Retrospective Insights: Unveiling the Sociodemographic Tapestry of Esophageal Carcinoma in Northeast India from a Cancer Center’s Records Analysis

Esophageal carcinoma is a significant health concern globally, and Northeast India, particularly Assam, exhibits a higher prevalence of this disease. Previous studies have highlighted the sociodemographic factors associated with esophageal carcinoma, but a specific focus on this region is lacking. The existing literature underscores the importance of understanding the patterns and correlates of esophageal carcinoma to inform targeted interventions and public health initiatives.

This article contributes novel insights into the sociodemographic landscape of esophageal carcinoma in Northeast India, mainly in Assam. The retrospective analysis at the Lakhimpur Cancer Center unveils distinctive patterns, showcasing a higher prevalence among males. Notably, common lifestyle factors such as tobacco consumption, smoking, and alcohol use are prevalent in this cohort. The study underscores the urgency for targeted interventions and awareness campaigns in the region.

The unique contribution lies in the specificity of the findings to Northeast India, providing a basis for more effective public health initiatives. Despite challenges related to incomplete records, the study navigates these limitations to offer valuable insights. This research addresses a crucial gap in the literature by shedding light on the sociodemographic factors influencing esophageal carcinoma in this specific context, thereby enriching the global understanding of the disease.

Esophageal cancer poses a substantial health burden globally, with a particularly alarming impact in India. The country witnesses a significant number of cancer-related deaths, with esophageal cancer ranking prominently among the leading causes of mortality. Despite advancements in cancer therapy, the grim prognosis associated with esophageal cancer remains a critical concern, especially given the limited treatment responsiveness observed, even in developed nations.

Notably, regional variations in cancer prevalence are observed within India, with esophageal cancer emerging as the predominant malignancy affecting the gastrointestinal tract in specific states such as Karnataka, Tamil Nadu, Kerala, and Assam^[1]. The situation in Assam, as one of the regions with high esophageal cancer incidence, underscores the urgency of understanding the sociodemographic determinants influencing the disease’s prevalence and impact on patient outcomes.

Recognizing the inherent challenges in the prognosis of esophageal carcinoma and the limited avenues for early detection or treatment, there arises a compelling need for a more nuanced understanding of its etiology and risk factors. This understanding could pave the way for primary prevention strategies, offering a ray of hope in the face of this formidable health challenge.

In light of these considerations, the present study focuses on unraveling the sociodemographic determinants of patients with esophageal cancer who sought care at the Lakhimpur Cancer Center, Assam. By examining the unique sociodemographic landscape of this specific population, the study aims to contribute valuable insights that may inform targeted interventions, improve early detection strategies, and ultimately enhance the overall management and prevention of esophageal cancer in this region.

Study Design: This study employed a retrospective observational design, analyzing records of patients diagnosed with esophageal cancer at Lakhimpur Cancer Center, unit of Assam Cancer Care Foundation (a Tata Trust’s initiative), north Lakhimpur, Assam.

Study Population: The study encompassed a cohort of 1732 patients diagnosed with different types of carcinomas between May 2022 and Nov 2023. From this cohort, records of 91 patients diagnosed with esophageal carcinoma were retrieved and included in the analysis.

Inclusion Criteria: Patients diagnosed with esophageal cancer during the specified time frame were included in the study. This cohort included both newly diagnosed and follow-up patients.

Exclusion Criteria: Patients with incomplete or missing data relevant to the study variables were excluded.

Data Collection: Patient records, including demographic details, medical history, and lifestyle factors, were systematically collected. The variables of interest included age, gender, occupation, history of tobacco use, smoking habits, alcohol consumption, and other relevant sociodemographic information.

Statistical Analysis: Data were analyzed using descriptive statistics, including percentages and proportions, to characterize the sociodemographic landscape of the study population.

Out of 1732 patients with different malignancies registered during 2022–2023 in Lakhimpur Cancer Center, 91 (5.26%) had esophageal cancer, indicating the prevalence and burden in the population. Out of the 91 esophageal carcinoma patients, 38 (41.8%) were females and 53 (58.2%) were males.

The sociodemographic determinants of our study population are presented in Table 1.

The age distribution among esophageal carcinoma patients varied, encompassing a spectrum of age groups. Specifically, eight individuals (8.8%) were under the age of 40 years, 13 patients (14.3%) fell within the 40–50 years range, 26 individuals (28.6%) were aged between 50 and 60 years, and the majority, 44 patients (48.4%), were 60 years or older. The age range spanned from a minimum of 33 years to a maximum of 90 years, reflecting a diverse demographic composition within the studied population.

Majority of esophageal carcinoma patients belonged to the lower socioeconomic strata, with 80 individuals (87.9%) holding below poverty line (BPL) cards, indicative of lower and lower-middle classes. In addition, 11 patients (12.1%) were classified into the upper class.

Within the subset of patients for whom occupation details were available (n = 11), the distribution across various occupational categories was as follows: farmers constituted seven individuals, daily laborers comprised two individuals, and employees were two individuals. Notably, the predominant occupation among female patients was homemaking.

Among the cohort of 91 esophageal carcinoma patients, a significant proportion exhibited tobacco and/or alcohol habits, with the majority, 76 individuals (83.5%), reporting the presence of one or more of these habits. When examining specific habits, 71 patients (78.0%) disclosed a history of betel nut chewing, 33 patients (36.3%) acknowledged a history of smoking (either cigarettes, bidis, or both), and 44 patients (48.4%) revealed a history of alcohol consumption. In addition, 17 patients (18.7%) had a history of other forms of tobacco chewing, while addiction history details were unavailable for 15 patients (16.5%). These findings underscore the prevalence of various lifestyle factors among those in the esophageal carcinoma patient population, as shown in Table 2.

Limitations: 1. The study is retrospective, relying on available hospital records. 2. Incomplete data, especially regarding occupation details, may impact the comprehensiveness of the analysis.

Esophageal cancer, classified as an upper digestive tract cancer, predominantly afflicts populations in developing and underdeveloped countries. While historically more prevalent in males, there is a concerning trend of increasing incidence among females as well^[2]. The gender distribution observed in our study aligns with previous research conducted by Sankaranarayanan et al.^[3], where males exhibited a higher prevalence than females, with a ratio of 2:1. Similar findings were reported by Sehgal et al.^[4], who observed a male-to-female ratio of 2.1:1. These consistent patterns of male predominance underscore the need for targeted research into the specific risk factors and underlying mechanisms contributing to the disparate incidence rates between genders. The findings of our study shed light on the sociodemographic and lifestyle characteristics of esophageal carcinoma patients in Northeast India, focusing on Assam. The observed gender distribution revealed a 58.2% predominance of males, aligning with existing literature indicating a higher susceptibility among men. The increasing incidence of esophageal cancer in females, noted both globally and in our study, challenges traditional gender-related patterns. While historically considered more prevalent in males, the rising rates among females underscore the evolving landscape of esophageal cancer epidemiology^[4]. These changing trends warrant continued exploration to discern the underlying factors contributing to the gender shift in esophageal cancer incidence.

The age distribution exhibited a notable proportion of patients aged 60 years and above, which is consistent with the increasing incidence of esophageal carcinoma with advancing age^[5,6]. The socioeconomic analysis conducted in our study revealed that majority of the patients were from lower socioeconomic strata (87.9%), underscoring the potential associations between socioeconomic status and disease incidence (1).

Epidemiological insights suggest that a substantial proportion of cancer incidences, ranging from 80% to 90%, can be attributed to environmental factors, with lifestyle-related factors emerging as pivotal contributors and, importantly, modifiable risk factors^[7]. The current study aligns with this paradigm, emphasizing the prominence of lifestyle-related factors in the context of esophageal carcinoma. As the risk factors identified for cancer, tobacco and alcohol consumption play a central role in the etiology of various malignancies, including esophageal carcinoma^[8]. The prevalence of tobacco consumption in diverse forms, such as cigarettes, hukkahs, bidis, or snuff, reflects the multifaceted nature of tobacco exposure in the studied population. The historical context of tobacco use in India further underscores the entrenched nature of these habits, dating back to the 1400s^[9]. The pervasiveness of these practices is a testament to the urgent need for targeted interventions and public health campaigns to mitigate the impact of tobacco-related cancers.

The findings of the current study corroborate earlier research indicating a significant association between lifestyle habits, particularly tobacco and alcohol consumption, and the predisposition to carcinoma^[10]. The consistency in results across studies emphasizes the robustness of these associations and reinforces the need for comprehensive strategies aimed at lifestyle modifications for cancer prevention.

Preventive measures to decrease the prevalence of esophageal cancer can have significant impacts on public health, especially in low-income populations where access to health care and awareness of preventive measures may be limited. Here are some key strategies and their potential applications to general, low-income populations:

Preventive Measures: 1. Dietary changes: increased fruits and vegetables: Encouraging a diet rich in fruits and vegetables can provide essential vitamins and antioxidants that may help prevent esophageal cancer. Reduced red and processed meat: Limiting the intake of red and processed meats, which are linked to higher cancer risks. Balanced diet: Promoting a balanced diet that includes whole grains and lean proteins.

2. Reducing alcohol and tobacco use: education and awareness programs: Implementing campaigns to educate about the risks of smoking and excessive alcohol consumption. Access to cessation programs: Providing resources for smoking cessation and alcohol moderation.

3. Treatment of acid reflux and gastroesophageal reflux disease (GERD): Access to health care: Ensuring access to health-care services for diagnosis and treatment of acid reflux and GERD. Education: Educating individuals on the importance of seeking medical help for persistent acid reflux symptoms.

4. Screening programs: Community outreach: Mobile screening clinics or community-based screening programs can reach populations with limited access to health-care facilities. Low-cost or free screening: Offering low-cost or free screening tests for at-risk populations.

5. Human papillomavirus (HPV) vaccination: vaccination programs: Implementing HPV vaccination programs, especially targeting adolescents before they become sexually active. School-based programs: Introducing vaccination programs in schools or community centers.

Application to Low-Income Populations: 1. Health education: community workshops: Conducting workshops and seminars in community centers or schools to raise awareness about healthy lifestyles and cancer prevention. Educational materials: Distributing pamphlets, posters, and other materials in local languages that explain the risk factors and preventive measures.

2. Access to affordable health care: health clinics: Establishing or supporting community health clinics that offer affordable or sliding-scale payment options. Telemedicine: Using telemedicine for remote consultations and follow-ups, reducing the need for in-person visits.

3. Nutritional support: food assistance programs: Partnering with food banks or government programs to provide nutritious foods to low-income families. Nutrition education: Including nutritional education in school curricula or adult education programs.

4. Cancer screening programs: Mobile clinics: Organizing mobile clinics that travel to low-income areas to provide screenings. Collaboration with non-governmental organizations (NGOs): Partnering with NGOs that focus on health care to offer free or subsidized screenings.

5. Community engagement: Peer support groups: Establishing support groups for cancer survivors and at-risk individuals. Cultural sensitivity: Ensuring that educational materials and programs are culturally sensitive and tailored to the community’s beliefs and practices.

6. Policy advocacy: Advocacy for health policies: Engaging in advocacy efforts to promote policies that support cancer prevention and access to health care for all income levels. Tobacco and alcohol regulations: Supporting policies that regulate tobacco and alcohol advertising and availability.

By combining these strategies and tailoring them to the specific needs of low-income populations, it is possible to decrease the prevalence of esophageal cancer and improve overall health outcomes. Collaboration between health-care providers, community organizations, policymakers, and individuals themselves is crucial for successful implementation.

In summary, our study provides a comprehensive examination of the sociodemographic and lifestyle factors associated with esophageal carcinoma in our specific population. The observed male preponderance and the increasing incidence in females underscore the evolving epidemiological landscape of esophageal cancer, necessitating ongoing research to elucidate the underlying factors contributing to these trends. The age-specific distribution, with a substantial proportion of cases occurring in individuals aged >50 years, highlights the significance of age as a crucial factor in esophageal cancer susceptibility. These findings emphasize the need for age-specific screening programs and interventions tailored to the unique needs of older individuals.

The prevalence of lifestyle-related risk factors, such as tobacco and alcohol habits, further emphasizes the preventable nature of a significant proportion of esophageal carcinoma cases. Public health initiatives targeting tobacco control and alcohol cessation should be prioritized to mitigate the impact of these modifiable risk factors. While our study contributes valuable insights into the local context of esophageal carcinoma, it is essential to acknowledge the limitations inherent in retrospective analyses and the reliance on hospital records. Future research endeavors should focus on prospective studies with larger cohorts and comprehensive data collection to further refine our understanding of the complex interplay between sociodemographic factors and esophageal cancer risk. In conclusion, the multifaceted nature of esophageal carcinoma necessitates a holistic approach to prevention, incorporating both individual-level lifestyle modifications and population-level interventions. By addressing the identified risk factors and understanding the demographic nuances, we can collectively work toward reducing the burden of esophageal cancer and improving the overall health outcomes in our community. Comprehensive tobacco control programs and alcohol cessation interventions should be prioritized to curb the rising burden of esophageal carcinoma. Moreover, efforts to raise awareness about the association between lifestyle habits and cancer risk are crucial for fostering preventive behaviors at the community level.