A concise review towards defining the exposome of oesophageal cancer in sub-Saharan Africa

Trancizeo Lipenga; Limbikani Matumba; Arnau Vidal; Zdenko Herceg; Valerie McCormack; Sarah De Saeger; Marthe De Boevre

doi:10.1016/j.envint.2021.106880

A concise review towards defining the exposome of oesophageal cancer in sub-Saharan Africa

Environ Int. 2021 Dec:157:106880. doi: 10.1016/j.envint.2021.106880. Epub 2021 Sep 17.

Authors

Trancizeo Lipenga¹, Limbikani Matumba², Arnau Vidal³, Zdenko Herceg⁴, Valerie McCormack⁵, Sarah De Saeger⁶, Marthe De Boevre⁷

Affiliations

¹ Department of Bioanalysis, Centre of Excellence in Mycotoxicology and Public Health, Ghent University, Ghent, Belgium; Department of Pathology, Kamuzu University of Health Sciences (KUHeS), Blantyre, Malawi; MYTOX-SOUTH, International Thematic Network, Ghent University, Ghent, Belgium; CRIG, Cancer Research Institute Ghent, Ghent, Belgium. Electronic address: trancizeo.lipenga@ugent.be.
² MYTOX-SOUTH, International Thematic Network, Ghent University, Ghent, Belgium; Food Technology and Nutrition Research Group-NRC, Lilongwe University of Agriculture and Natural Resources, Lilongwe, Malawi.
³ Department of Bioanalysis, Centre of Excellence in Mycotoxicology and Public Health, Ghent University, Ghent, Belgium; MYTOX-SOUTH, International Thematic Network, Ghent University, Ghent, Belgium.
⁴ Epigenomics and Mechanism Branch, International Agency for Research on Cancer (WHO-IARC), Lyon, France.
⁵ Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer (WHO-IARC), Lyon, France.
⁶ Department of Bioanalysis, Centre of Excellence in Mycotoxicology and Public Health, Ghent University, Ghent, Belgium; MYTOX-SOUTH, International Thematic Network, Ghent University, Ghent, Belgium; CRIG, Cancer Research Institute Ghent, Ghent, Belgium; Department of Biotechnology and Food Technology, Faculty of Science, University of Johannesburg, Doornfontein Campus, Gauteng, South Africa.
⁷ Department of Bioanalysis, Centre of Excellence in Mycotoxicology and Public Health, Ghent University, Ghent, Belgium; MYTOX-SOUTH, International Thematic Network, Ghent University, Ghent, Belgium; CRIG, Cancer Research Institute Ghent, Ghent, Belgium.

PMID: 34543937
DOI: 10.1016/j.envint.2021.106880

Abstract

Context: Oesophageal cancer (EC) is among the common causes of illness and death among all cancers worldwide. Advanced EC has a poor prognosis, with worse outcomes observed in low-income settings. Oesophageal squamous cell carcinoma (ESCC) is the most common EC histology reported globally, with the highest ESCC incidence rates in the 'Asian Belt' and the African EC corridor. While the aetiology of ESCC is well-documented in the 'Asian belt', data for the African EC corridor and the entirety of sub-Saharan Africa (SSA) are fewer.

Objective: To help address gaps in ESCC aetiology in SSA, we critically evaluated evidence of lifestyle, environmental, and epigenetic factors associated with ESCC risk and discussed prospects of defining ESCC exposome.

Data inclusion: Unlimited English and non-English articles search were made on PubMed Central and Web of Science databases from January 1970 to August 2021. In total, we retrieved 999 articles and considered meta-analyses, case-control, and cohort studies. The quality of individual studies was assessed using the Newcastle-Ottawa scale.

Data extraction: Details extracted include the year of publication, country of origin, sample size, comparators, outcomes, study subjects, and designs.

Data analysis: Together, we assessed 13 case-control studies and two meta-analyses for the effect of lifestyle or environmental exposures on ESCC risk. Again, we evaluated seven case-control studies and one meta-analysis regarding the role of epigenetics in ESCC tumorigenesis.

Results: In general, evidence of ESCC aetiology points to essential contributions of alcohol, tobacco, hot beverages, biomass fuel, and poor oral health/hygiene, although more precise risk characterisation remains necessary.

Conclusion: We conclude that ESCC in SSA is a multifactorial disease initiated by several external exposures that may induce aberrant epigenetic changes. The expanding aetiological research in this domain will be enhanced by evidence synthesis from classical and molecular epidemiological studies spanning the external and internal exposome.

Keywords: Africa; Environmental health; Exposome; Oesophageal cancer; Oesophageal squamous cell carcinoma.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Review

MeSH terms

Africa South of the Sahara / epidemiology
Esophageal Neoplasms* / epidemiology
Esophageal Neoplasms* / etiology
Esophageal Squamous Cell Carcinoma* / epidemiology
Esophageal Squamous Cell Carcinoma* / etiology
Exposome*
Humans
Incidence

Grants and funding

001/WHO_/World Health Organization/International