Effects of smoking and alcohol use on oesophageal cancer amongst Black South Africans in Johannesburg from 1999-2009

Nhleko, Mandlakayise Lucky
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Background: Oesophageal cancer is the fourth most common cancer in black South African males with an age-standardised incidence rate of 7.31 per 100 000 in 2010, and sixth in black South African females, 3.59 per 100 000. The adoption of lifestyle behaviours such as tobacco and alcohol use was on the rise in that decade, amongst black South Africans living in Johannesburg. Aim: The overall aim was to investigate the association of smoking and alcohol use on oesophageal cancer amongst 18 to 74-year-old black South Africans in Johannesburg from 1999 to 2009. Methods: Secondary analysis were done based on a matched case-control study design. We used the conditional univariate and matched multiple logistic regression for statistical analysis as the main analysis. Gender was ascertained as an effect modifier therefore the analysis were done separately for males and females. Sensitivity analysis of the findings were tested using the unconditional univariate and unmatched multiple logistic regression. Results: Heavy smokers had an increased likelihood of oesophageal cancer as shown in the conditional multivariate logistic regression (AOR = 9.0; 95% CI: 5.2 – 15.5) in males and (AOR = 5.2; 95% CI: 1.3 – 20.1) in females. Alcohol consumption was a much stronger risk factor for oesophageal cancer among female heavy drinkers (AOR = 2.1; 95% CI: 1.5 – 2.9) relative to the light drinkers, controlling for other variables. There was a significant interaction of tobacco use and alcohol drinking as they acted synergistically to increase the likelihood of oesophageal cancer among current heavy smokers and heavy drinkers, (AOR = 15.0; 95% 7.2 – 31.3) in males and (AOR = 2.7; 95% 0.6 – 11.2) in females, compared to non-drinkers. iv Conclusion: We established that over the ten-year study period, smoking and alcohol use were both associated with oesophageal cancer independently and as combined exposures. An increase in sin tax on cigarettes and alcohol as well as increased education on the risk factors associated with the development of oesophageal cancer could be used as interventions to decrease the burden of this disease. Keywords: Smoking, Alcohol, Cancer, South Africa