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Overview and Aims

Oesophageal squamous cell carcinoma has a very peculiar geographical distribution worldwide. Within Africa, the highest incidence areas lie along an easterly corridor, which includes the countries of Malawi, Kenya, Uganda, and the United Republic of Tanzania, as well as the eastern parts of South Africa. In the hope of informing future primary prevention efforts, the ESCCAPE consortium aims to conduct studies to shed light on the etiological epidemiology of oesophageal cancer in this setting, and in particular of the most common histological subtype, oesophageal squamous cell carcinoma.

Specific aims:

  • To investigate the descriptive epidemiology of oesophageal cancer in Africa, in particular to focus on early-onset disease, gender differences, and geographical variations
  • To investigate the role of established risk factors for oesophageal squamous cell carcinoma in the African setting
  • To investigate the “determinants of the determinants” of environmental risk factors in this setting, i.e. to understand exposure sources, routes, and influences
  • To investigate genetic susceptibility and exposure-associated genetic signatures of oesophageal cancer in the African oesophageal cancer corridor.

ESCCAPE’s research strategy is based on the following perspectives. First, a broad perspective on putative risk factors is being taken. The consortium is studying the individual and combined effects of a broad range of lifestyle, infectious, environmental, and genetic risk factors and protective factors. Second, descriptive and analytical studies are being undertaken in Africa-wide or multiple settings, with a view to interpreting findings more holistically in terms of the African oesophageal cancer corridor. Third, the consortium considers that the priority factors that need to be investigated are those that have already been established, or probable carcinogens for squamous cell oesophageal cancer in non-African settings. Such factors are being evaluated with respect to their population-level exposure levels and sources as well as their contribution to the cancer burden. The factors being studied as causal factors or risk markers include socioeconomic indicators, occupation, consumption of high-ethanol alcohols, tobacco use, opium use, exposure to polycyclic aromatic hydrocarbons (PAHs), consumption of hot foods and beverages, fruit and vegetable intake, consumption of pickled and salted vegetables, tooth loss, micronutrient deficiencies, and N-nitrosamines.