519, NC, USA
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Mmbaga EJ, Deardorff KV, Mushi B, Mgisha W, Merritt M, Hiatt RA, Mwaiselage J, Zhang L, Van Loon K. Characteristics of Esophageal Cancer Cases in Tanzania. J Glob Oncol 2017; 4:1-10. [PMID: 30241222 PMCID: PMC6180793 DOI: 10.1200/jgo.2016.006619] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose Age-standardized incidence rates for esophageal cancer (EC) in East Africa
have been reported as disproportionately high compared with the worldwide
incidence of nine per 100,000 population. This study aimed to characterize
EC cases seen at Muhimbili National Hospital and Ocean Road Cancer Institute
in Dar es Salaam, Tanzania. Methods Demographic, clinical, and treatment variables were abstracted from charts of
patients who received care for a diagnosis of EC at one or both institutions
between 2011 and 2013. Categorical data were summarized as frequency counts
and percentages. Continuous data were presented as medians and ranges. To
compare men and women, Pearson’s χ2 and two-sample
t tests were applied. Results Seven hundred thirty-eight unique cases of EC were identified, of whom 68%
were men and the median age was 60 years (range, 19 to 95 years). Notably,
93 cases (13%) were ≤ 40 years old at diagnosis. Squamous cell
carcinoma was the dominant histology, comprising 90% of cases with
documented histopathology. However, 34% of cases with a diagnosis of EC were
not pathologically confirmed. The stage was documented as locoregional in 4%
of cases, locally advanced in 20% of cases, metastatic in 14% of cases, and
unknown in 63% of cases. Of 430 patients who received treatment at Ocean
Road Cancer Institute, 76% were treated with radiation, 44% were treated
with chemotherapy, 3% underwent a cancer-related surgical procedure, and 10%
of cases received no cancer-directed therapy. The median overall survival
for all patients was 6.9 months (95% CI, 5.0 to 12.8), regardless of stage
at presentation. Conclusion Between 2011 and 2013, cases of EC represented a large clinical burden at
both institutions.
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Affiliation(s)
- Elia J Mmbaga
- Elia J. Mmbaga, Beatrice Mushi, and William Mgisha, Muhimbili University of Health and Allied Sciences; Julius Mwaiselage, Ocean Road Cancer Institute, Dar es Salaam, Tanzania; Katrina V. Deardorff, Megan Merritt, Robert A. Hiatt, Li Zhang, and Katherine Van Loon, University of California, San Francisco, San Francisco, CA
| | - Katrina V Deardorff
- Elia J. Mmbaga, Beatrice Mushi, and William Mgisha, Muhimbili University of Health and Allied Sciences; Julius Mwaiselage, Ocean Road Cancer Institute, Dar es Salaam, Tanzania; Katrina V. Deardorff, Megan Merritt, Robert A. Hiatt, Li Zhang, and Katherine Van Loon, University of California, San Francisco, San Francisco, CA
| | - Beatrice Mushi
- Elia J. Mmbaga, Beatrice Mushi, and William Mgisha, Muhimbili University of Health and Allied Sciences; Julius Mwaiselage, Ocean Road Cancer Institute, Dar es Salaam, Tanzania; Katrina V. Deardorff, Megan Merritt, Robert A. Hiatt, Li Zhang, and Katherine Van Loon, University of California, San Francisco, San Francisco, CA
| | - William Mgisha
- Elia J. Mmbaga, Beatrice Mushi, and William Mgisha, Muhimbili University of Health and Allied Sciences; Julius Mwaiselage, Ocean Road Cancer Institute, Dar es Salaam, Tanzania; Katrina V. Deardorff, Megan Merritt, Robert A. Hiatt, Li Zhang, and Katherine Van Loon, University of California, San Francisco, San Francisco, CA
| | - Megan Merritt
- Elia J. Mmbaga, Beatrice Mushi, and William Mgisha, Muhimbili University of Health and Allied Sciences; Julius Mwaiselage, Ocean Road Cancer Institute, Dar es Salaam, Tanzania; Katrina V. Deardorff, Megan Merritt, Robert A. Hiatt, Li Zhang, and Katherine Van Loon, University of California, San Francisco, San Francisco, CA
| | - Robert A Hiatt
- Elia J. Mmbaga, Beatrice Mushi, and William Mgisha, Muhimbili University of Health and Allied Sciences; Julius Mwaiselage, Ocean Road Cancer Institute, Dar es Salaam, Tanzania; Katrina V. Deardorff, Megan Merritt, Robert A. Hiatt, Li Zhang, and Katherine Van Loon, University of California, San Francisco, San Francisco, CA
| | - Julius Mwaiselage
- Elia J. Mmbaga, Beatrice Mushi, and William Mgisha, Muhimbili University of Health and Allied Sciences; Julius Mwaiselage, Ocean Road Cancer Institute, Dar es Salaam, Tanzania; Katrina V. Deardorff, Megan Merritt, Robert A. Hiatt, Li Zhang, and Katherine Van Loon, University of California, San Francisco, San Francisco, CA
| | - Li Zhang
- Elia J. Mmbaga, Beatrice Mushi, and William Mgisha, Muhimbili University of Health and Allied Sciences; Julius Mwaiselage, Ocean Road Cancer Institute, Dar es Salaam, Tanzania; Katrina V. Deardorff, Megan Merritt, Robert A. Hiatt, Li Zhang, and Katherine Van Loon, University of California, San Francisco, San Francisco, CA
| | - Katherine Van Loon
- Elia J. Mmbaga, Beatrice Mushi, and William Mgisha, Muhimbili University of Health and Allied Sciences; Julius Mwaiselage, Ocean Road Cancer Institute, Dar es Salaam, Tanzania; Katrina V. Deardorff, Megan Merritt, Robert A. Hiatt, Li Zhang, and Katherine Van Loon, University of California, San Francisco, San Francisco, CA
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Yan Y, Zhou K, Wang L, Wang F, Chen X, Fan Q. Clinical significance of serum cathepsin B and cystatin C levels and their ratio in the prognosis of patients with esophageal cancer. Onco Targets Ther 2017; 10:1947-1954. [PMID: 28435284 PMCID: PMC5388217 DOI: 10.2147/ott.s123042] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE The main purpose of this study was to analyze the serum cathepsin B (CTSB) and cystatin C (CysC) levels in patients with esophageal carcinoma and their correlation with the clinical indices and prognosis. METHODS The serum levels of CTSB and CysC from 56 patients with esophageal carcinoma and 30 healthy donors were determined preoperatively by using enzyme-linked immunosor-bent assay. The correlation between CTSB and CysC was evaluated by Spearman correlation coefficient test. Kaplan-Meier survival curves were plotted, while the survival rates were compared using the log-rank test. Univariate and multivariate analyses of prognostic factors for survival were performed using the Cox proportional hazard regression model with a 95% confidence interval. RESULTS CTSB (38.35±4.3 ng/mL) and CysC (703.96±23.6 ng/mL) levels were significantly higher in the sera of the patients than in controls. A significant correlation was observed between CTSB and CysC (r=0.754, P<0.001). The levels of CTSB and CysC/CTSB in the patient serum significantly correlated with the T status. CysC/CTSB ratio was also found to be significantly correlated with lymph node metastasis. None of the parameters were observed to be related to CysC, including age, gender, pathologic type, tumor differentiation and tumor invasion depth. Kaplan-Meier analysis showed that patients with higher levels of CysC/CTSB and negative lymph node metastasis experienced significantly longer overall survival time, whereas patients with higher CSTB levels tended to live shorter, although the difference was not statistically significant (P=0.081). CONCLUSION Serum CTSB and CysC levels are of diagnostic significance in esophageal cancer. The ratio of serum CysC/CTSB is prognostic for the survival of esophageal carcinoma patients.
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Affiliation(s)
| | | | | | | | - Xinfeng Chen
- Department of Biotherapy Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China
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Da C, Wu L, Liu Y, Wang R, Li R. Effects of irradiation on radioresistance, HOTAIR and epithelial-mesenchymal transition/cancer stem cell marker expression in esophageal squamous cell carcinoma. Oncol Lett 2017; 13:2751-2757. [PMID: 28454462 DOI: 10.3892/ol.2017.5774] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 09/22/2016] [Indexed: 12/29/2022] Open
Abstract
Radiotherapy is a common therapeutic strategy used to treat esophageal squamous cell carcinoma (ESCC). However, tumor cells often develop radioresistance, thereby reducing treatment efficacy. Here, we aimed to identify the mechanisms through which ESCC cells develop radioresistance and identify associated biomarkers. Eca109 cells were exposed to repeated radiation at 2 Gy/fraction for a total dose of 60 Gy (Eca109R60/2Gy cells). MTT and colony formation assays were performed to measure cell proliferation and compare the radiation biology parameters of Eca109 and Eca109R60/2Gy cells. Cell cycle distributions and apoptosis were assessed by flow cytometry. Reverse transcription-quantitative polymerase chain reaction and western blotting were employed to analyze the expression of HOX transcript antisense RNA (HOTAIR), in addition to biomarkers of the epithelial-mesenchymal transition (EMT) and cancer stem cells (CSCs). Eca109R60/2Gy cells exhibited increased cell proliferation and clone formation, with significantly higher radiobiological parameters compared with the parental Eca109 cells. The Eca109R60/2Gy cells also exhibited significantly decreased accumulation in G2 phase and increased accumulation in S phase. Additionally, the apoptosis rate was significantly lower in Eca109R60/2Gy cells than in parental Eca109 cells. Finally, HOTAIR expression levels and SNAI1 and β-catenin mRNA and protein expression levels were significantly higher, whereas E-cadherin levels were significantly lower in Eca109R60/2Gy cells than in Eca109 cells. Therefore, our findings demonstrated that radioresistance was affected by the expression of HOTAIR and biomarkers of the EMT and CSCs.
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Affiliation(s)
- Chunli Da
- Radiotherapy Center, Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830000, P.R. China
| | - Li Wu
- Radiotherapy Center, Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830000, P.R. China
| | - Yuting Liu
- Department of Anesthesiology, Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830000, P.R. China
| | - Ruozheng Wang
- Radiotherapy Center, Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830000, P.R. China
| | - Ruiguang Li
- Endoscopic Diagnosis and Treatment Center, Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830000, P.R. China
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Korir A, Yu Wang E, Sasieni P, Okerosi N, Ronoh V, Maxwell Parkin D. Cancer risks in Nairobi (2000-2014) by ethnic group. Int J Cancer 2017; 140:788-797. [PMID: 27813082 DOI: 10.1002/ijc.30502] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Revised: 10/03/2016] [Accepted: 10/19/2016] [Indexed: 01/18/2023]
Abstract
We investigated the ethnic differences in the risk of several cancers in the population of Nairobi, Kenya, using data from the Nairobi Cancer Registry. The registry records the variable "Tribe" for each case, a categorisation that includes, as well as 22 tribal groups, categories for Kenyans of European and of Asian origin, and non-Kenyan Africans. Tribes included in the final analysis were Kikuyu, Kamba, Kisii, Kalenjin, Luo, Luhya, Somalis, Asians, non-Kenyans, Caucasians, Other tribes and unknown. The largest group was taken as the reference category for the calculation of odds ratios; this was African Kenyans (for comparisons by race), and Kikuyus (the tribe with the largest numbers of cancer registrations (38% of the total)) for comparisons between the Kenyan tribes. P-values are obtained from the Wald test. Cancers that were more common among the white population than in black Kenyans were skin cancers and cancers of the bladder, while cancers that are more common in Kenyan Asians include colorectal, lung, breast, ovary, corpus uteri and non-Hodgkin lymphoma. Cancers that were less common among Asians and Caucasians were oesophagus, stomach and cervix cancer. Within the African population, there were marked differences in cancer risk by tribe. Among the tribes of Bantu ethnicity, the Kamba had higher risks of melanoma, Kaposi sarcoma, liver and cervix cancer, and lower risks of oesophagus, stomach, corpus uteri and nervous system cancers. Luo and Luhya had much higher odds of Kaposi sarcoma and Burkitt lymphoma.
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Affiliation(s)
- Anne Korir
- Nairobi Cancer Registry, Kenya Medical Research Institute, Nairobi, Kenya
| | - Emma Yu Wang
- Centre for Cancer Prevention, Wolfson Institute, Queen Mary University, London, United Kingdom
| | - Peter Sasieni
- Centre for Cancer Prevention, Wolfson Institute, Queen Mary University, London, United Kingdom
| | - Nathan Okerosi
- Nairobi Cancer Registry, Kenya Medical Research Institute, Nairobi, Kenya
| | - Victor Ronoh
- Nairobi Cancer Registry, Kenya Medical Research Institute, Nairobi, Kenya
| | - D Maxwell Parkin
- Clinical Trials Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, United Kingdom
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McCormack VA, Menya D, Munishi MO, Dzamalala C, Gasmelseed N, Leon Roux M, Assefa M, Osano O, Watts M, Mwasamwaja AO, Mmbaga BT, Murphy G, Abnet CC, Dawsey SM, Schüz J. Informing etiologic research priorities for squamous cell esophageal cancer in Africa: A review of setting-specific exposures to known and putative risk factors. Int J Cancer 2017; 140:259-271. [PMID: 27466161 PMCID: PMC5763498 DOI: 10.1002/ijc.30292] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 07/08/2016] [Indexed: 12/30/2022]
Abstract
Esophageal squamous cell carcinoma (ESCC) is one of the most common cancers in most Eastern and Southern African countries, but its etiology has been understudied to date. To inform its research agenda, we undertook a review to identify, of the ESCC risk factors which have been established or strongly suggested worldwide, those with a high prevalence or high exposure levels in any ESCC-affected African setting and the sources thereof. We found that for almost all ESCC risk factors known to date, including tobacco, alcohol, hot beverage consumption, nitrosamines and both inhaled and ingested PAHs, there is evidence of population groups with raised exposures, the sources of which vary greatly between cultures across the ESCC corridor. Research encompassing these risk factors is warranted and is likely to identify primary prevention strategies.
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Affiliation(s)
- V A McCormack
- Section of Environment and Radiation, International Agency for Research on Cancer (IARC), Lyon, France
| | - D Menya
- School of Public Health, Moi University, Eldoret, Kenya
| | - M O Munishi
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - C Dzamalala
- College of Medicine, University of Malawi, Blantyre, Malawi
- Malawi Cancer Registry, Malawi
| | - N Gasmelseed
- National Cancer Institute, University of Gezira, Sudan
- Faculty of Science, University of Hafr Al Batin, Saudi Arabia
| | - M Leon Roux
- Section of Environment and Radiation, International Agency for Research on Cancer (IARC), Lyon, France
| | - M Assefa
- Radiotherapy Center, Addis-Ababa-University, Addis Ababa, Ethiopia
| | - O Osano
- School of Environmental Studies, University of Eldoret, Kenya
| | - M Watts
- Inorganic Chemistry, Centre for Environmental Geochemistry, British Geological Survey, Nottingham, United Kingdom
| | - A O Mwasamwaja
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - B T Mmbaga
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - G Murphy
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - C C Abnet
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - S M Dawsey
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - J Schüz
- Section of Environment and Radiation, International Agency for Research on Cancer (IARC), Lyon, France
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Wang Z, Lu H, Wu L, Yuan B, Liu J, Shi H, Wang F. Long-term outcomes of endoscopic multiband mucosectomy for early esophageal squamous cell neoplasia: a retrospective, single-center study. Gastrointest Endosc 2016; 84:893-899. [PMID: 27108060 DOI: 10.1016/j.gie.2016.04.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 04/07/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Endoscopic multiband mucosectomy (EMBM) has been used to treat early Barrett's esophagus and esophagogastric junction neoplasia, yet it is seldom reported for the treatment of early esophageal squamous cell neoplasia. Here we retrospectively evaluated the feasibility, safety, and efficacy of EMBM for early esophageal squamous cell neoplasia. METHODS A total of 125 patients were included in the study. Lesions were delineated using electrocoagulation and resected using the EMBM technique. The primary outcomes were local recurrence and adverse events. Secondary outcomes were histology of the endoscopic resection specimens, specimen area, and speed of resection. All patients were followed up endoscopically. RESULTS There were 135 esophageal lesions, of which 40 were pathologically diagnosed as low-grade intraepithelial neoplasia, 57 as high-grade intraepithelial neoplasia, 34 as early esophageal cancer, and 4 as squamous epithelium without neoplasia. No severe adverse events were observed, except for 1 perforation, which was treated by application of clips. The median follow-up was 27.75 months. Three patients had local recurrence and were endoscopically treated again. Local recurrence rate was 2.4% (3/125). No deaths occurred during the follow-up. All specimens were visible with a dividing rule, and the mean specimen area was 4.63 cm2. Mean operation time was 31.2 ± 17.4 minutes. Mean speed of resection was 6.74 min/cm2. CONCLUSIONS EMBM seems to be effective and safe for patients with early esophageal squamous cell neoplasia. The long-term recurrence rate is low.
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Affiliation(s)
- Zhenkai Wang
- Department of Gastroenterology and Hepatology, Jinling Hospital, Nanjing, Jiangsu Province, China
| | - Heng Lu
- Department of Gastroenterology and Hepatology, Jinling Hospital, Nanjing, Jiangsu Province, China
| | - Lin Wu
- Department of Gastroenterology and Hepatology, Jinling Hospital, Nanjing, Jiangsu Province, China
| | - Boshi Yuan
- Department of Gastroenterology and Hepatology, Jinling Hospital, Nanjing, Jiangsu Province, China
| | - Jiong Liu
- Department of Gastroenterology and Hepatology, Jinling Hospital, Nanjing, Jiangsu Province, China
| | - Hui Shi
- Department of Gastroenterology and Hepatology, Jinling Hospital, Nanjing, Jiangsu Province, China
| | - Fangyu Wang
- Department of Gastroenterology and Hepatology, Jinling Hospital, Nanjing, Jiangsu Province, China
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46
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Arnold M, Leitzmann M, Freisling H, Bray F, Romieu I, Renehan A, Soerjomataram I. Obesity and cancer: An update of the global impact. Cancer Epidemiol 2016; 41:8-15. [PMID: 26775081 DOI: 10.1016/j.canep.2016.01.003] [Citation(s) in RCA: 177] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 12/28/2015] [Accepted: 01/03/2016] [Indexed: 02/06/2023]
Abstract
In view of the growing global obesity epidemic, this paper reviews the relation between recent trends in body mass index (BMI) and the changing profile of cancer worldwide. By examining seven selected countries, each representing a world region, a pattern of increasing BMI with region and gender-specific diversity is noted: increasing levels of BMI were most pronounced in the Middle East (Saudi Arabia), rather modest in Eastern Asia (India) and generally more rapid in females than in males. This observation translates into a disproportionate distribution of cancer attributable to high levels of BMI, ranging by sex from 4-9% in Saudi Arabia and from 0.2-1.2% in India. Overweight and obesity may also influence cancer outcomes, and hence have a varying impact on cancer survival and death in different world regions. Future challenges in cancer studies exploring the association with overweight and obesity concern the measurement of adiposity and its potentially cumulative effect over the life course. Given the limitations of BMI as an imperfect measure of body fatness, routine anthropometric data collection needs to be extended to develop more informative measures, such as waist circumference in settings where the gold standard tools remain unaffordable. Furthermore, questions surrounding the dose-response and timing of obesity and their associations with cancer remain to be answered. Improved surveillance of health risk factors including obesity as well as the scale and profile of cancer in every country of the world is urgently needed. This will enable the design of cost-effective actions to curb the growing burden of cancer related to excess body weight.
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Affiliation(s)
- Melina Arnold
- Section of Cancer Surveillance, International Agency for Research on Cancer (IARC), Lyon, France
| | - Michael Leitzmann
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Germany
| | - Heinz Freisling
- Section of Nutrition and Metabolism, Dietary Exposure Assessment Group, International Agency for Research on Cancer (IARC), Lyon, France
| | - Freddie Bray
- Section of Cancer Surveillance, International Agency for Research on Cancer (IARC), Lyon, France
| | - Isabelle Romieu
- Section of Nutrition and Metabolism, Nutritional Epidemiology Group, International Agency for Research on Cancer (IARC), Lyon, France
| | - Andrew Renehan
- Institute of Cancer Sciences, University of Manchester, Manchester, United Kingdom
| | - Isabelle Soerjomataram
- Section of Cancer Surveillance, International Agency for Research on Cancer (IARC), Lyon, France.
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47
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Chokunonga E, Windridge P, Sasieni P, Borok M, Parkin DM. Black-white differences in cancer risk in Harare, Zimbabwe, during 1991-2010. Int J Cancer 2016; 138:1416-21. [PMID: 26437451 DOI: 10.1002/ijc.29883] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 09/12/2015] [Accepted: 09/15/2015] [Indexed: 01/07/2023]
Abstract
Data from 20 years of cancer registration in Harare (Zimbabwe) are used to investigate the risk of cancer in the white population of the city (of European origin), relative to that in blacks (of African origin). In the absence of information on the respective populations-at-risk, we calculated odds of each major cancer among all cancers, and took the odds ratios of whites to blacks. Some major differences reflect obvious phenotypic differences (the very high incidence of skin cancer-melanoma and nonmelanoma--in the white population), whereas others (high rates of liver cancer, Kaposi sarcoma and conjunctival cancers in blacks) are the result of differences in exposure to infectious agents. Of particular interest are cancers related to lifestyle factors, and how the differences in risk are changing over time, as a result of evolving lifestyles. Thus, the high risk of cancers of the esophagus and cervix uteri in blacks (relative to whites) and colorectal cancers in whites show little change over time. Conversely, the odds of breast cancer, on average four times higher in whites than blacks, has shown a significant decrease in the differential over time. Cancer of the prostate, with the odds initially (1991-1997) 15% higher in whites had become 33% higher in blacks by 2004-2010.
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Affiliation(s)
- Eric Chokunonga
- Zimbabwe National Cancer Registry, Avondale, Harare, Zimbabwe
| | - Peter Windridge
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine & Dentistry, London, United Kingdom
| | - Peter Sasieni
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine & Dentistry, London, United Kingdom
| | - Margaret Borok
- Zimbabwe National Cancer Registry, Avondale, Harare, Zimbabwe
| | - D Maxwell Parkin
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine & Dentistry, London, United Kingdom
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48
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Pakzad R, Mohammadian-Hafshejani A, Khosravi B, Soltani S, Pakzad I, Mohammadian M, Salehiniya H, Momenimovahed Z. The incidence and mortality of esophageal cancer and their relationship to development in Asia. Ann Transl Med 2016; 4:29. [PMID: 26889482 DOI: 10.3978/j.issn.2305-5839.2016.01.11] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Esophageal cancer is the most common cancer in less developed countries. It is necessary to understand epidemiology of the cancer for planning. The aim of this study was to evaluate the incidence and mortality of esophageal cancer, and its relationship with Human Development Index (HDI) and its components in Asia in 2012. METHODS This study was an Ecological study, which conducted based on GLOBOCAN project of WHO for Asian counters. We assess the correlation between standardized incidence rates (SIR) and standardized mortality rates (SMR) of esophageal cancer with HDI and its components with using of SPSS18. RESULTS A total of 337,698 incidence (70.33% were males and 29.87% females. Sex ratio was 2.37) and 296,734 death (69.45% in men and 30.54% in women. The sex ratio was 2.27) esophageal cancer was recorded in Asian countries in 2012. Five countries with the highest SIR and SMR of esophageal cancer were Turkmenistan, Mongolia and Tajikistan, Bangladesh and China respectively. Correlation between HDI and SIR was -0.211 (P=0.159), in men -0.175 (P=0.244) and in women -0.231 (P=0.123). Also between HDI and SMR -0.250 (P=0.094) in men -0.226 (P=0.131) and in women -0.251 (P=0.037). CONCLUSIONS The incidence of esophageal cancer is more in less developed and developing countries. Statistically significant correlation was not found between standardized incidence and mortality rates of esophageal cancer, and HDI and its dimensions, except for life expectancy at birth.
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Affiliation(s)
- Reza Pakzad
- 1 Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ; 2 Epidemiologist, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran ; 3 Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ; 4 Department of Microbiology, Medical School, Ilam University Of Medical Sciences, Ilam, Iran ; 5 Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran ; 6 Deputy of Health, Isfahan University of Medical Sciences, Isfahan, Iran ; 7 Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran ; 8 Students' Scientific Research Center, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ; 9 Qom University of Medical Sciences, Qom, Iran
| | - Abdollah Mohammadian-Hafshejani
- 1 Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ; 2 Epidemiologist, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran ; 3 Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ; 4 Department of Microbiology, Medical School, Ilam University Of Medical Sciences, Ilam, Iran ; 5 Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran ; 6 Deputy of Health, Isfahan University of Medical Sciences, Isfahan, Iran ; 7 Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran ; 8 Students' Scientific Research Center, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ; 9 Qom University of Medical Sciences, Qom, Iran
| | - Bahman Khosravi
- 1 Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ; 2 Epidemiologist, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran ; 3 Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ; 4 Department of Microbiology, Medical School, Ilam University Of Medical Sciences, Ilam, Iran ; 5 Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran ; 6 Deputy of Health, Isfahan University of Medical Sciences, Isfahan, Iran ; 7 Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran ; 8 Students' Scientific Research Center, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ; 9 Qom University of Medical Sciences, Qom, Iran
| | - Shahin Soltani
- 1 Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ; 2 Epidemiologist, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran ; 3 Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ; 4 Department of Microbiology, Medical School, Ilam University Of Medical Sciences, Ilam, Iran ; 5 Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran ; 6 Deputy of Health, Isfahan University of Medical Sciences, Isfahan, Iran ; 7 Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran ; 8 Students' Scientific Research Center, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ; 9 Qom University of Medical Sciences, Qom, Iran
| | - Iraj Pakzad
- 1 Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ; 2 Epidemiologist, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran ; 3 Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ; 4 Department of Microbiology, Medical School, Ilam University Of Medical Sciences, Ilam, Iran ; 5 Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran ; 6 Deputy of Health, Isfahan University of Medical Sciences, Isfahan, Iran ; 7 Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran ; 8 Students' Scientific Research Center, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ; 9 Qom University of Medical Sciences, Qom, Iran
| | - Mahdi Mohammadian
- 1 Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ; 2 Epidemiologist, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran ; 3 Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ; 4 Department of Microbiology, Medical School, Ilam University Of Medical Sciences, Ilam, Iran ; 5 Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran ; 6 Deputy of Health, Isfahan University of Medical Sciences, Isfahan, Iran ; 7 Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran ; 8 Students' Scientific Research Center, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ; 9 Qom University of Medical Sciences, Qom, Iran
| | - Hamid Salehiniya
- 1 Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ; 2 Epidemiologist, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran ; 3 Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ; 4 Department of Microbiology, Medical School, Ilam University Of Medical Sciences, Ilam, Iran ; 5 Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran ; 6 Deputy of Health, Isfahan University of Medical Sciences, Isfahan, Iran ; 7 Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran ; 8 Students' Scientific Research Center, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ; 9 Qom University of Medical Sciences, Qom, Iran
| | - Zohre Momenimovahed
- 1 Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ; 2 Epidemiologist, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran ; 3 Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ; 4 Department of Microbiology, Medical School, Ilam University Of Medical Sciences, Ilam, Iran ; 5 Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran ; 6 Deputy of Health, Isfahan University of Medical Sciences, Isfahan, Iran ; 7 Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran ; 8 Students' Scientific Research Center, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ; 9 Qom University of Medical Sciences, Qom, Iran
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