Abstract
Squamous cancer of the oesophagus has been, for almost a century, a major cause of morbidity and mortality in East and Southern Africa, and has been referred to as endemic in many high-incidence regions. Uncertainty about aetiology has inhibited effective preventive initiatives. 
 
 The aims of this study are to assess why some African regions and countries have a very high incidence of oesophageal cancer; to assess evidence-based associations and risk factors for population susceptibility and for individual susceptibility; to identify which of these are amenable to change; to put forward possible strategies to achieve change.
 
 A literature review identified the well-evidenced associations with high incidences of squamous oesophageal cancer to be maize, maize meal, and tobacco. A predominantly maize-based diet, and high use of maize meal are associated with population susceptibility. Tobacco is associated with individual susceptibility within a susceptible population. Alcohol, polycyclic aromatic hydrocarbons and wild vegetables are possible risk factors; other proposed risk factors are improbable.
 
 Possible actions are discussed for countries where there is a very high incidence of squamous cancer of the oesophagus. Measures to reduce population susceptibility include regulation of commercially produced maize meal to reduce content of free fatty acids at the time of consumption and supplementation of the diet with omega-3 fatty acid. Fortification of maize meal with zinc and selenium, and health education about production and consumption of fruit and vegetables may be helpful.
 
 Legislation to reduce tobacco consumption will reduce individual susceptibility.
Highlights
IntroductionThe history of squamous cell carcinoma (SCCO) in Africa is of great differences in incidence between populations, and great differences over time within the same populations
Cancer of the oesophagus in Africa is predominantly squamous cell carcinoma (SCCO)
They were used in combination with meta-analysis, Africa, cancer, carcinoma, tobacco, papillomavirus, alcohol, pylori, nitrosamine, polycyclic aromatic hydrocarbon, maize, fumonisin, wood, charcoal, diet, trace element, selenium, zinc, p53, and non-acid reflux
Summary
The history of SCCO in Africa is of great differences in incidence between populations, and great differences over time within the same populations. Study of the history of the start of the epidemic phase of the disease, its growth and spread in South and East Africa, and comparisons with unaffected countries within the continent all indicate the presence of a factor or factors which have created population susceptibility. Much of the research into the aetiology of SCCO in Africa has involved case-control and cohort studies within endemic areas. These are proven methods for pinpointing the reasons for individual susceptibility within an affected community, but may not provide insight into the reasons for population susceptibility
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
