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UNC Project Malawi Cancer Program esophageal cancer and cancer clinic division lead Bongani Kaimila, MBBS, MSc, launched a cross-sectional study to determine the feasibility of endoscopic screening for Esophageal Squamous Cell Carcinoma (ESCC) precursor lesions in Malawi and the relationship with poor oral health.

bongani kaimila new
Bongani Kaimila

In Malawi, ESCC is the third commonest cancer nationwide. Among cancers that are not classically HIV-related, ESCC has the highest incidence in Malawi. Few data are available on precursor lesions of ESCC in Malawi, and there relationship to poor oral health. Kaimila’s study will make a significant contribution to existing literature from Malawi and Sub-Saharan Africa.

The study is being conducted at Nkhoma Hospital in the central region, approximately 1 hour from Lilongwe. Asymptomatic individuals living within a 15km radius of Nkhoma Hospital are recruited and managed by Kaimila, Gift Mulima, MBBS (Kamuzu Central Hospital) and Chifundo Kajombo MBBS (Kamuzu Central Hospital). Patient’s exposures are measured using a structured questionnaire and molecular sequencing of biospecimens. Patients also undergo an oral health exam and endoscopy. Laboratory testing will include tumor immunohistochemistry assays, salivary DNA isolation for genetic studies, and molecular profiling.

Kaimila’s previous ESCC research includes a National Cancer Institute funded and UNC Lineberger Comprehensive Cancer Center sponsored study which looked at HIV and other risk factors for ESCC in Malawi. The study completed follow-up in December 2020.

Kaimila also currently serves as a co-investigator for a prospective, observational, multi-center, open cohort study, the Treatment Outcomes of Esophageal Cancer in Eastern Africa (TOEC-Eastern Africa). The study has been established as a collaborative effort within the African Esophageal Cancer Consortium (AfrECC) and aims to describe the therapeutic landscape of ESCC in Eastern Africa and investigate the outcomes of different treatment strategies within the region. The 4.5-year study will recruit at a total of six sites in Kenya, Malawi and Tanzania. Enrolment in Malawi commenced in June 2021 at Kamuzu Central Hospital and includes two sub-studies looking at esophageal stenting and ESCC imaging.