Abstract
Squamous cell esophageal cancer is common throughout East Africa, but its etiology is poorly understood. We investigated the contribution of alcohol consumption to esophageal cancer in Kenya, based on a hospital-based case–control study conducted from 08/2013 to 03/2018 in Eldoret, western Kenya. Cases had an endoscopy-confirmed esophageal tumor whose histology did not rule out squamous cell carcinoma. Age and gender frequency-matched controls were recruited from hospital visitors/patients without digestive diseases. Logistic regression was used to calculate odds ratios (ORs) and their 95% confidence intervals (CI) adjusting for tobacco (type, intensity) and 6 other potential confounders. A total of 422 cases (65% male, mean at diagnosis 60 (SD 14) years) and 414 controls were included. ORs for ever-drinking were stronger in ever-tobacco users (9.0, 95% CI: 3.4, 23.8, with few tobacco users who were never drinkers) than in never-tobacco users (2.6, 95% CI: 1.6, 4.1). Risk increased linearly with number of drinks: OR for >6 compared to >0 to ≤2 drinks/day were 5.2 (2.4, 11.4) in ever-tobacco users and 2.1 (0.7, 4.4) in never-tobacco users. Although most ethanol came from low ethanol alcohols (busaa or beer), for the same ethanol intake, if a greater proportion came from the moonshine chang'aa, it was associated with a specific additional risk. The population attributable fraction for >2 drinks per day was 48% overall and highest in male tobacco users. Alcohol consumption, particularly of busaa and chang'aa, contributes to half of the esophageal cancer burden in western Kenya.
| Original language | English |
|---|---|
| Pages (from-to) | 459-469 |
| Number of pages | 11 |
| Journal | International Journal of Cancer |
| Volume | 144 |
| Issue number | 3 |
| Early online date | 12 Nov 2018 |
| DOIs | |
| Publication status | Published - 01 Feb 2019 |
| Externally published | Yes |
Bibliographical note
Funding Information:Key words: esophageal cancer, Africa, Kenya, alcohol, spirits Abbreviations: ASR: Age-standardized incidence rate; busaa: local alcoholic drink, brewed from sorghum, maize or millet-flour, 4.5% ethanol; chang’aa: moonshine (illicit) spirit distilled from maize husks, 20–60% ethanol, 40% assumed; EC: Esophageal cancer; ESCC: Esophageal squamous cell carcinoma; ESCCAPE: Esophageal Squamous Cell Cancer African PrEvention research; KDHS: Kenyan Demographic and Health Survey; kumi kumi: Illegal liquor made from sorghum, maize or millet-flour, and a commonly used alcohol cost unit (10 Kenyan shilling); MTRH: Moi Teaching and Referral Hospital, Eldoret, Kenya; NACADA: Kenyan National Authority for the Campaign against Alcohol and Drug Abuse; PAF: Population attributable fraction (if drinkers of >2 drinks/day were never drinkers) Additional Supporting Information may be found in the online version of this article. Conflict of interest: The authors declare no competing interests. Grant sponsor: The International Agency for Research on Cancer (IARC); Grant sponsor: NIH/NCI; Grant number: R21CA191965; Grant sponsor: IARC-UICC Development Fellowship; Grant sponsor: IARC post-doctoral fellowship supported by the European Commission FP7 Marie Curie Actions—People—Co-funding of regional, national and international programs (COFUND). DOI: 10.1002/ijc.31804 History: Received 28 May 2018; Accepted 18 Jul 2018; Online 17 Aug 2018 Correspondence to: Diana Menya, School of Public Health, College of Health Sciences, Moi University, Eldoret, Kenya, E-mail: dianamenya@gmail.com
Publisher Copyright:
© 2018 UICC
Keywords
- Africa
- alcohol
- esophageal cancer
- Kenya
- spirits
ASJC Scopus subject areas
- Oncology
- Cancer Research
