Abstract:
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.
