Department of Surgery and Endoscopy, Tenwek Hospital, Bomet, Kenya.
Department of Surgery and Endoscopy, Tenwek Hospital, Bomet, Kenya.
Cancer Epidemiol. 2022 Jun;78:102141. doi: 10.1016/j.canep.2022.102141. Epub 2022 Mar 15.
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.
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.
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.
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.
食管鳞状细胞癌（ESCC）及其无症状前体病变食管鳞状上皮不典型增生（ESD）在东非很常见。目前尚不清楚食管癌家族史是否是非洲 ESD 和 ESCC 的危险因素，以及受影响者的家庭成员是否应该进行筛查。
我们招募了 296 名居住在肯尼亚西南部的 ESCC 患者的无症状一级亲属。参与者完成了问卷调查，并接受了卢戈氏碘染色和活组织检查的内镜检查，以确定 ESD 的患病率。与来自同一集水区的先前基于人群的队列进行患病率比较，该队列也接受了卢戈氏染色内镜检查。
平均年龄为 40.7 岁，而先前的人群研究为 62.7 岁。一级亲属中 ESD/ESCC 的总体患病率为 14.7%，与背景人群的患病率 14.4%相当，即使在调整了两项研究的不同年龄分布后，这种可比性仍然存在。接受过中学后教育是唯一与 ESD/ESCC 风险降低相关的测量变量（调整后的 OR=0.31，95%CI：0.11，0.83）。即使在调整了年龄和其他测量因素的差异后，家族间 ESD 的患病率仍然存在异质性。
ESCC 患者一级亲属的食管鳞状上皮不典型增生患病率与肯尼亚西南部背景人群相似；然而，家族间 ESD 患病率存在异质性，提示其他遗传或环境因素可能影响家族患病率。有必要对 ESD 或 ESCC 患病率较高的家族进行进一步研究。
