On the International Agency for Research on Cancer's 60th birthday, we reflect on the continuing importance of the agency's international remit in cancer research, driven by its founding principle that the discovery of carcinogenic agents is relevant to all humans globally. The present narrative elaborates on this continued stimulus through the discussion of three themes: (1) trust and independence, especially amid vested interests and misinformation; (2) equity and efficiency as essential elements of progress in cancer research, achieved by prioritizing research in underserved and understudied areas and locations where exposure doses or contrasts are high; and (3) a commitment to context-relevant research through strong local collaborations and capacity building. We demonstrate that the international research conducted at the International Agency for Research on Cancer is a core means to advance carcinogenic discovery, building reciprocal partnerships where all countries benefit when discoveries are shared across borders. If we do not attempt to understand cancer everywhere, we will never fully understand it anywhere.

Sub-Saharan Africa (SSA) faces a unique cancer burden, characterized by a disproportionately high mortality-to-incidence ratio, a large share of infection-related cancers, and distinct environmental exposures. Implementation of national policies on primary prevention is limited, and public literacy regarding cancer risk and curability remains low. Furthermore, the implementation of existing prevention and treatment interventions is hindered by resource constraints and deeply rooted cultural beliefs. Thus, cancer prevention guidelines developed for other regions are often inadequate for this specific context. Following the International Agency for Research on Cancer's strategic and methodological World Code Against Cancer Framework-which develops region-specific, evidence-based recommendations-we call to join forces for the development of an African Code Against Cancer (AfCAC). The AfCAC would be targeted to the public and policymakers, tailored to the epidemiological, socio-cultural, and health system realities of SSA, and incorporated into existing National Cancer Control Plans (NCCPs). This Code would be aligned with the most relevant risk factors, local knowledge, and culturally appropriate effective cancer preventive interventions. Successful development of the AfCAC will require sustained commitment from diverse African stakeholders, including national governments, key scientists, non-governmental actors and funders. Successful implementation will necessitate multistakeholder input such as from policy implementers, advocacy groups, social anthropologists, religious leaders, and traditional healers and other local multisectoral stakeholders who possess a nuanced understanding of local norms integral to cancer prevention efforts. Importantly, strong national governmental commitment, demonstrated through developing and funding effective NCCPs and robust cancer registries, alongside capacity building for local health and non-health actors, will be paramount.

"Very hot beverage" (>65°C) consumption is an IARC probable carcinogen and may contribute to the African esophageal cancer burden. We conducted community cross-sectional exposure studies of hot beverage consumption in Kenya and Malawi during 2018-2019, aiming to: (i) implement a detailed measurement protocol incorporating three measurements of sip temperature and volume so as to predict each sip's intra-esophageal liquid temperature (IELT); (ii) examine variations by seasonality, drinking venue and age, including children. 246 participants were included, of whom 236 had drink measurements (52 children and 183 adults). Among adults, mean (SD) temperatures at first sip were 67 (9) and 68 (7) °C in Kenya and Malawi respectively, i.e. 58 and almost 70 % of first sips were > 65 °C. In both countries, adults exhibited a protective habit of smaller sips at higher temperatures (mean 11 mL at first sip), whereas the larger middle sip (20 mL) had the highest IELT (45 °C). The highest temperatures were observed in men and for drinks taken in social settings, whereas we did not detect seasonality or associations with other esophageal cancer risk factors. Measurements were difficult to make for 20 % (8/43) of Kenyan children whose drink was cooled by pouring between cups ('poesha'). Where poesha was not practiced, IELTs were lower in children (especially < 10 years) than in adults, owing to a mean of 8 °C cooler first sip temperature, however 20 % of first sips were > 65 °C. If very hot beverage consumption is an esophageal carcinogen, lowering sip temperatures and volumes in East Africa would form important prevention avenues.

ImportanceEffective communication between patients and health care teams is essential in the health care setting for delivering optimal cancer care and increasing cancer awareness. While the significance of communication in health care is widely acknowledged, the topic is largely understudied within African settings.ObjectiveTo assess how the medical language of cancer and oncology translates into African languages and what these translations mean within their cultural context.Design, Setting, and ParticipantsIn this multinational survey study in Africa, health professionals, community health workers, researchers, and scientists involved in cancer care and research and traditional healers were invited to participate in an online survey on a voluntary basis through online platforms. The survey provided 16 cancer and oncologic terms used in cancer diagnosis and treatment (eg, cancer, radiotherapy) to participants, mostly health care workers, who were asked to provide these terms in their local languages (if the terms existed) followed by a direct or close translation of the meaning in English. The survey was open from February to April 2023.Main Outcomes and MeasuresPatterns of meaning that recurred across languages were identified using thematic analysis of 16 English-translated terms categorized into 5 themes (neutral, negative, positive, phonetic or borrowed, and unknown).ResultsA total of 107 responses (response rate was unavailable given the open and widespread distribution strategy) were collected from 32 countries spanning 44 African languages, with most participants (63 [59%]) aged 18 to 40 years; 54 (50%) were female. Translations for cancer were classified as phonetic or borrowed (34 [32%]), unknown (30 [28%]), neutral (24 [22%]), and negative (19 [18%]), with the latter category including universal connotations of fear, tragedy, incurability, and fatality. Similar elements connoting fear or tragedy were found in translations of terms such as malignant, chronic, and radiotherapy. The term radiotherapy yielded a high percentage of negative connotations (24 [22%]), with a prevailing theme of describing the treatment as being burned or burning with fire, heat, or electricity, which may potentially hinder treatment.Conclusions and RelevanceIn this survey study of cancer communication and the translation of oncology terminology in African languages, the findings suggest that the terminology may contribute to fear, health disparities, and barriers to care and pose communication difficulties for health professionals. The results reinforce the need for culturally sensitive cancer terminology for improving cancer awareness and communication.

Smokeless tobacco (SLT) use is an established carcinogen to the nasal cavity, lip, and oropharynx, however, few studies have examined cancer risks in older African women among whom SLT use is common. We investigated snuff use and the risk of site-specific cancers among 15,336 newly diagnosed female cancer patients in the Johannesburg Cancer Study, South Africa. We designed case-control comparisons across multiple cancer outcomes: (a) known SLT-associated cancers; (b) other tobacco-related cancers and (c) genital cancers owing to intravaginal snuff use. Controls (n = 2961) comprised all other cancer patients. We also investigated (d) each control cancer type versus the remaining controls to explore possible associations with other cancers. Logistic models were fitted to estimate odds ratios adjusted for age, education, tobacco smoking, alcohol, HIV, and language. Overall, ever use of snuff was 22% among control cancers. Ever snuff use was associated with cervical (OR 1.14 [95%CI 1.00-1.30]) and eye and adnexa cancer (OR 1.95 [95%CI 1.03-3.70]). Associations with vulva cancer were less clear, 95% CI's for the main effects included 1 but a subgroup analysis restricted to never-smokers of current-versus-never users was positive (OR 2.10 [95%CI 1.25-3.50]). Surprisingly SLT users have lower risks of stomach cancer (OR 0.60 [95%CI 0.37-0.99]) and Hodgkin Lymphoma (OR 0.48 [95%CI 0.23-0.97]). Snuff use may increase the risk for cervical and vulva cancer in women, which is plausible via intravaginal use. Further research on the impact of SLT on female genital cancers with more detailed exposure data, including timing, intensity, and routes of use are required.

Background Oesophageal squamous cell carcinoma (OSCC) is one of the most common and lethal cancers worldwide. Despite advances in treatment, the five-year survival rate for OSCC remains suboptimal. Recent studies reveal that microRNAs (miRNAs) are involved in developing and progressing various types of cancer. Therefore, the modulation of miRNAs could have implications for new OSCC treatments. The purpose of this research was to summarise the published evidence on the impact of miRNA-140 on OSCC development and progression. Methods PubMed and Scopus were searched for the relevant literature. Study inclusion criteria were: basic science studies published during 1 June 2014–1 June 2023. Study exclusion criteria were: research without an appropriate analysis, non-English language publications, and grey literature. No study quality assessment tool currently exists for basic science studies, and all studies that met the eligibility criteria were incorporated in the review. The literature search results were analyzed with descriptive statistics (frequencies, percentages) and presented as a narrative synthesis. Results Eight papers were included in this review. All included studies were from China, and ECA109 was the most common OSCC cell line used (8 studies, 100%). Findings from studies involving transfection of OSCC cell lines with miRNA-140 mimics suggest that increased levels of miRNA-140 impair OSCC development and progression. Several genes appear to be regulated by miRNA-140 in OSCC development and progression (NFYA, ZEB1 & 2, ErbB4, and NRIP1). Hypoxia reduces miRNA-140 levels, thereby promoting OSCC development and progression. High levels of miRNA-140 were found to confer resistance to platinum-based chemotherapy drugs. Conclusion miRNA-140 plays multiple roles in the development and progression of OSCC, including influencing tumorigenesis, apoptosis of tumor cells, genome instability, invasion, metastasis, and chemotherapy resistance. Recommendation More research is needed to extend and validate these results, and to develop OSCC therapies aimed at modulating miRNA-140.

PURPOSEAn understanding of the cultural and context-specific perceptions of the causes of cancer is an important prerequisite for designing effective primary health prevention and early detection strategies. We aimed to use the Murdock Ill Health Theoretical Model to conceptualize views on illness causation among dysphagia-suffering patients undergoing diagnostic workup for esophageal cancer (EC) in Tanzania.METHODSAt the end of a structured interview on lifestyle habits, patients with suspected EC were asked about beliefs on the reasons behind their illness through (1) a set of questions with fixed binary answers, whose determinants were analyzed using logistic regression, and (2) a single question with free-text answers. Responses were coded using a hierarchy of natural and supernatural (godly and social constructs) causes.RESULTSAmong 322 patients interviewed between November 2015 and December 2019, we found complex and varied views about the origins of their illness. Overall, 49% of patients attributed illness to natural causes and 39% to supernatural causes. Natural causes ranged from infection, use of alcohol and tobacco, other ailments, and the environment. The supernatural causes included attributing illness to God, curses, and spells from personal acquaintances. Belief in supernatural causes was more common in the less educated and those who sought help first via a traditional healer.CONCLUSIONThe results underscore the need for increased community awareness of biomedical causes of ill health and patient-based participatory research to inform prevention programs. The results also highlight the importance of building health systems that support a series of health-seeking behaviors that acknowledge both biomedical and local traditional healing belief systems.

In June, 2023, a Working Group of 25 scientists from 12 countries met at the International Agency for Research on Cancer (IARC) in Lyon, France, to finalise their evaluation of the carcinogenicity of aspartame, methyleugenol, and isoeugenol. Aspartame was classified as "possibly carcinogenic to humans" (Group 2B) based on "limited" evidence for cancer in humans. There was also "limited" evidence for cancer in experimental animals and "limited" mechanistic evidence. Methyleugenol was classified as "probably carcinogenic to humans" (Group 2A) based on "sufficient" evidence for cancer in experimental animals and "strong" mechanistic evidence, including studies in humanised mice and supported by mechanistic studies in exposed humans.

Background The African Esophageal Squamous Cell Carcinoma (ESCC) corridor, which spans from Ethiopia down to South Africa, is an esophageal cancer hotspot. Disproportionately high incidence and mortality rates of esophageal cancer have been reported from this region. The aim of this study was to systematically assess the evidence on environmental and life-style risk factors associated with ESCC in African populations. Methods We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and carried out a comprehensive search of all African published studies up to March 2023 using PubMed, Embase, Scopus, and African Index Medicus databases. Results We identified 45 studies with measures of association [odds ratio (OR), relative risk (RR), and 95% confidence intervals (95%CI)], which reported on several environmental and lifestyle risk factors for ESCC in Africa. We performed a meta-analysis on 38 studies investigating tobacco, alcohol use, combined tobacco and alcohol use, polycyclic aromatic hydrocarbon exposure, hot food and beverages consumption (which served as a proxy for esophageal injury through exposure to high temperature), and poor oral health. We found significant associations between all the risk factors and ESCC development. Analysis of fruit and vegetable consumption showed a protective effect. Using population attributable fraction (PAF) analysis, we calculated the proportion of ESCC attributable to tobacco (18%), alcohol use (12%), combined tobacco and alcohol use (18%), polycyclic aromatic hydrocarbon exposure (12%), hot food and beverages intake (16%), poor oral health (37%), and fruit and vegetable consumption (-12%). Conclusions Tobacco smoking and alcohol consumption were the most studied risk factors overall. Areas where there is an emerging body of evidence include hot food and beverages and oral health. Concurrently, new avenues of research are also emerging in PAH exposure, and diet as risk factors. Our results point to a multifactorial etiology of ESCC in African populations with further evidence on prevention potential.

Purpose: Communication is an essential aspect of cancer care and awareness but has been largely understudied in the African setting. There is no documentation, to our knowledge, of the spoken language used to communicate cancer terms in African languages. These languages are characterized by immense linguistic and ethno-cultural diversity and may not have any official term for ‘cancer’. Instead, the communicated language may have nuances and connotations which need to be understood. Methods: We conducted a survey on “The Language of Cancer Communication in Africa”. The aim was to gather information on how the medical language of cancer and its treatment is communicated to patients and by the community in African languages, and what these communication terms mean. Using an online survey administered in the English and French, a list of 16 cancer terms used in diagnosis and treatment (such as ‘cancer’, ‘biopsy’, ‘radiotherapy’, ‘chemotherapy’) were provided to participants who were asked to provide these terms in their local language (if it exists) followed by a direct translation of the meaning of the term into English (if they know). Participants were also allowed to provide any additional information or comments regarding the term to allow for documentation of nuances in the form of idioms, metaphors, or euphemisms. Analysis included descriptive and summary statistics on the variables collected as well as thematic analysis. Results: We present here examples of results from Zimbabwe and Uganda for the term ‘cancer’. The Shona (Zimbabwe) word is “gomarara” which means a parasitic plant. One of the explanations from the participants was that “This is a plant that grows on top of another plant, in a parasitic way, usually killing or disabling the plant.” In Uganda, the Luganda word for cancer is “kokolo” which means “Once it has come, no retreat, the disease will eat you until death”. Conclusion: The survey is still ongoing and will highlight the existence or nonexistence of cancer terms as well as the nature of cancer terminology in African languages and how it may contribute to fear, disparities for patients, and pose communication difficulties for Health Professionals. We envision that information collected from this survey will highlight the state of cancer communication in Africa and serve as platform for future in-depth work on the topic given the multiplicities of languages and cultures across the Continent. Citation Format: Hannah Simba, Justina Onwuka, Bernadette Chimera, Yahya Mahamat Saleh, Felix Oyinje, Grace Akinyi Odongo, Miriam Mutebi, Adamu Addissie, Efua Prah, Elom Aglago, Joachim Schuz, Valerie McCormack, Moses Galukande. The Language of Cancer Communication in Africa [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 82.

Purpose: Esophageal cancer caused 544,076 deaths in 2020. It has two major subtypes: esophageal adenocarcinoma (EAC) and esophageal squamous cell carcinoma (ESCC). A geographically intriguing African Esophageal Cancer Corridor has very high incidence and mortality rates for ESCC. We propose that ESCC research in this corridor might benefit from leveraging advances in tools used for the early detection of EAC, namely using the esophageal sponge cytology. The Cytosponge™ was developed by the University of Cambridge Fitzgerald-laboratory. This pill-on-a-string is an endoscopy-alternative and may form an attractive appropriate health technology in Africa. However, use of the Cytosponge™ for ESCC research in Africa is limited to the CytoSCCAPE study which demonstrated high acceptability and safety of administering the device among 102 asymptomatic adult community volunteers in Kilimanjaro, Tanzania. Methods: In the present proof-of-concept pilot study, we investigated whether FFPE cytology blocks obtained in the CytoSCCAPE study could be used for exposure-specific methylation studies, via two objectives: (i) examine DNA yield from the cytology blocks and (ii) evaluating if the isolated DNA can be used for investigating DNA methylation-based exposure analysis. Here we performed pyrosequencing to compare DNA methylation status of established tobacco-specific methylation markers (CpG cg05575921 & a nearby CpG locus) in ever compared to never tobacco users. Results: Among 102 participants (mean age 50 (SD 12) years, 52% female), 58% (N=58) had good DNA yield (>100 ng), 19 had poor DNA concentration (range 3-54.9ng) and 25 had low DNA concentration (range 60-104ng). In total, 49 (77%) samples passed the quantification stage out of 64 samples that were pyrosequenced. Among these 49 participants, median (IQR) cg05575921 methylation was low overall: 33% (27-44) and did not differ between the 8 ever and 41 never-tobacco users (p=0.85). Hypomethylation in tobacco consumers was not observed, in contrast to work published using blood DNA. Conclusion: We discuss possible reasons for this inconsistency, which include low cellularity and deparaffinization of FFPE sections and provide recommendations for future Cytosponge™ studies for ESCC etiological research. Citation Format: Hannah Simba, Fazlur Rahman Taludkar, Daniel Middleton, Blandina Mmbaga, Alex Mremi, Valerie McCormack. Utility of the Cytosponge for Aetiological Research in Esophageal Squamous Cell Carcinoma: Proof-of-Concept Pilot Study Using Tobacco-Specific Methylation Markers [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 93.

Tobacco use is a well‐established risk factor for oesophageal squamous cell carcinoma (ESCC) but the extent of its contribution to the disease burden in the African oesophageal cancer corridor has not been comprehensively elucidated, including by type of tobacco use. We investigated the contribution of tobacco use (smoking and smokeless) to ESCC in Tanzania, Malawi and Kenya. Hospital‐based ESCC case‐control studies were conducted in the three countries. Incident cases and controls were interviewed using a comprehensive questionnaire which included questions on tobacco smoking and smokeless tobacco use. Logistic regression models were used to estimate odds ratios (OR) and their 95% confidence intervals (CI) of ESCC associated with tobacco, adjusted for age, sex, alcohol use, religion, education and area of residence. One thousand two hundred seventy‐nine cases and 1345 controls were recruited between August 5, 2013, and May 24, 2020. Ever‐tobacco use was associated with increased ESCC risk in all countries: Tanzania (OR 3.09, 95%CI 1.83‐5.23), and in Malawi (OR 2.45, 95%CI 1.80‐3.33) and lesser in Kenya (OR 1.37, 95%CI 0.94‐2.00). Exclusive smokeless tobacco use was positively associated with ESCC risk, in Tanzania, Malawi and Kenya combined (OR 1.92, 95%CI 1.26‐2.92). ESCC risk increased with tobacco smoking intensity and duration of smoking. Tobacco use is an important risk factor of ESCC in Tanzania, Malawi and Kenya. Our study provides evidence that smoking and smokeless tobacco cessation are imperative in reducing ESCC risk.

BACKGROUND:Healthcare workers (HCWs) are at the frontline of response to the COVID-19 pandemic. Protecting HCWs is of paramount importance to the World Health Organization (WHO). Outbreak investigation which is based on a critical assessment of core components of infection prevention and control (IPC) programs allows for the identification of different sources of exposure to the COVID-19 virus and for informing additional IPC recommendations. To date, the Democratic Republic of the Congo (DRC) is categorized as a high-risk country due to weaknesses in the health system, low capacity for diagnosis, socioeconomic characteristics of the population, and insufficient vaccination coverage.AIM:To investigate the burden of COVID-19 among HCWs and identification of IPC gaps to reduce HCWs-associated infection at different levels (facilities, communities, and points of entry) following the WHO strategy for IPC program implementation during the first to the third wave of the pandemic.METHODS:A retrospective cohort study was conducted using the DRC National Department of Health (NDOH) database and WHO questionnaire suspected and confirmed COVID-19 cases among HCWs from 10/03/2020 to 22/06/2021. The investigation was conducted by a trained IPC response team to identify the sources of the exposures. The questionnaire included demographics, profession, types of interaction between HCWs and patients, and community-based questions regarding family members and other behaviors. These variables were assessed using a multimodal strategy framework. Knowledge and adherence to IPC gaps using WHO guidelines were performed for each COVID-19-positive or suspected HCW. WHO rapid Scorecard dashboard was conducted for evaluating healthcare facilities (HCFs) performance during the COVID-19 pandemic.RESULTS:Cumulative incidence of positive HCWs was 809 /35,898(2.2%) from the first to the third wave of COVID-19 among 6 provinces of DRC. The distribution of the HCWs infected by COVID-19 was predominated by nurses (42%), doctors (27%), biologists (8%), environmental health practitioners (5%), interns (3%), and other categories (15%). Other categories included nutritionists, physiotherapists, midwives, pharmacists, and paramedics. The investigation revealed that about 32% of HCWs were infected from household contacts, 11% were infected by HCFs, 35% were infected in the community and 22% were infected from unknown exposures. The mean score of IPC performance for all evaluated HCFs was 27/42(64%). This shows that IPC performance was moderate. Lower or minimal performance was noted in the implementation of the IPC program at the national and facility level, triage and screening, isolation handwashing and multimodal strategies of hand hygiene, PPE availability, and rationale, waste segregation, waste disposal, sterilization, and training of HCWs.CONCLUSION:This study revealed that the prevalence of HCWs who tested positive for the COVID-19 virus was high among frontline healthcare workers from 6 provinces of DRC. A high prevalence of nosocomial infection was correlated with insufficient IPC adherence in the context of COVID-19. Strategies to strengthen IPC capacity building and provide HCWs with sufficient PPE stocks and budgets may improve IPC performance in the Democratic Republic of the Congo. This will further allow for adherence to WHO recommendations for successful program implementation to minimize COVID-19 transmission in HCFs, communities, and public gatherings. And this may be transferable to other infectious diseases.

OPINION article Front. Genet., 25 March 2022Sec. Human and Medical Genomics Volume 13 - 2022 | https://doi.org/10.3389/fgene.2022.864575

In December 2019, coronavirus disease 2019 (COVID-19) emerged as a health crisis in Wuhan, China, and was later declared by the World Health Organization (WHO) as a Public Health Emergency of International Concern. As it spread and its death toll increased, on the 11th of March 2020 it was declared a pandemic at 4,369 deaths worldwide, and cases and deaths have since surged. With gender disparities already known to leave women and their health at the margins of society during outbreaks, it is important to understand how COVID-19 affects women's health. In this article, we discuss how the COVID-19 pandemic can create vulnerabilities for women and their health and further exacerbate long-existing inequalities and social disparities. These include gender-based roles, economic and food security, violence, work pressure, and access to health and healthcare facilities. These issues have significant repercussions on the physical and mental health of women. To focus our lenses on these issues, we draw lessons from three specific examples of past outbreaks: 1918 Flu pandemic, Zika virus disease, and Ebola virus disease. We conclude by stating how public health responses and strategies for COVID-19 can be inclusive to women's health.

Background: Esophageal squamous cell carcinoma (ESCC), one of the most aggressive cancers, is endemic in Sub-Saharan Africa, constituting a major health burden. It has the most divergence in cancer incidence globally, with high prevalence reported in East Asia, Southern Europe, and in East and Southern Africa. Its etiology is multifactorial, with lifestyle, environmental, and genetic risk factors. Very little is known about the role of genetic factors in ESCC development and progression among African populations. The study aimed to systematically assess the evidence on genetic variants associated with ESCC in African populations. Methods: We carried out a comprehensive search of all African published studies up to April 2019, using PubMed, Embase, Scopus, and African Index Medicus databases. Quality assessment and data extraction were carried out by two investigators. The strength of the associations was measured by odds ratios and 95% confidence intervals. Results: Twenty-three genetic studies on ESCC in African populations were included in the systematic review. They were carried out on Black and admixed South African populations, as well as on Malawian, Sudanese, and Kenyan populations. Most studies were candidate gene studies and included DNA sequence variants in 58 different genes. Only one study carried out whole-exome sequencing of 59 ESCC patients. Sample sizes varied from 18 to 880 cases and 88 to 939 controls. Altogether, over 100 variants in 37 genes were part of 17 case-control genetic association studies to identify susceptibility loci for ESCC. In these studies, 25 variants in 20 genes were reported to have a statistically significant association. In addition, eight studies investigated changes in cancer tissues and identified somatic alterations in 17 genes and evidence of loss of heterozygosity, copy number variation, and microsatellite instability. Two genes were assessed for both genetic association and somatic mutation. Conclusions: Comprehensive large-scale studies on the genetic basis of ESCC are still lacking in Africa. Sample sizes in existing studies are too small to draw definitive conclusions about ESCC etiology. Only a small number of African populations have been analyzed, and replication and validation studies are missing. The genetic etiology of ESCC in Africa is, therefore, still poorly defined.