Uncovering Risks Associated with Smoking Types and Intensities in Esophageal Cancer within High-Prevalence Regions in Africa: A Comprehensive Meta-Analysis.

Abstract

Tobacco is usually cited among the well-known risk factors of esophageal cancer, nevertheless, the extent of the contribution of the type of smoking and its intensity to the disease has not been comprehensively elucidated in Africa. We searched Medline/PubMed, Embase, Web of Science, Scopus, Cochrane Library, and African Journals Online studies published before September 2023. The quality of the studies was assessed using the Newcastle-Ottawa scale and the funnel plot was used for assessing potential publication bias. Meta-analyses were conducted to estimate summary effects using random-effects models. This study included 22,319 participants from 27 studies. The results strongly indicate a significant link between tobacco use and a higher risk of esophageal cancer. The risk of esophageal cancer is notably higher among pipe smokers [OR=4.68(95%CI,3.38-6.48)], followed by hand-rolled cigarettes [OR=3.79(95%CI,2.68-5.35], in comparison to commercially manufactured cigarettes [OR=2.46(95%CI,1.69-3.60)]. Our findings also showed that the risk of esophageal cancer is highest in people smoking more than 183 packs/year [OR=5.47(95%CI,3.93-7.62), followed by those smoking 93-183 packs/year [OR=3.90(95%CI, 3.13-4.86), in comparison with those smoking between ≤ 92 packs/year [OR=2.90(95%CI,2.19-3.84). Our findings strongly support that in Africa, among different types of tobacco use, pipe, and hand-rollers smokers face a higher risk of esophageal cancer.