Risk factors of Esophageal Cancer in Punjab- A Case Control Study

Esophageal cancer is a significant health concern globally. In Punjab, where pesticides use and heavy metal exposure are widespread esophageal squamous cell carcinoma is among the leading cancers. This study aims to investigate the association between these environmental factors and esophageal carcinoma, for instituting preventive strategies.

We conducted a case-control study in Punjab, with 380 carcinoma cases and 760 age, gender, and district-matched controls from hospital and community settings. The participants completed a case report form with validated questions on risk factors. The urine, water, oral cytology, blood, and esophageal biopsies samples were collected from a subset of the population to evaluate pesticide metabolites, heavy metal exposure, cytological changes and infections like H. pylori and HPV.

The mean age of cases was 57.17 ± 9.54 (SD) years, similar to that of controls, 56.96 ± 8.93 (SD)years  (p>0.05).The key risk factors for esophageal carcinoma were, Dimethylphosphate presence in urine (5.41 (95% CI: 1.42-20.67, p<0.05), tobacco use  (OR 1.60, 95% CI 1.24-2.06, p < 0.001), alcohol use (OR 1.65, 95% CI 1.31-2.08, p < 0.001) and hot beverages (OR 1.81, 95% CI 1.44-2.28, p < 0.001), with population attributable fraction of 86.7%, 10.8%, 16.5%, and 16.7%, respectively.. The daily intake of fruits (OR 0.74, 95% CI 0.59-0.92, p = 0.008) and vegetables (OR 0.81, 95% CI 0.65-0.99, p = 0.045) had protective association, with inadequate intake contributing to 27% and 26.8% of risk, respectively. The exposure to heavy metals from drinking water was higher in both groups but not statistically significant.

This study confirms established risk factors like tobacco, alcohol, and diet contribute to esophageal squamous cell carcinoma in Punjab, while identifying pesticide exposure as a new risk factor. It calls for stricter regulations, public health interventions, and further research into environmental risks.