Esophageal Cancer in Somalia: Burden and Outcomes From a Multicenter Observational Study in Mogadishu

Abstract

PURPOSE: Esophageal cancer (EC) remains a leading cause of cancer mortality worldwide, with East Africa forming a high-incidence EC belt. Despite Somalia's inclusion in this region, there are no cancer registries or outcome data. We conducted a multicenter observational study in Mogadishu to describe the burden, clinicopathologic characteristics, treatment patterns, referral pathways, and outcomes of EC. METHODS: We retrospectively reviewed records of patients (18 years and older) with histologically confirmed EC diagnosed between January 2022 and December 2024 in the two major diagnostic centers in Mogadishu. Demographic, clinical, pathologic, treatment, and referral data were extracted and analyzed descriptively. RESULTS: A total of 468 patients were included (mean age 55.9 years; 62% female). EC was the most common cancer diagnosed in both females and males. Dysphagia was the commonest symptom (56.8%). Squamous cell carcinoma accounted for 97.6%. Disease staging was poorly documented (>80% missing) although available data showed that most presented with advanced disease. Limited radiology capacity meant that diagnoses relied mainly on endoscopic biopsy. Hot tea consumption was the most recorded risk factor (48.9%). Treatment access was restricted: chemotherapy alone predominated (25.9%), whereas surgery (1.3%) and chemoradiotherapy (6.0%) were rare. Over one fifth (21.8%) received no treatment, and 44.2% was lost to follow-up. Of those cases with follow-up, 40.0% had died and 15.8% was alive. Referral analysis showed that 6.0% sought care in India, 0.6% in Ethiopia, 0.4% each in Kenya and Egypt, and 0.2% in Saudi Arabia, whereas 48.1% was managed locally and 43.8% had undocumented destinations. CONCLUSION: To our knowledge, this first multicenter study from Somalia reveals late-stage presentation, severe staging and treatment gaps, and poor survival. Strengthening diagnostic infrastructure, multidisciplinary care, and cancer registry systems is urgently needed to improve EC outcomes in Somalia.