Cytopathology of the esophagus in Transkei

Esophageal brush biopsy capsules were used to prepare exfoliative cytologic smears of 1,000 residents of low-, intermediate-, and high-risk areas for esophageal cancer in Transkei, southern Africa. Satisfactory smears were obtained from 96.4% of the persons screened. The technique used was rapid, simple, inexpensive, safe, and effective in the determination of the prevalence of dysplasia and early carcinoma and the progression rate of dysplasia to carcinoma. In the high-risk area, precursor lesions (esophagitis and cellular atypia) were detected in 24% of adults older than 35 years, dysplastic changes in 9%, and carcinoma in 2%. Dysplastic changes were also present in 7% of young adults (25-34 yr of age) and in 1.5% of persons 15-24 years old. Precursor lesions were detected in 16% of the population group between 15 and 24 years old. Dysplastic changes and other precursor lesions were significantly less frequent in the population from the low-risk areas. A total of 14 malignant cases were detected in 8 females and 6 males. Of these, 9 were histologically confirmed squamous cell carcinomas in various stages of differentiation. The progression of dysplastic changes to carcinoma was observed in 5 of the total 14 cases. Three early cancers were successfully treated by esophagectomy. Seasonal variation occurred in the prevalence of mild cytologic changes.