KENYA NATIONAL CANCER SCREENING GUIDELINES I 71
OESOPHAGEAL CANCER EARLY DETECTION
Oesophageal cancer is the 7th most common cancer and 6th most frequent cause of
cancer mortality in the world, with estimates of 572, 034 new cases and 508,585 deaths
in 2018 (GLOBOCAN, 2018). In Kenya it is one of the top cancers in both men and wom-
en. With an incidence of 4,380 cases, it is the second most common in males and third
in females. Worryingly, the mortality rate and the incidence rates are almost equal at
18.4% (GLOBOCAN, 2018). In addition, the cancer has been reported to be on the rise
and in particular hot spots in the country. The main variant of oesophageal cancer seen
in Kenya is oesophageal squamous cell carcinoma unlike in the Europe and A
Currently, international screening guidelines for oesophageal cancer do not exist. How- ever, due to the high disease burden in Kenya, there is a need provide guidance on how to improve early detection of the cancer. This can lead to better treatment outcomes, better prognosis and will be a more cost-effective approach as compared to the current status whereby late diagnosis is most common.
Non-modifiable risk factors
• Increasing age
• Family history of oesophageal cancer
Modifiable risk factors
• Overweight and obesity
• Alcohol consumption
• Tobacco use
• Carbon exposure from firewood and other sources
72 1 KENYA NATIONAL CANCER SCREENING GUIDELINES
RATIONALE FOR EARLY DETECTION
The most recent data from GLOBOCAN shows an increase in mortality from oesophageal
cancer in Kenya (GLOBOCAN, 2018). Many patients present late, at a point when curative
treatment cannot be offered. Early detection provides a chance to catch precancerous
lesions or dysplasia and early disease which can lead to less morbidity, better chances of
successful treatment and lower treatment costs.
Current international recommendations do not support population wide screening.
However, in high-risk populations in Asia and in Africa, it seems feasible to do targeted
screening in these populations as has been done in China (Codipilly, 2018; Chen 2016,
Roshandel, 2014). A study done in Kenya showed the feasibility of this and also provided
initial estimates of dysplasia rates (Mwachiro, 2016).
GOALS OF SCREENING
Early detection makes it possible to detect precancerous lesions and early cancer
APPROACHES TO SCREENING
1. Identifying individuals in areas of high-risk/ incidence for oesophageal
2. Recommending screening tests that can be done for detection
3. Providing facilities that can carry out the screening tests
1. White Light Endoscopy:
a. Advantages: Can be done in any endoscopy unit.
b. Disadvantage: Misses out on precursor lesions. Has a cost
attached to it and needs sedation as well as trained
2. Lugol’s chromoendoscopy
a. Advantages: Shows precursor lesions. Lugol’s iodine is cheap.
b. Disadvantages: Endoscopists need additional training. Allergic
reaction to iodine can occur. Needs sedation and endoscopy.
3. Narrow band Imaging endoscopy
a. Advantages: Shows precursor lesions
b. Disadvantages: Needs special endoscopy equipment.
Endoscopists need additional training and also sedation risks.
Possible future screening test:
1. Breath test- still in research phase
2. Cytosponge screening test
3. Blood markers- to check for autoantibodies and methylated DNA
1. Individuals with first degree relatives with biopsy proven oesophageal cancer
should have screening endoscopy 10 years prior to index age of diagnosis of
the first degree relative or at age 40 whichever is earlier
2. Asymptomatic individuals living in high risk areas should get a one-time
screening endoscopy at age 40 years.
3. Patients treated for head and neck cancer squamous cell carcinoma should be
screened annually for ten years.
4. Patients who have had caustic acid ingestion should be screened 10years
from the injury via endoscopy.
KENYA NATIONAL CANCER SCREENING GUIDELINES I 73
GLOBOCAN 2018 data
Codipilly DC, Qin Y, Dawsey SM, Kisiel J, Topazian M, Ahlquist D, Iyer PG. Screening for esophageal squamous cell carcinoma: recent advances. Gastrointest Endosc. 2018
Sep;88(3):413-426. doi: 10.1016/j.gie.2018.04.2352. Epub 2018 Apr 27. Review. PMID:
Mwachiro MM, Burgert SL, Lando J, Chepkwony R, Bett C, Bosire C, Abnet CC, Githan- ga J, Waweru W, Giffen CA, Murphy G, White RE, Topazian MD, Dawsey SM. Esophageal Squamous Dysplasia is Common in Asymptomatic Kenyans: A Prospective, Communi- ty-Based, Cross-Sectional Study. Am J Gastroenterol. 2016 Apr;111(4):500-7. doi: 10.1038/ ajg.2016.26. Epub 2016 Feb 23. PMID: 26902228
Chen Q, Yu L, Hao C et al. Effectiveness evaluation of organized screening for esophageal cancer: a case-control study in Linzhou city, China. Sci Rep 2016;6:35707
Roshandel G, Khoshnia M, Sotoudeh M et al. Endoscopic screening for precancerous le- sions of the esophagus in a high risk area in Northern Iran. Arch Iran Med 2014;17:246-52
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