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Traditional and commercial alcohols and esophageal cancer risk in Kenya
Author(s) -
Menya Diana,
Kigen Nicholas,
Oduor Margaret,
Maina Stephen Karuru,
Some Fatma,
Chumba David,
Ayuo Paul,
Osano Odipo,
Middleton Daniel RS,
Schüz Joachim,
McCormack Valerie A
Publication year - 2018
Publication title -
international journal of cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.475
H-Index - 234
eISSN - 1097-0215
pISSN - 0020-7136
DOI - 10.1002/ijc.31804
Subject(s) - medicine , odds ratio , esophageal cancer , confounding , confidence interval , population , logistic regression , etiology , epidemiology , cancer , gastroenterology , environmental health
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.