Comprehensive Evaluation of Risk Factors for Esophageal Cancer in India: Evidence from a Systematic Review and Meta-Analysis

Context: Esophageal cancer in India is known for its high incidence and mortality rate, with a strong socioeconomic and geographic component. Aims: The study aimed to explore the relationships between esophageal cancer and various potential risk factors. Settings and Design: The present study used a systematic review and meta-analysis for the identification of region-specific esophageal cancer risk exposures among the Indian population. Material and Methods: A comprehensive literature search was conducted in databases such as PubMed, Medline, Scopus, and Embase and the study registered with PROSPERO (CRD42024583490) based on PEOS framework for systematic review and meta-analysis. Statistical Analysis Used: Regional pooled estimates of odds ratios (OR) along with overall estimates and 95% confidence intervals (CI) were calculated for each exposure using random effects models via the Mantel–Haenszel method. Results: Out of 3,024 studies reviewed, 74 systematic reviews and meta-analyses, specific to India, were included in the study. The study revealed that the use of fuels such as animal dung, wood, and biomass presents a significant risk for esophageal cancer in the northern region of India (OR 9.32, 95% CI 6.85-12.67). In southern India, betel nut consumption exhibited an even higher risk (OR 13.65, 95% CI 4.67-39.84). In the North-East region, consuming foods at elevated temperatures posed a severe risk (OR 9.38, 95% CI 6.77-12.99), exceeding other variables investigated. However, the reducing effect for the diseases was observed among those who have higher education levels, daily brushing habits, and the consumption of fruits and/or leafy vegetables. Conclusions: Our findings indicate that efforts to control esophageal cancer in India must take into account regional differences. Key risk factors, such as the use of cooking fuels like biomass, cow dung, and wood, along with the consumption of excessively hot foods, need to be addressed as highlighted by this study.