Tobacco and alcohol as risk factors for oesophageal cancer in a high incidence area in South Africa |
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| Institution: | 1. African Cancer Institute, Faculty of Medicine and Health Sciences, Stellenbosch University, P.O. Box 241, Cape Town 8000, South Africa;2. Division of Community Health, Department of Interdisciplinary Health Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, P.O. Box 241, Cape Town 8000, South Africa;3. Cancer Research Division, Cancer Council New South Wales, P.O. Box 572, Kings Cross, NSW 1340, Australia;4. Sydney School of Public Health, University of Sydney, Camperdown, Australia;5. School of Public Health and Community Medicine, University of New South Wales, Kensington, Australia;6. School of Medicine and Public Health, University of Newcastle, Australia;7. Centre for Occupational and Environmental Health Research, School of Public Health and Family Medicine, University of Cape Town, Observatory 7925, South Africa;1. UMR 1094, Tropical Neuroepidemiology, INSERM, Limoges, France;2. UMR 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, University of Limoges, Limoges, France;3. Department of Cardiology, CHU Limoges, Limoges, France;4. Department of Neurology, Amitié Hospital, Bangui, Central African Republic;5. Department of Neurology, CHU Brazzaville, Brazzaville, Republic of Congo;6. Centre of Epidemiology, Biostatistic, and Research Methodology, CEBIMER, CHU Limoges, Limoges, France;7. Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, Centre for Global Mental Health, King''s College London, London, UK;1. Division of Gastroenterology, University of Michigan Health System, Ann Arbor, Michigan, USA;2. Division of Gastroenterology, Ann Arbor Veterans'' Administration Health Care System, Ann Arbor, Michigan, USA;3. Division of Gastroenterology, Case Western Reserve University Hospital, Cleveland, Ohio, USA;4. Center for Clinical Management Research, Ann Arbor Veterans'' Administration Health Care System, Ann Arbor, Michigan, USA;1. Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, 20246, Hamburg, Germany;2. Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany;1. Acute and Communicable Disease Prevention Program, Oregon Public Health Division, Portland, Oregon, United States;2. Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, United States;1. Unit of Cancer Epidemiology/Belgian Cancer Centre, Scientific Institute of Public Health, J. Wytsmanstreet 14, B1050 Brussels, Belgium;2. International Centre for Reproductive Health (ICRH), Ghent University, Ghent, Belgium;3. Algemeen Medisch Labo, Sonic Healtcare, Antwerp, Belgium;4. AMBIOR, Laboratory for Cell Biology & Histology, University of Antwerp, Antwerp, Belgium;5. N. Goormachtigh Institute for Pathology, Ghent University, Ghent, Belgium;6. Department of Gynaecology & Oncology, UZ Brussel, Free University of Brussels, Brussels, Belgium;7. Department of Pathology, VUB, Brussels, Belgium;8. Department of Pathology, UZ Leuven, Leuven, Belgium;9. Department of Gynaecology and Obstetrics, UZ Leuven, Leuven, Belgium;10. Department of Microbiology and Immunology, Rega Institute, KU Leuven, Leuven, Belgium;11. Department of Pathology, ULg, Liège, Belgium;12. Institut de Pathologie et de Génétique, Charlerloi, Belgium;13. Centrum voor Medische Analyse, Herentals, Belgium;14. Pathological Anatomy, AZ Groeninge, Kortrijk, Belgium;15. Pathology Mariaziekenhuis Noord Limburg, Overpelt, Belgium;p. Vaccine & Infectious Disease Institute (VAXINFECTIO), Antwerp University, Antwerp, Belgium;q. Reproductive Health and Research, World Health Organization, Geneva, Switzerland;r. Department of Gynaecology and Obstetrics, Ghent University, Ghent, Belgium;1. Menzies Centre for Health Policy, Sydney School of Public Health, University of Sydney, Camperdown, Australia |
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| Abstract: | BackgroundThe Eastern Cape Province of South Africa, which includes the former Transkei has high rates of squamous cell oesophageal cancer (OC), thought to be caused mainly by nutritional deficiencies and fungal contamination of staple maize. A hospital-based case-control study was conducted at three of the major referral hospitals in this region to measure, among other suspected risk factors, the relative importance of tobacco smoking and alcohol consumption for the disease in this population.MethodsIncident cases (n = 670) of OC and controls (n = 1188) were interviewed using a structured questionnaire which included questions on tobacco and alcohol-related consumption. Odds ratios (ORs) with 95% confidence intervals for each of the risk factors were calculated using unconditional multiple logistic regression models.ResultsA monotonic dose-response was observed across the categories of each tobacco-related variable in both sexes. Males and females currently smoking a total of >14 g of tobacco per day were observed to have over 4-times the odds of developing OC (males OR = 4.36, 95% CI 2.24–8.48; females OR = 4.56, 95% CI 1.46–14.30), with pipe smoking showing the strongest effect. Similar trends were observed for the alcohol-related variables. The quantity of ethanol consumed was the most important factor in OC development rather than any individual type of alcoholic beverage, especially in smokers. Males and females consuming >53 g of ethanol per day had approximately 5-times greater odds in comparison to non-drinkers (males OR = 4.72, 95% CI 2.64–8.41; females OR = 5.24, 95% CI 3.34–8.23) and 8.5 greater odds in those who smoked >14 g tobacco daily. The attributable fractions for smoking and alcohol consumption were 58% and 48% respectively, 64% for both factors combined.ConclusionTobacco and alcohol use are major risk factors for OC development in this region.ImpactThis study provides evidence for further reinforcement of cessation of smoking and alcohol consumption to curb OC development. |
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| Keywords: | Oesophageal cancer Tobacco Alcohol Attributable proportion Risk factors South Africa |
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