Eastern Cape remains the capital for oesophageal cancer, but newer research is needed — study

Residing in KwaZulu-Natal and the Eastern Cape has been linked with greater chances of having oesophageal cancer, new local research suggests.

The study by the University of KwaZulu-Natal (UKZN), which reviewed data over the last six decades spanning from 1957—2020, has found that not only are males more prone to this form of cancer, but that late presentation by cancer patients to healthcare centres is a huge factor that has often resulted in low chance of recovery.

Smoking and a diet low in fresh fruit and vegetables have been identified as risk factors for oesophageal cancer. Existing research shows that SA is one of the two countries worst affected by oesophageal cancer, with China being the second.

In both countries, environmental toxins such as tobacco use, alcohol consumption, nutritional deficiencies and exposure to environmental toxins seem to play a major role in increasing the chance of developing oesophageal cancer.

Linked to a high mortality rate, this extremely aggressive cancer is generally only diagnosed at the later stages and has a poor five-year survival rate due to the limited treatment options.

In the latest research, incidence of oesophageal cancer was found to be highest in the Eastern Cape with at least 15 females per 100,000 people having this upper digestive tract cancer compared with about 25 men per 100,000. The incidence in KwaZulu-Natal is unknown.

But research on oesophageal cancer remains neglected and there are large research gaps regarding new cases, screening, curative management and follow-up treatment.

Females that presented with cancer were much older and did not share the same exposure to tobacco as males. The majority of patients presented late with advanced disease and are treated palliatively, mostly with endoscopic stenting.

They said research gaps that require exploration include the national burden of disease, data on curative management such as surgery, chemoradiotherapy and survival patterns at major treatment centres.

Writing in the SA Journal of Oncology, lead researcher Lucien Ferndale from UKZN’s department of surgery and his colleagues said such gaps should be filled by academic centres from high incidence areas such as the Eastern Cape and KwaZulu-Natal. In addition, a national population-based registry needs to be started, “and the potential feasibility of screening high-risk populations should be investigated in the modern era”.

“It is clear that research on oesophageal cancer in SA has been neglected with the result that we have not progressed much since the 1970s. Research on the topic has decreased since the year 2000 with no new knowledge being obtained on curative management of the disease.

“These issues need to be addressed urgently in order to formulate optimal management guidelines and improve the prognosis of this disease. A nationwide collaborative project would be the ideal solution to this problem,” he said.

One of the reasons there are discrepancies in the data on the incidence of oesophageal cancer in SA is the reliance on one province, the Eastern Cape, which could have a different disease burden than the rest of the country.

Researchers argue that data on mortality rates is equally inconsistent. While there is a significant amount of evidence of the inverse relationship between oesophageal cancer and intake of fresh fruit and vegetables, “whether a specific nutrient in the SA diet increases the risk of oesophageal cancer is not clear”, researchers noted.

Researchers noted that most research on palliative management of oesophageal cancer in the country is outdated and was performed before 2000.

“There needs to be a strong drive towards research on oesophageal cancer in order to first establish the burden of disease in SA and thereafter investigate ways to diagnose the disease and institute appropriate management earlier.”

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