Esophageal cancer in West Kenya

 描述(申请人提供)：食道癌是东非部分地区最常见的癌症之一，但在西非却极为罕见。肯尼亚西部位于非洲大裂谷的海拔地区，是东非的地方病流行地区之一。通常，患者在很晚的时候才被诊断出来，大多数人在几个月内死亡。目前还没有大规模的研究来系统地研究这种癌症的潜在原因。在一项成功进行的先导性病例对照研究的基础上，我们建议继续并扩大这项研究，以调查食道癌患者和非癌症患者的潜在危险因素。风险因素是通过与参与者的访谈获得的，包括酒精、烟草、暴露于室内污染和饮用热饮料的信息。我们还旨在研究一种新的假设，即饮食中某些矿物质的缺乏可能导致这一地区的这种疾病。东非食道癌带与非洲裂谷的共同位置表明，饮食不足可能起到一定作用，因为饮食是当地来源的，以谷物/植物为基础。食道癌患者的饮食缺乏很难评估，因为患者在确诊时通常已经减轻了相当大的体重，因此尿液和血液中的维生素和矿物质水平会受到疾病的影响。由于家庭成员经常有非常相似的饮食，我们会评估这种家庭成员的营养水平是否可以用来接近患者患病前的正常营养水平。正在研究的因素都是可以改变的，因此，如果它们被发现是肯尼亚西部食道癌的原因，可以采取干预措施，以消除与致癌物的接触(例如，关于饮酒的建议，特别是烈性酒)，或通过强化化肥。

 DESCRIPTION (provided by applicant): Cancer of the esophagus is one of the most frequently diagnosed cancers in parts of East Africa, yet this cancer is extremely rare in West Africa. West Kenya, a region at altitude in Africa's Rift Valley, is one of East Africa's endemic areas. Typically patients are diagnosed at very late stages, and most die within months. No large-scale studies have been conducted to systematically investigate the potential causes of this cancer. Building on a successfully conducted pilot case-control study in which esophageal cancer patients are compared to non-cancer patients, we propose to continue and expand this study to investigate potential risk factors for the disease. Risk factors are obtained through interviews with participants, and include information on alcohol, tobacco, exposures to indoor pollution and hot beverage drinking. We also aim to investigate a novel hypothesis that deficiencies of some minerals in the diet may contribute to this disease in this area. The co-location of the East African esophageal cancer belt with the African rift valley suggest the dietary deficiencies may play a role as the diet is locally-source and cereal/plant based. Dietary deficiencies are difficult to evaluate in esophageal cancer patients, as patients have typically lost considerable weight by the time of diagnosis so urine and blood levels of vitamins and minerals are affected by their disease. As household members often have very similar diets, we will evaluate whether nutrient levels in such a household member can be used to approximate the patient's levels usual nutrient levels before they were ill. The factors being studied are all modifiable, thus if they are found to be causes of esophageal cancer in West Kenya, interventions could be implemented to remove exposures to carcinogens (e.g. advice on alcohol intake, particularly stronger spirits), or through fortification of fertilizers.