Hot beverages and oesophageal cancer risk in western Kenya: Findings from the ESCCAPE case–control study

Abstract

Oesophageal squamous cell carcinoma (ESCC) has markedly high incidence rates in Kenya and much of East Africa, with a dire prognosis and poorly understood aetiology. Consumption of hot beverages—a probable carcinogen to humans—is associated with increased ESCC risk in other settings and is habitually practiced in Kenya. We conducted a case–control study in Eldoret, western Kenya between August 2013 and March 2018. Cases were patients with endoscopically confirmed oesophageal cancer whose histology did not rule out ESCC. Age and sex‐matched controls were hospital visitors and hospital out and in‐patients excluding those with digestive diseases. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated for self‐reported drinking temperatures; consumption frequency; mouth burning frequency and hot porridge consumption using logistic regression models adjusted for potential confounders. Drinking temperature association with tumour sub‐location was also investigated. The study included 430 cases and 440 controls. Drinkers of ‘very hot’ and ‘hot’ beverages (>95% tea) had a 3.7 (95% CI: 2.1–6.5) and 1.4‐fold (1.0–2.0) ESCC risk, respectively compared to ‘warm’ drinkers. This trend was consistent in males, females, never and ever alcohol/tobacco and was stronger over than under age 50 years. The tumour sub‐location distribution (upper/middle/lower oesophagus) did not differ by reported drinking temperature. Our study is the first comprehensive investigation in this setting to‐date to observe a link between hot beverage consumption and ESCC in East Africa. These findings provide further evidence for the role of this potentially modifiable risk factor in ESCC aetiology.

Missing and decayed teeth, oral hygiene and dental staining in relation to esophageal cancer risk: ESCCAPE case‐control study in Kilimanjaro, Tanzania

“…However, the evidence base for ESCC in Africa is relatively thin and not entirely consistent 2 . Since then, alcohol and hot beverages have been identified as risk factors in Kenya 4,5 …”

Systematic review of esophageal cancer in Africa: Epidemiology, risk factors, management and outcomes

“…Risk factors for developing ESCC include tobacco consumption (smoking)[3-5], heavy alcohol consumption[6,7], drinking hot tea[8,9], consuming red meat[10], poor oral health[11], low intake of fresh fruit and vegetables[10,12], and low socioeconomic status[6,13]. Esophageal mucosa dysplasia from acid reflux and Barrett’s esophagus is a risk factor for developing EAC[14].…”

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

“…Our institution is undertaking a case-control trial on the risk factors for ESCC, the validation and information of the questionnaire will help in the understanding of hot chai as a risk factor. A case-control study from Eldoret in Kenya reported an association between hot beverages and ESCC 24 . Although no temperature measurements were included, the controls reported consuming “very hot”, “hot”, and “warm” tea in 7%, 68%, and 25%, respectively, which is quite similar to our distribution of 11%, 64%, and 25%.…”

“…One recent study from Tanzania has measured beverage temperature, and it found that the participants drank their beverages (mainly tea) at an average temperature of 70.6 °C, higher than that reported in previous studies from other populations 23 . A recent case-control study by Middleton et al in Kenya, showed an association between self-reported ingestion of hot beverages with ESCC 24 . Historically, studies have utilized participant self-assessed questionnaires to report on their preferences for the temperature.…”