Cancer of the Œsophagus and Alcoholic Drinks in East Africa

Cancer of the Oesophagus in Africa

“…An association with alcohol consumption has been established elsewhere in the world but the mere quantity of alcohol consumed is insufficient to explain global (Table 1; 47,37,45,46,43,33,30,16,23,24 (Cook and Burkitt, 1971 (Ahmed and Cook, 1969 (Cook and Burkitt, 1970, unpublished report (Nabri, 1966-69, personal communication) whereas in East and southern Africa it is the middle and lower thirds of the oesophagus which are most commonly affected (Ahmed, 1966;Burkitt and Cook, unpublished data;Higginson and Oettle', 1960;Schonland and Bradshaw, 1968 (Burkitt, Hutt and Slavin, 1968;Cook and Burkitt, 1970, unpublished report Oettle' followed the original study of frequency with a postal questionnaire to all general hospitals in southern Africa to see whether other similar gradients could be established (Oettle', 1963). He asked for the number of oesophageal tumours to be expressed relative to the number of hospital beds and found a ratio which varied from 25-8 per 100 beds in the Transkei and 25-4 in Tembuland (immediately to the north of the Transkei) to only 0-2 in Swaziland.…”

“…However, reliable incidence figures have been published for a few centres and these indicate both that the frequency in parts of East and South Africa is among the highest known anywhere in the world and that the range of frequency within Africa is almost hundredfold compared with say liver cancer for which the range is only about fivefold (Cook and Burkitt, 1971). All estimates of incidence given below are age standardized for the limited age group (Doll and Cook, 1967).…”

“…The figure of 5-5 per 100,000 from Kampala in 1954-60 (Davies et al, 1965;Doll, 1969) Cook and Burkitt, 1971 1968-69 2-5 :I*t Souther Malawi (S of 13' S) Cook and Burkitt, 1971 1968-69 10-8 :I*t * Ratio of cases adjusted for the sex ratio of the population at risk. Burrell, 1962), in areas of moderate frequency such as Puerto Rico (Martinez, 1969) and in areas of low frequency such as the United States or Sweden (Wynder and Bross, 1961;Wynder et al, 1957).…”

“…Many of these however are features of the preparation of drinks in urban areas and cannot explain the very high frequencies of cancer of the oesophagus in rural areas such as the Transkei (Oettle', 1967). A survey of the methods of preparation of alcoholic drinks in a range of areas of differing frequency in Kenya and Uganda showed marked regional variation in the use of containers made of clay or metal and in the use of copper piping, but the distribution patterns showed no association with the distribution of cancer of the oesophagus (Cook et al, 1971). There was also no evidence for the use of exhaust pipes as part of the distilling apparatus or for the inclusion of exotic additives in the drinks consumed.…”

“…Many nitrosamines have been shown to be highly carcinogenic, and several are specific to the oesophagus causing tumours at this site by whichever route they are administered (Magee and Barnes, 1967 (Cook et al, 1971). …”