Oesophageal cancer and alcoholic spirits in central Africa

Abstract

SUMMARY A geographical pathology survey of a large area in central Africa is described and a contrast is recognized between neighbouring areas with apparently many and apparently few cases of oesophageal cancer. This distribution is compared first with other known areas of high and low incidence in sub-Saharan Africa and then with the drinking of indigenous types of distilled spirits. A significant order of spatial correlation is shown between the geographical pattern of the disease and the drinking of sugar-based alcoholic spirit in central Africa. Samples of spirits from eastern Zambia, central Kenya, and the Transkei, although prepared in apparently dissimilar utensils, were all shown to be contaminated in varying degree with zinc. Nitrosamine-like compounds in native spirits were also reported in all these areas.The need for a geographical survey of indigenous drinking habits in Africa is illustrated. Since legislation against distilling is ineffective, a simple means of excluding carcinogenic compounds from illicit spirits should be ascertained and widely promulgated at village level.For several years it has been recognized that carcinoma of the oesophagus has a remarkable geographical distribution in Africa. Recent reports (Ahmed, 1966;McGlashan, 1967; Oettle, 1963a) emphasize the difference of incidence in qualitative terms but data have usually been collected only for small areas, often a region familiar to one medical officer, and it is rare to find numbers of cases related to the population at risk to allow quantitative comparison with other areas.Statistical data of the type described by Doll (1967) are not available for most of Africa and are unlikely to be produced for another generation.

Clinical and epidemiologic variations of esophageal cancer in Tanzania

“…This can be observed for all age groups and sexes. This is an interesting observation, as the Western part of Kenya has been noted to have a higher incidence compared to other areas in Kenya [6,[10][11][12][13][14] . Because our study hospital (ORCI) is on the eastern side of Tanzania, the higher rates of the disease from eastern Tanzania might be related to more accessibility to care.…”

“…Africa specifically has a much higher incidence of EC in the Eastern and Southern regions [6] . The highest risk populations in Africa tend to be poorer, malnourished, and consume alcohol and tobacco [6,7,9,10] . There is also a large variation of risk for EC based on geographic region in Africa.…”

Informing etiologic research priorities for squamous cell esophageal cancer in Africa: A review of setting‐specific exposures to known and putative risk factors

“…However, precise delineation of the ESCC corridor is not possible due to the scarcity of high‐quality cancer registry data and differential probabilities of underdiagnosis . Nevertheless, the broad geographical pattern is not dissimilar to McGlashan's 1969 hand‐drawn map …”

“…Despite a mapping of this ESCC corridor by Burkitt, McGlashan et al . in 1960's–1970's, it remains today, in part because little etiological research has hitherto been conducted. Hence there are no unified hypotheses and little evidence to explain this disease, thus a logical starting point for etiological research is to evaluate whether ESCC risk factors, which have been established or strongly suggested throughout the world, are present in ESCC‐affected African countries.…”

Africa’s oesophageal cancer corridor: Do hot beverages contribute?

“…The African ESCC corridor includes Malawi, Kenya, Uganda, Tanzania and parts of South Africa, but its aetiology is not well understood [5]. In addition to alcohol and tobacco, [6,7] potential contributors to the burden include polycyclic aromatic hydrocarbons, nitrosamines, dietary deficiencies, and, under investigation here, hot beverage drinking [8]. The Kilimanjaro region of North Tanzania has high rates of ESCC today and indeed since the 1970s, [9,10] where the disease is known locally as kansa ya koo , literally throat cancer in Kiswahili.…”