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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 from08/2013to03/2018in 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 oddsratios (ORs) and their95%confidence intervals (CI) adjusting for tobacco (type, intensity) and6other potential confounders.A total of422cases (65% male, mean at diagnosis60(SD14)years)and414controls 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 >6compared to >0to≤2drinks/day were5.2(2.4,11.4) in ever-tobacco users and2.1(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 >2drinks per day was48% 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 |
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