title: Environmental risk factors for oesophageal cancer in Malawi: A case-control study.
abstract: OBJECTIVE
  There is a high burden of oesophageal cancer in Malawi with dismal outcomes. It is not known whether environmental factors are associated with oesophageal cancer. Without knowing this critical information, prevention interventions are not possible. The purpose of this analysis was to explore environmental factors associated with oesophageal cancer in the Malawian context.
  
  
  METHODS
  A hospital-based case-control study of the association between environmental risk factors and oesophageal cancer was conducted at Kamuzu Central Hospital in Lilongwe, Malawi and Queen Elizabeth Central Hospital in Blantyre, Malawi. Ninety-six persons with squamous cell carcinoma and 180 controls were enrolled and analyzed. These two groups were compared for a range of environmental risk factors, using logistic regression models. Unadjusted and adjusted odds ratios and 95% confidence intervals (CI) were calculated.
  
  
  RESULTS
  Firewood cooking, cigarette smoking, and use of white maize flour all had strong associations with squamous cell carcinoma of the oesophagus, with adjusted odds ratios of 12.6 (95% CI: 4.2-37.7), 5.4 (95% CI: 2.0-15.2) and 6.6 (95% CI: 2.3-19.3), respectively.
  
  
  CONCLUSIONS
  Several modifiable risk factors were found to be strongly associated with squamous cell carcinoma. Research is needed to confirm these associations and then determine how to intervene on these modifiable risk factors in the Malawian context.
authors.affiliation: College of Medicine, University of Malawi, Blantyre, Malawi.
authors.forename: Y B
authors.initials: YB
authors.lastname: Mlombe
authors.affiliation: UNC Project-Malawi, Lilongwe, Malawi ; University of North Carolina, Chapel Hill, North Carolina, USA.
authors.forename: N E
authors.initials: NE
authors.lastname: Rosenberg
authors.affiliation: UNC Project-Malawi, Lilongwe, Malawi.
authors.forename: L L
authors.initials: LL
authors.lastname: Wolf
authors.affiliation: College of Medicine, University of Malawi, Blantyre, Malawi.
authors.forename: C P
authors.initials: CP
authors.lastname: Dzamalala
authors.affiliation: Queen Elizabeth Central Hospital, Blantyre, Malawi.
authors.forename: K
authors.initials: K
authors.lastname: Chalulu
authors.affiliation: College of Medicine, University of Malawi, Blantyre, Malawi.
authors.forename: J
authors.initials: J
authors.lastname: Chisi
authors.affiliation: University of North Carolina, Chapel Hill, North Carolina, USA.
authors.forename: N J
authors.initials: NJ
authors.lastname: Shaheen
authors.affiliation: UNC Project-Malawi, Lilongwe, Malawi ; University of North Carolina, Chapel Hill, North Carolina, USA.
authors.forename: M C
authors.initials: MC
authors.lastname: Hosseinipour
authors.affiliation: University of North Carolina, Chapel Hill, North Carolina, USA.
authors.forename: C G
authors.initials: CG
authors.lastname: Shores
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016902:Air Pollution, Indoor / Q000009:adverse effects; D000428:Alcohol Drinking / Q000009:adverse effects; D002294:Carcinoma, Squamous Cell / Q000208:ethnology* / Q000209:etiology; D016022:Case-Control Studies; D002606:Charcoal / Q000009:adverse effects; D004781:Environmental Exposure / Q000009:adverse effects*; D004938:Esophageal Neoplasms / Q000208:ethnology* / Q000209:etiology; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D016015:Logistic Models; D008295:Malawi / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects
chemical_list: D002606:Charcoal