Traditional and commercial alcohols and esophageal cancer risk in Kenya

Diana Menya*, Nicholas Kigen, Margaret Oduor, Stephen Karuru Maina, Fatma Some, David Chumba, Paul Ayuo, Odipo Osano, Daniel R.S. Middleton, Joachim Schüz, Valerie A. McCormack

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

16 Citations (Scopus)


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 languageEnglish
Pages (from-to)459-469
Number of pages11
JournalInternational Journal of Cancer
Issue number3
Early online date12 Nov 2018
Publication statusPublished - 01 Feb 2019
Externally publishedYes

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:

Publisher Copyright:
© 2018 UICC


  • Africa
  • alcohol
  • esophageal cancer
  • Kenya
  • spirits

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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