Correction: Africa's Oesophageal Cancer Corridor: Geographic Variations in Incidence Correlate with Certain Micronutrient Deficiencies

Schaafsma, Torin T; Wakefield, Jon; Hanisch, Rachel; Bray, Freddie; Schöz, Joachim; Joy, Edward J.M.; Watts, Michael J.; McCormack, Valerie

doi:10.1371/journal.pone.0142648

Cited by 12 publications

(15 citation statements)

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“…A prospective study of the Chinese population conducted over a period of 5.5 years revealed a significant inverse association with the risk of developing ESCC and initial Se levels (43). Dietary intake studies confirmed a strong inverse dose-response trend of Zn and Se to the risk of ESCC (44), as was also the case in the Rift Valley region of East Africa (24).…”

Section: Nutrition Studiessupporting

confidence: 63%

“…Epidemiological studies have been reviewed for China (2,(16)(17)(18), Iran (19)(20)(21), Africa (6,10,(22)(23)(24), USA and globally (25). Exceedingly high incidence rates have been recorded in the 'Asian esophageal cancer belt' encompassing Eastern Turkey, Iran, Kazakhstan, Turkmenistan, Mongolia and Northern China.…”

Section: Populations Studiedmentioning

confidence: 99%

“…Large rural and peri-urban indigent populations may have 'endemic' rates of up to 20 per 100,000 individuals, while 'westernized' populations are considered as relatively low-risk; nevertheless, cancer registers exhibit much variation. Traditional African communities in West Africa adhering to ancient lifestyle habits and having the lowest socio-economic status are known to have virtually no risk (24).…”

Section: Populations Studiedmentioning

confidence: 99%

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Esophageal squamous cell cancer susceptibility: Environmental and nutritional associations reveal a universally applicable pathogenesis scenario (Review)

Rensburg¹,

Rensburg

2019

Wrld Acd Sci

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Some epidemiological features, such as marked variations of incidence between geographical regions, are unique to esophageal squamous cell carcinoma (ESCC). The objective of this evaluation of only ESCC was to collate those factors that have quantitative and biological credibility, enabling the deduction of an etiological hypothesis to explain this, based on facts. Worldwide, 80% of new cases arise in less developed regions and are generally not associated with alcohol or tobacco use. Abstinence was also usual in some European localities where a high incidence occurred in certain remote regions, as well as in patients with malabsorption syndromes. All had multiple micronutrient deficiencies, resulting in atrophy and chronic esophagitis that preceded clinical carcinomas. The esophagus has an extraordinarily high cell replication rate requiring higher micronutrient nutrition than other epithelia. Stable communities worldwide, whose staple diet was maize (corn) or wheat were invariably at high risk, whereas the use of nutritious food sources resulted in an unusually low risk. The susceptibility of animals fed such diets mirrored the human situation exactly. Pertinent deficiencies identified thus far are riboflavin, nicotinamide, molybdenum (Mo), magnesium (Mg), manganese (Mn), selenium (Se) and zinc (Zn). Subclinical deficiencies of these have been shown to enhance the susceptibility of rats to ESCC. Extraordinary carcinogen exposure has only been shown in rural epidemic regions. Geologically determined poor soils yield plants vulnerable to fungal pathogens, some of which are carcinogenic to the rat esophagus. Tobacco exerts its synergistic effects on the nutritionally impaired esophagus. Nitrosamine exposure is not unusual; however, regenerative stress such as that caused by constrictions and hot drinks increase the risk. The common underlying determinant of susceptibility worldwide is chronic deficiencies of multiple micronutrients that normally maintain the integrity of the esophagus and are necessary for a number of anti-carcinogenic mechanisms. Micronutrient fortification of staple foods appears to markedly reduce the risk. Contents 1. Introduction 2. Populations studied 3. Environmental similarities in ESCC epidemic regions 4. Nutrition studies 5. Esophageal epithelial pathology possibly related to nutrition 6. Mycotoxin contamination of food 7. Other potentially harmful factors 8. Discussion and conclusions

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Section: Nutrition Studiessupporting

confidence: 63%

Section: Populations Studiedmentioning

confidence: 99%

Section: Populations Studiedmentioning

confidence: 99%

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Esophageal squamous cell cancer susceptibility: Environmental and nutritional associations reveal a universally applicable pathogenesis scenario (Review)

Rensburg¹,

Rensburg

2019

Wrld Acd Sci

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“…Brazil), Asia (e.g. China and Iran) and Southern and Eastern Africa – the focus of this paper – where incidence rates are 20-fold higher than in West Africa [ 3 ]. In this African EC corridor of high risk, ESCC accounts for 94% of EC cases [ 2 ] and is the 2nd most common cancer in some populations e.g.…”

Section: Introductionmentioning

confidence: 99%

Esophageal cancer male to female incidence ratios in Africa: A systematic review and meta-analysis of geographic, time and age trends

Middleton

Bouaoun

Hanisch

et al. 2018

Cancer Epidemiology

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HighlightsWe conducted a review and meta-analysis of esophageal cancer sex ratios in mainland Africa using data from 197 populations in 36 countries.We observed a consistent male excess in incidence rates overall and in the high-risk Eastern and Southern African regions.A male excess was evident in 30–39 year olds in high-risk Eastern and Southern African regions.Our findings suggest that a substantial fraction of the African EC burden could be avoided by targeting gender-specific exposures.

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“…Esophageal squamous cell carcinoma (ESCC), the most common histologic type of esophageal cancer, has a very unusual geographic distribution, with distinct areas of high risk across central Asia and from eastern to southern Africa 2 . Western Kenya and the Eastern Cape Province of South Africa have long been reported as endemic areas of ESCC 3–5 , but a larger corridor, from Ethiopia to South Africa, has recently been recognized as having a similar high risk 6–8 . Esophageal cancer often presents late and carries a poor prognosis, but this is particularly true in low-resource settings, where 5-year survival is often < 5% 9 , and palliation is too often the only option 10 .…”

Section: Introductionmentioning

confidence: 99%

Investigating tea temperature and content as risk factors for esophageal cancer in an endemic region of Western Kenya: Validation of a questionnaire and analysis of polycyclic aromatic hydrocarbon content

Mwachiro

Parker

Pritchett

et al. 2019

Cancer Epidemiology

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Background Esophageal squamous cell carcinoma (ESCC) is common in certain areas worldwide. One area, western Kenya, has a high risk of ESCC, including many young cases (< 30 years old), but has limited prior study of potential risk factors. Thermal injury from hot food and beverages and exposure to polycyclic aromatic hydrocarbons (PAHs) have been proposed as important risk factors for ESCC in other settings. The beverage of choice in western Kenya is milky tea (chai). Methods Healthy individuals ≥18 years of age who were accompanying relatives to an endoscopy unit were recruited to participate. The preferred initial temperature of chai consumption in these adults was measured by questionnaire and digital thermometer. Comparisons of these results were assessed by kappa statistics. Concentrations of 26 selected PAHs were determined by gas chromatography/mass spectrometry in samples of 11 brands of commercial tea leaves commonly consumed in Kenya. Results Kappa values demonstrated moderate agreement between questionnaire responses and measured temperatures. The mean preferred chai temperatures were 72.1°C overall, 72.6°C in men (n=78), and 70.2°C in women (n=22; p<0.05). Chai temperature did not significantly differ by age or ethnic group. The PAH levels in the commercial Kenyan tea leaves were uniformly low (total PAH <300 ng/g of leaves). Conclusions Study participants drink chai at higher temperatures than previously reported in other high-risk ESCC regions. Chai is not, however, a source of significant PAH exposure. Very hot chai consumption should be further evaluated as a risk factor for ESCC in Kenya with the proposed questionnaire.

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Correction: Africa's Oesophageal Cancer Corridor: Geographic Variations in Incidence Correlate with Certain Micronutrient Deficiencies

Cited by 12 publications

References 1 publication

Esophageal squamous cell cancer susceptibility: Environmental and nutritional associations reveal a universally applicable pathogenesis scenario (Review)

Esophageal squamous cell cancer susceptibility: Environmental and nutritional associations reveal a universally applicable pathogenesis scenario (Review)

Esophageal cancer male to female incidence ratios in Africa: A systematic review and meta-analysis of geographic, time and age trends

Investigating tea temperature and content as risk factors for esophageal cancer in an endemic region of Western Kenya: Validation of a questionnaire and analysis of polycyclic aromatic hydrocarbon content

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