A case-control investigation on modifiable risk factors of Esophageal Squamous cell carcinoma in Southern Malawi

Malawi is affected by the highest incidence of esophageal squamous cell carcinoma (ESCC) in the world, for which several modifiable risk factors may play a key role. More information about these variables are needed to implement useful prevention steps.The study is conducted as hospital-based case-control study in Zomba Central Hospital, Malawi. Questionnaires and histologic sampling were applied. A control group was matched for age, and gender in a 1:1 ratio, was well as controlled for income. An Odds Ratio (OR) and confidence intervals (CI) were calculated for all variables. In a logistic regression model, relevant risk actors where controlled for confounding. 113 ESCC Patients were included. It was found that smoking raised the odds for ESCC by 2.6 times (CI 1.36:4.87), the exposition of smoke from cooking by 3.1 times (CI 1.80:5.33), and that of burning trash by 2.7 times (CI 1.80:5.33). Hot foods and drinks were also found to raise cancer risk by 2.4 times (CI 1.40:4.01) and 2.2 times (CI 1.35:3.57), respectively. The choice of unprocessed maize flour, such as m’gaiwa (OR 0.4, CI 0.19:0.66), instead of white flour (OR 1.1, CI 0.57:1.94), was shown to have a protective effect. Other factors considered were not found to influence the odds ratio significantly. This study contributes to shed light on the increased incidence of ESCC among the Malawian population. A multifactorial genesis is likely. Implementing measures to reduce modifiable these risks could decrease the country's burden.Preprint presented under https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4181699 Keywords: Esophageal Squamous Cell Carcinoma; Esophageal Cancer; High incidence; Malawi.