ArticleAsian Pacific journal of cancer prevention : APJCP2025
Risk factors of Esophageal Cancer in Punjab- A Case Control Study.
Article in Asian Pacific journal of cancer prevention : APJCP, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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- Immune exhaustion in esophageal cancer: interferon pathway dysregulation and neoadjuvant therapy response.Frontiers in cell and developmental biology · 2026Review
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Abstract
backgroundEsophageal cancer is a significant health concern globally. In Punjab, where pesticides use and heavy metal exposure are widespread esophageal squamous cell carcinoma is among the leading cancers. This study aims to investigate the association between these environmental factors and esophageal carcinoma, for instituting preventive strategies.
methodsWe conducted a case-control study in Punjab, with 380 carcinoma cases and 760 age, gender, and district-matched controls from hospital and community settings. The participants completed a case report form with validated questions on risk factors. The urine, water, oral cytology, blood, and esophageal biopsies samples were collected from a subset of the population to evaluate pesticide metabolites, heavy metal exposure, cytological changes and infections like H. pylori and HPV.
findingsThe mean age of cases was 57.17 ± 9.54 (SD) years, similar to that of controls, 56.96 ± 8.93 (SD)years (p>0.05).The key risk factors for esophageal carcinoma were, Dimethylphosphate presence in urine (5.41 (95% CI: 1.42-20.67, p<0.05), tobacco use (OR 1.60, 95% CI 1.24-2.06, p < 0.001), alcohol use (OR 1.65, 95% CI 1.31-2.08, p < 0.001) and hot beverages (OR 1.81, 95% CI 1.44-2.28, p < 0.001), with population attributable fraction of 86.7%, 10.8%, 16.5%, and 16.7%, respectively.. The daily intake of fruits (OR 0.74, 95% CI 0.59-0.92, p = 0.008) and vegetables (OR 0.81, 95% CI 0.65-0.99, p = 0.045) had protective association, with inadequate intake contributing to 27% and 26.8% of risk, respectively. The exposure to heavy metals from drinking water was higher in both groups but not statistically significant.
interpretationThis study confirms established risk factors like tobacco, alcohol, and diet contribute to esophageal squamous cell carcinoma in Punjab, while identifying pesticide exposure as a new risk factor. It calls for stricter regulations, public health interventions, and further research into environmental risks.
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