title: Esophageal Squamous Dysplasia is Common in Asymptomatic Kenyans: A Prospective, Community-Based, Cross-Sectional Study.
abstract: Esophageal squamous cell carcinoma (ESCC) is endemic in east Africa and is a leading cause of cancer death among Kenyans. The asymptomatic precursor lesion of ESCC is esophageal squamous dysplasia (ESD). We aimed to determine the prevalence of ESD in asymptomatic adult residents of southwestern Kenya.
  
  
  
  In this prospective, community-based, cross-sectional study, 305 asymptomatic adult residents completed questionnaires and underwent video endoscopy with Lugol's iodine chromoendoscopy and mucosal biopsy for detection of ESD.
  
  
  
  Study procedures were well tolerated, and there were no adverse events. The overall prevalence of ESD was 14.4% (95% confidence interval (CI): 10-19%), including 11.5% with low-grade dysplasia and 2.9% with high-grade dysplasia. The prevalence of ESD was >20% among men aged >50 years and women aged >60 years. Residence location was significantly associated with ESD (Zone A adjusted odds ratio (OR) 2.37, 95% CI: 1.06-5.30 and Zone B adjusted OR 2.72, 95% CI: 1.12-6.57, compared with Zone C). Iodine chromoendoscopy with biopsy of unstained lesions was more sensitive than white-light endoscopy or random mucosal biopsy for detection of ESD and had 67% sensitivity and 70% specificity.
  
  
  
  ESD is common among asymptomatic residents of southwestern Kenya and is especially prevalent in persons aged >50 years and those living in particular local regions. Lugol's iodine chromoendoscopy is necessary for detection of most ESD but has only moderate sensitivity and specificity in this setting. Screening for ESD is warranted in this high-risk population, and endoscopic screening of Kenyans is feasible, safe, and acceptable, but more accurate and less invasive screening tests are needed.
authors.affiliation: Tenwek Hospital, Bomet, Kenya.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Mwachiro
authors.affiliation: Tenwek Hospital, Bomet, Kenya.
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Burgert
authors.affiliation: Tenwek Hospital, Bomet, Kenya.
authors.forename: Justus
authors.initials: J
authors.lastname: Lando
authors.affiliation: Tenwek Hospital, Bomet, Kenya.
authors.forename: Robert
authors.initials: R
authors.lastname: Chepkwony
authors.affiliation: Tenwek Hospital, Bomet, Kenya.
authors.forename: Collins
authors.initials: C
authors.lastname: Bett
authors.affiliation: National Cancer Institute, Bethesda, Maryland, USA.
authors.forename: Claire
authors.initials: C
authors.lastname: Bosire
authors.affiliation: National Cancer Institute, Bethesda, Maryland, USA.
authors.forename: Christian C
authors.initials: CC
authors.lastname: Abnet
authors.affiliation: Department of Pathology, University of Nairobi, Nairobi, Kenya.
authors.forename: Jessie
authors.initials: J
authors.lastname: Githanga
authors.affiliation: Department of Pathology, University of Nairobi, Nairobi, Kenya.
authors.forename: Wairimu
authors.initials: W
authors.lastname: Waweru
authors.affiliation: Information Management Services, Calverton, Maryland, USA.
authors.forename: Carol A
authors.initials: CA
authors.lastname: Giffen
authors.affiliation: National Cancer Institute, Bethesda, Maryland, USA.
authors.forename: Gwen
authors.initials: G
authors.lastname: Murphy
authors.affiliation: Tenwek Hospital, Bomet, Kenya.
authors.forename: Russell E
authors.initials: RE
authors.lastname: White
authors.affiliation: Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Topazian
authors.affiliation: National Cancer Institute, Bethesda, Maryland, USA.
authors.forename: Sanford M
authors.initials: SM
authors.lastname: Dawsey
mesh_terms: D000328:Adult; D001706:Biopsy; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000473:pathology; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer; D004938:Esophageal Neoplasms / Q000453:epidemiology / Q000473:pathology; D000077277:Esophageal Squamous Cell Carcinoma; D004945:Esophagoscopy; D004947:Esophagus / Q000473:pathology*; D005260:Female; D006801:Humans; D007454:Iodides; D007630:Kenya / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011230:Precancerous Conditions / Q000453:epidemiology / Q000473:pathology*; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires
chemical_list: D007454:Iodides; C010389:Lugol's solution