title: Esophageal squamous cell cancer in a highly endemic region.
abstract: OBJECTIVE
  To identify risk factors associated with esophageal cancer in Zambia and association between dietary intake and urinary 8-iso prostaglandin F2α (8-isoPGF2α).
  
  
  METHODS
  We conducted a prospective, case control study at the University Teaching Hospital. Subjects included both individuals admitted to the hospital and those presenting for an outpatient upper endoscopy. Esophageal cancer cases were compared to age and sex-matched controls. Cases were defined as patients with biopsy proven esophageal cancer; controls were defined as subjects without endoscopic evidence of esophageal cancer. Clinical and dietary data were collected using a standard questionnaire, developed a priori. Blood was collected for human immunodeficiency virus (HIV) serology. Urine was collected, and 8-isoPGF2α was measured primarily by enzyme-linked immunosorbent assay and expressed as a ratio to creatinine.
  
  
  RESULTS
  Forty five controls (mean age 54.2 ± 15.3, 31 male) and 27 cases (mean age 54.6 ± 16.4, 17 males) were studied. Body mass index was lower in cases (median 16.8) than controls (median 23.2), P = 0.01. Histopathologically, 25/27 (93%) were squamous cell carcinoma and 2/27 (7%) adenocarcinoma. More cases smoked cigarettes (OR = 11.24, 95%CI: 1.37-92.4, P = 0.02) but alcohol consumption and HIV seropositivity did not differ significantly (P = 0.14 for both). Fruit, vegetables and fish consumption did not differ significantly between groups (P = 0.11, 0.12, and 0.10, respectively). Mean isoprostane level was significantly higher in cases (0.03 ng/mg creatinine) than controls (0.01 ng/mg creatinine) (OR = 2.35, 95%CI: 1.19-4.65, P = 0.014).
  
  
  CONCLUSIONS
  Smoking and isoprostane levels were significantly associated with esophageal cancer in Zambians, but diet, HIV status, and alcohol consumption were not.
authors.affiliation: Akwi W Asombang, Division of Gastroenterology and Hepatology, University of Missouri School of Medicine, Columbia, MO 65203, United States.
authors.forename: Akwi W
authors.initials: AW
authors.lastname: Asombang
authors.affiliation: Akwi W Asombang, Division of Gastroenterology and Hepatology, University of Missouri School of Medicine, Columbia, MO 65203, United States.
authors.forename: Violet
authors.initials: V
authors.lastname: Kayamba
authors.affiliation: Akwi W Asombang, Division of Gastroenterology and Hepatology, University of Missouri School of Medicine, Columbia, MO 65203, United States.
authors.forename: Mpala M
authors.initials: MM
authors.lastname: Lisulo
authors.affiliation: Akwi W Asombang, Division of Gastroenterology and Hepatology, University of Missouri School of Medicine, Columbia, MO 65203, United States.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Trinkaus
authors.affiliation: Akwi W Asombang, Division of Gastroenterology and Hepatology, University of Missouri School of Medicine, Columbia, MO 65203, United States.
authors.forename: Victor
authors.initials: V
authors.lastname: Mudenda
authors.affiliation: Akwi W Asombang, Division of Gastroenterology and Hepatology, University of Missouri School of Medicine, Columbia, MO 65203, United States.
authors.forename: Edford
authors.initials: E
authors.lastname: Sinkala
authors.affiliation: Akwi W Asombang, Division of Gastroenterology and Hepatology, University of Missouri School of Medicine, Columbia, MO 65203, United States.
authors.forename: Stayner
authors.initials: S
authors.lastname: Mwanamakondo
authors.affiliation: Akwi W Asombang, Division of Gastroenterology and Hepatology, University of Missouri School of Medicine, Columbia, MO 65203, United States.
authors.forename: Themba
authors.initials: T
authors.lastname: Banda
authors.affiliation: Akwi W Asombang, Division of Gastroenterology and Hepatology, University of Missouri School of Medicine, Columbia, MO 65203, United States.
authors.forename: Rose
authors.initials: R
authors.lastname: Soko
authors.affiliation: Akwi W Asombang, Division of Gastroenterology and Hepatology, University of Missouri School of Medicine, Columbia, MO 65203, United States.
authors.forename: Paul
authors.initials: P
authors.lastname: Kelly
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects / Q000453:epidemiology; D001706:Biopsy; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology* / Q000473:pathology / Q000652:urine; D016022:Case-Control Studies; D004032:Diet / Q000009:adverse effects; D019353:Endemic Diseases; D004938:Esophageal Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000652:urine; D000077277:Esophageal Squamous Cell Carcinoma; D004945:Esophagoscopy; D005260:Female; D015658:HIV Infections / Q000453:epidemiology; D006785:Hospitals, University; D006801:Humans; D028421:Isoprostanes / Q000652:urine*; D008019:Life Style; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology; D015024:Zambia / Q000453:epidemiology
chemical_list: D028421:Isoprostanes
keywords: Gastrointestinal cancer; Non-communicable diseases; Zambia