Esophageal cancer male to female incidence ratios in Africa: A systematic review and meta-analysis of geographic, time and age trends

Daniel R S Middleton, Liacine Bouaoun, Rachel Hanisch, Freddie Bray, Charles Dzamalala, Steady Chasimpha, Diana Menya, Charles Gombé Mbalawa, Guy N'Da, Mathewos A Woldegeorgis, Ramou Njie, Moussa Koulibaly, Nathan Buziba, Josefo Ferro, Hassan Nouhou, Femi Ogunbiyi, Henry R Wabinga, Eric Chokunonga, Margaret Z Borok, Anne R KorirAmos O Mwasamwaja, Blandina T Mmbaga, Joachim Schüz, Valerie A McCormack

Research output: Contribution to journalArticlepeer-review

29 Citations (Scopus)
34 Downloads (Pure)


Esophageal squamous cell carcinoma (ESCC) remains the predominant histological subtype of esophageal cancer (EC) in many transitioning countries, with an enigmatic and geographically distinct etiology, and consistently elevated incidence rates in many Eastern and Southern African countries. To gain epidemiological insights into ESCC patterns across the continent, we conducted a systematic review and meta-analysis of male-to-female (M:F) sex ratios of EC age-standardised (world) incidence rates in Africa according to geography, time and age at diagnosis. Data from 197 populations in 36 countries were included in the analysis, based on data from cancer registries included in IARC's Cancer Incidence in Five Continents, Cancer in Africa and Cancer in Sub-Saharan Africa reports, alongside a systematic search of peer-reviewed literature. A consistent male excess in incidence rates overall (1.7; 95% CI: 1.4, 2.0), and in the high-risk Eastern (1.6; 95% CI: 1.4, 1.8) and Southern (1.8; 95% CI: 1.5, 2.0) African regions was observed. Within the latter two regions, there was a male excess evident in 30–39 year olds that was not observed in low-risk regions. Despite possible referral biases affecting the interpretability of the M:F ratios in place and time, the high degree of heterogeneity in ESCC incidence implies a large fraction of the disease is preventable, and directs research enquiries to elucidate early-age exposures among young men in Africa.

Original languageEnglish
Pages (from-to)119-128
Number of pages10
JournalCancer Epidemiology
Early online date06 Feb 2018
Publication statusPublished - Apr 2018
Externally publishedYes

Bibliographical note

Funding Information:
The work reported was undertaken during the tenure of a Postdoctoral Fellowship from the International agency for Research on cancer, partially supported by the European Commission FP7 Marie Curie Actions – People – Co-funding of regional, national and international programmes (COFUND) .

Publisher Copyright:
© 2018


  • Adult
  • Africa/epidemiology
  • Age Factors
  • Aged
  • Esophageal Neoplasms/epidemiology
  • Female
  • Geography
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Registries/statistics & numerical data
  • Time Factors
  • Young Adult

ASJC Scopus subject areas

  • Epidemiology
  • Oncology
  • Cancer Research


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