NCI UNC Project ESCC
NCI UNC Project ESCC
Background:

 Esophageal cancer is a common cause of cancer deaths. Most cases of this cancer are
 esophageal squamous cell carcinoma (ESCC). Many of these cases come from two parts of the
 world with high-risk. One of these is in East Africa and include the country of Malawi.
 Researchers want to learn what factors explain the high risk there so we can understand
 better what causes this cancer in people everywhere.

 Objective:

 To learn more about causes and outcomes of esophageal squamous cell carcinoma using Malawi
 because of the large number of cases in that country.

 Eligibility:

 Adults at least 18 years old who have ESCC and live in a certain region of Malawi

 Adults in the same age group and location who do not have ESCC

 Design:

 Participants will be screened at a hospital in Malawi.

 Participants will have a 1-hour interview. They will answer questions about:

 Demographics (age, ethnicity, education)

 Place of residence

 Medical history and family medical history

 Drug, alcohol, and tobacco use

 Hot beverage consumption

 Indoor air pollution

 Occupation

 Food habits

 Farming

 Gastrointestinal health

 Participants will have their teeth and fingernails examined.

 Participants will be asked to give samples of blood, urine, saliva, toenails, and for the
 cancer cases, a small piece of their tumor.

 Participants will have 4 phone calls a year for 2 years to ask about their health....
Background: Esophageal cancer causes an estimated 400,000 deaths per year and ranks as the
 sixth leading cause of cancer death worldwide, just after breast cancer. Esophageal squamous
 cell carcinoma (ESCC) accounts for 89% of all esophageal cancer cases worldwide and many of
 the cases originate in two high risk regions, one in Asia and the other in Africa.

 Smoking tobacco and heavy alcohol consumption do not explain the incidence rates in the
 high-risk regions. It is therefore important to consider a wide range of etiologic factors to
 explain the high rates of cancer in these populations.

 Malawi has the highest incidence rates of ESCC in Africa. Our previous studies in Kenya and
 preliminary studies in Malawi point to a number of potential ESCC risk factors.

 Objectives: Our study aims to enhance our understanding of the causes and outcomes for ESCC
 in Malawi

 Eligibility: All suspected ESCC cases will be eligible for enrollment.

 Design: We will conduct a case-control study of ESCC jointly at Kamuzu Central Hospital and
 St. Gabriel s Hospital, recruiting 300 ESCC cases and 300 controls, to (1) evaluate exposures
 (including consumption of very hot beverages, use of firewood as fuel, tooth loss and animal
 exposure) which may influence risk of ESCC in Malawi and (2) collect biological samples to
 quantify exposures of interest (included in the current proposal) and to study the genetics
 and genomics of ESCC tumors (to be included in a future proposal).
-  INCLUSION CRITERIA:

 -  All suspected ESCC cases will be eligible for enrollment.

 -  All KCH and St Gabriel s patients greater than or eqaul to 18 years of age who are
 residents of the Central Region of Malawi and are diagnosed with histology-confirmed
 ESCC will be invited to participate as cases in the study.

 EXCLUSION CRITERIA:

 -  Patients <18 years old

 -  Those living outside the Central Region, those who are medically unable to complete
 the study procedures (including questionnaire, biosample collection or endoscopy), and
 those who are unable to understand the study procedures or give informed consent.

 While we do expect to see younger people with ESCC in Malawi (as we have seen in Kenya),
 cases under the age of 18 are rare: the field team would expect to see one or two a year.
 This estimate is in line with the cancer registry data from Malawi. Therefore, we will not
 enroll subjects younger than 18 years old.