Investigating tea temperature and content as risk factors for esophageal cancer in an endemic region of Western Kenya: Validation of a questionnaire and analysis of polycyclic aromatic hydrocarbon content

Abstract

Background Esophageal squamous cell carcinoma (ESCC) is common in certain areas worldwide. One area, western Kenya, has a high risk of ESCC, including many young cases (< 30 years old), but has limited prior study of potential risk factors. Thermal injury from hot food and beverages and exposure to polycyclic aromatic hydrocarbons (PAHs) have been proposed as important risk factors for ESCC in other settings. The beverage of choice in western Kenya is milky tea (chai). Methods Healthy individuals ≥18 years of age who were accompanying relatives to an endoscopy unit were recruited to participate. The preferred initial temperature of chai consumption in these adults was measured by questionnaire and digital thermometer. Comparisons of these results were assessed by kappa statistics. Concentrations of 26 selected PAHs were determined by gas chromatography/mass spectrometry in samples of 11 brands of commercial tea leaves commonly consumed in Kenya. Results Kappa values demonstrated moderate agreement between questionnaire responses and measured temperatures. The mean preferred chai temperatures were 72.1°C overall, 72.6°C in men (n=78), and 70.2°C in women (n=22; p<0.05). Chai temperature did not significantly differ by age or ethnic group. The PAH levels in the commercial Kenyan tea leaves were uniformly low (total PAH <300 ng/g of leaves). Conclusions Study participants drink chai at higher temperatures than previously reported in other high-risk ESCC regions. Chai is not, however, a source of significant PAH exposure. Very hot chai consumption should be further evaluated as a risk factor for ESCC in Kenya with the proposed questionnaire.

Dietary and Environmental Determinants of Oesophageal Cancer in Arsi Zone, Oromia, Central Ethiopia: A Case–Control Study

“…32 However, shreds of evidence from recent studies among African populations identified statistically significant associations between the source fuels used for cooking foods, cooking places, 34 consumption of hot foods and an increased risk developing of oesophageal carcinoma. [35][36][37][38] Besides, positive associations were found between tobacco use (smoking and sniffing), alcohol drinking, 36 and SCC of the esophagus. 34 Oesophageal cancer is ranked 5th of all types of malignancies in Ethiopia following uterine, cervical, breast, and colorectal cancers.…”

<p>Cancer Incidence and Distribution at a Tertiary Care Hospital in Somalia from 2017 to 2020: An Initial Report of 1306 Cases</p>

“…In this region, there is an excessive consumption of extremely hot tea and rice. 17,18 In addition, another factor that should be questioned is the frequent use of the plant called qat (chat or khat; Catha edulis Forsskal). Chewed in the mouth, this herb is rich in alkaloids, does not contain nicotine, but has amphetamine-like effects, leading to a psychoactive effect.…”

The Upper Digestive Tract Microbiome and Oesophageal Squamous Cell Carcinoma: Epidemiology, Pathogenesis, and Clinical Implications in Africa

“…In African countries like Tanzania, Malawi, and Kenya, hot tea consumption, especially milk tea with a high fat content that retains heat, is quite frequent and the contribution of this custom to OSCC needs to be evaluated in the AOCC, together with other risk factors acting synergistically in this malignancy. Studies in the region described hot beverage consumption could reach over 71°C [32, 33]. Middleton et al [34] conducted a case-control study in Kenya observing that “very hot” and “hot” beverage drinkers had a 3.7- and 1.4-fold OSCC risk, respectively, when compared to “warmer” drinkers.…”