OESOPHAGUS

Risk factors for oesophageal squamous dysplasia in adult inhabitants of a high risk region of China

W-Q Wei¹, C C Abnet², N Lu¹, M J Roth², G-Q Wang¹, B A Dye³, Z-W Dong¹, P R Taylor², P Albert⁴, Y-L Qiao¹, S M Dawsey²

¹ Department of Cancer Epidemiology, Cancer Institute, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
² Cancer Prevention Studies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
³ Centers for Disease Control and Prevention, National Center for Health Statistics, Hyattsville, Maryland, USA
⁴ Biometric Research Branch, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, Maryland, USA

Correspondence to:
Correspondence to:
Dr C Abnet
Cancer Prevention Studies Branch, 6116 Executive Blvd, Rm 705, Bethesda, MD 20892-8314, USA; abnetc{at}mail.nih.gov

Background: Oesophageal squamous cell carcinoma (OSCC) is a common cancer worldwide and has a very high mortality rate. Squamous dysplasia is the precursor lesion for OSCC and it can be seen during routine endoscopy with Lugol’s iodine staining. We aimed to examine the risk factors for squamous dysplasia and determine if a risk model could be constructed which would be useful in selecting apparently healthy subjects for endoscopic screening in a high risk population in Linzhou, People’s Republic of China.

Subjects and methods: In this cross sectional study, 724 adult volunteers aged 40–65 years were enrolled. All subjects completed a questionnaire regarding potential environmental exposures, received physical and dental examinations, and underwent upper endoscopy with Lugol’s iodine staining and biopsy. Subjects were categorised as having or not having histologically proven squamous dysplasia/early cancer. Risk factors for dysplasia were examined using univariate and multivariate logistic regression. The utility of the final multivariate model as a screening tool was assessed using a receiver operating characteristics curve.

Results: We found that 230 of 720 subjects (32%) with complete data had prevalent squamous dysplasia. In the final multivariate model, more household members (odds ratio (OR) 1.12/member (95% confidence interval (CI) 0.99, 1.25)), a family history of cancer (OR 1.57 (95% CI 1.13-2.18)), higher systolic blood pressure OR 1.11/10 mm Hg (95% CI 1.03-1.19)), heating the home without a chimney (OR 2.22 (95% CI 1.27–3.86)), and having lost more but not all of your teeth (OR 1.91 for 12–31 teeth lost (95% CI 1.17–3.15)) were associated with higher odds of having dysplasia. Higher household income (OR 0.96/100 RMB (95% CI 0.91–1.00)) was associated with a lower odds of having dysplasia. Although we found several statistically significant associations, the final model had little ability to accurately predict dysplasia status, with maximum simultaneous sensitivity and specificity values of 57% and 54%, respectively.

Conclusions: We found that risk factors for dysplasia were similar to those previously identified as risk factors for OSCC in this population. The final model did a poor job of identifying subjects who had squamous dysplasia. Other methods will need to be developed to triage individuals to endoscopy in this high risk population.

Abbreviations: OSCC, oesophageal squamous cell carcinoma; NHANES, National Health and Nutrition Examination Survey; ROC, receiver operating characteristic; PAH, polycyclic aromatic hydrocarbons; OR, odds ratio

Keywords: oesophageal cancer; dysplasia; tooth loss; cancer screening; China

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