Dental fluorosis and oral health in the African Esophageal Cancer Corridor: Findings from the Kenya ESCCAPE case-control study and a pan-African perspective
Dental fluorosis and oral health in the African Esophageal Cancer Corridor: Findings from the Kenya ESCCAPE case-control study and a pan-African perspective
复制标题
DOI：
10.1002/ijc.32086
复制
发表时间：
2019-07-01
影响因子：
6.4
通讯作者：
McCormack, Valerie A.
中科院分区：
文献类型：
--
作者：
Menya, Diana;Maina, Stephen K.;McCormack, Valerie A.
没有关于非洲食管癌或东非地方性氟牙症（一种由于早年过量摄入氟化物而造成的不可逆的牙釉质矿化不足）与口腔健康关系的研究。在2014-18年期间，我们在肯尼亚西部的埃尔多雷特进行了一项鳞状细胞食管癌的病例对照研究。根据设计因素、烟草、酒精、种族、教育、口腔卫生和牙齿缺失/龋齿调整比值比（AOR（95%置信区间））。食管癌病例（N = 430）的口腔健康和卫生状况比对照组（N = 440）差。与无氟斑牙相比，中度/重度氟中毒影响44%的病例，其粗OR为20.8（11.6，37.4），完全校正后风险增加9.4倍（4.6，19.1），而轻度氟中毒（43%的病例）的AOR为2.3（1.3，4.0）。口腔白斑和牙齿脱落/龋齿的患病率随着氟中毒严重程度的增加而增加，与中度/重度氟中毒相关的癌症风险增加在牙齿脱落/龋齿较多的个体中尤其明显。使用mswaki棒（AOR = 1.7（1.0，2.9））而不是商业牙刷和不频繁刷牙也独立增加了风险。地理差异表明，食管癌高发病率地区和地下水氟含量高的地区在整个东非的位置非常相似。总之，口腔健康不良与高海拔地区对水文地质影响的氟斑牙的易感性相结合，或作为其结果，可能是非洲食管癌走廊与裂谷惊人的共同位置的基础。研究结果呼吁加强对这种高度致命但常见的癌症的初级预防机会的研究。
There are no studies of oral health in relation to esophageal cancer in Africa, or of Eastern Africa's endemic dental fluorosis, an irreversible enamel hypo-mineralization due to early-life excessive fluoride intake. During 2014-18, we conducted a case-control study of squamous cell esophageal cancer in Eldoret, western Kenya. Odds ratios (AORs (95% confidence intervals)) were adjusted for design factors, tobacco, alcohol, ethnicity, education, oral hygiene and missing/decayed teeth. Esophageal cancer cases (N = 430) had poorer oral health and hygiene than controls (N = 440). Compared to no dental fluorosis, moderate/severe fluorosis, which affected 44% of cases, had a crude OR of 20.8 (11.6, 37.4) and on full adjustment was associated with 9.4-fold (4.6, 19.1) increased risk, whilst mild fluorosis (43% of cases) had an AOR of 2.3 (1.3, 4.0). The prevalence of oral leukoplakia and tooth loss/decay increased with fluorosis severity, and increased cancer risks associated with moderate/severe fluorosis were particularly strong in individuals with more tooth loss/decay. Using a mswaki stick (AOR = 1.7 (1.0, 2.9)) rather than a commercial tooth brush and infrequent tooth brushing also independently increased risk. Geographic variations showed that areas of high esophageal cancer incidence and those of high groundwater fluoride levels have remarkably similar locations across Eastern Africa. In conclusion, poor oral health in combination with, or as a result of, high-altitude susceptibility to hydro-geologically influenced dental fluorosis may underlie the striking co-location of Africa's esophageal cancer corridor with the Rift Valley. The findings call for heightened research into primary prevention opportunities of this highly fatal but common cancer.