Abstract:
Background The contribution of alcohol to the large burden of oesophageal squamous cell carcinoma (ESCC) in east
Africa remains uncertain and difficult to assess owing to complex consumption patterns of traditional and commercial
drinks. We aimed to assess whether alcohol drinking, overall and at specific intake levels, contributes to ESCC risk in
east Africa.
Methods We did a hospital-based case-control study in Kenya, Tanzania, and Malawi, which included comprehensive
assessment of a variety of locally consumed alcohol that we used to classify drinkers as exclusively low alcohol-by volume (ABV; <30% ABV) drinkers or drinkers of some high-ABV drinks, as well as the number of drinks consumed,
average weekly ethanol intake, and the contribution of each drink type to overall ethanol consumption. Cases were
patients aged 18 years and older with incident primary ESCC, confirmed histologically for the majority of cases, and
a clinical diagnosis for the remainder. Controls were frequency-matched on age and sex in a 1:1 ratio with cases. The
controls were recruited from the same hospitals as cases and included outpatients, inpatients, and hospital visitors
who did not have cancer or any other digestive disease. Consenting participants took part in face-to-face interviews in
which they were asked whether they had ever consumed alcohol (the primary exposure variable); those who had were
asked follow-up questions about their consumption habits for different alcoholic drinks.
Findings 1279 cases and 1346 controls were recruited between Aug 5, 2013, and May 24, 2020, including 430 cases and
440 controls from Kenya, 310 cases and 313 controls from Tanzania, and 539 cases and 593 controls from Malawi.
65 (4·8%) of 1344 cases were excluded. Consistent positive associations with ESCC risk were found for ever having
consumed alcohol in Kenyan men and Tanzanian men, and for daily number of drinks and estimated ethanol intake
in Kenya, Tanzania (both sexes) and Malawian women. Corresponding population-attributable fractions of ESCC for
those reporting ever drinking alcohol (vs never drinking) were 65% (95% CI 52–78) in Kenyan men and 23% (<1–45)
in Kenyan women, and 56% (95% CI 36–76) in Tanzanian men and 5% (0–42) in Tanzanian women. Increased risk
and population-attributable fractions were almost entirely due to risks in high-ABV drinkers.