The changing epidemiology of esophageal cancer in sub-Saharan Africa – the case of Ghana

INTRODUCTION: Esophageal cancer portends a grim prognosis. Most patients present with incurable disease. Scanty epidemiologic data on the disease has contributed to its low priority on the national. We sought to evaluate the current national trend in the presentation and outcome of esophageal cancer using our institutional experience from 1992 – 2010. METHODS: This is a retrospective study based on 152 patients who were seen in our institution during the study period. The perioperative data of these patients were retrieved and the relevant details recorded. Histopathological reports were available for 75 patients managed over the period. The study setting was The National Cardiothoracic Centre, which serves as the only tertiary referral centre in the country for cardiothoracic problems. RESULTS: There were 122 males and 30 females with a mean age of 57.8±11.7 years. The yearly trend from 1992 to 2010 showed a steady increase in the incidence of esophageal cancer. High alcohol consumption and smoking dominated the history of 82.2% of the patients. Squamous cell carcinoma accounted for 78.7% and adenocarcinoma 21.3%. Distribution of esophageal carcinoma by anatomical location was 84.9% for distal third, 11.8% for middle third and 3.3% for upper third. All patients presented with incurable disease. CONCLUSION: The study shows an increasing incidence of esophageal carcinoma in this country. Alcohol abuse and smoking are major risk factors; squamous cell carcinoma is the dominant histological type in this study.