#Africa&Cancer

 The upsurge of Esophageal cancer in Ethnic Somali patients in Kenya: A call to action

In Kenya, cancer is the second leading cause of non-communicable disease deaths, and the trend of cancer deaths is projected to increase. Among men, the most common cancers are prostate cancer, esophageal cancers, and colorectal cancers, while in women, breast, cervical, and esophageal cancers are the most common(1).

Overall, esophageal cancer (EC) is the most diagnosed cancer in both males and females and the leading cancer-related mortality in Kenya(2). While EC is prevalent across many ethnic Kenyan tribes (3), local unpublished clinical data shows a continuing upsurge in EC cases unique to ethnic Somali communities living in Kenya. 

 Expectedly, our diagnostic capabilities have improved, and more patients are coming to the hospital, albeit at a late stage, leading to a higher detection rate that informs the high incidence rate of this debilitating disease. However, this particular community's uniquely high disease burden requires further epidemiological inquiry. 

 Published studies regarding the epidemiological factors that drive the high incidence of EC in Kenya include poor diet and nutritional insufficiencies with high intake of red meat(4), use of alcohol and tobacco(5), environmental carcinogenic exposure(6), intake of hot beverages(7), and genetic susceptibility citing a remarkable positive close family history of esophageal cancers(8) 

 There are many theories for the upsurge of this disease, but there is a paucity of epidemiological data in the Somali community on the causes and the patterns of disease presentation. Similarly, there are no available well-established data on environmental concerns or population-based genetic studies to highlight the possibility of genetic susceptibility to the disease in the Somali community, leading to a substantial unmet need for research in this space.  

 Plausible undetermined theories regarding the epidemiological factors that drive the high incidence of EC in ethnic Somali communities include nomadic lifestyle (albeit large rural-urban migration), poor diet and micro and macro nutritional insufficiencies, rampant use of miraa, unique patient geographical demographics (northern Kenya region), lack of existing cancer diagnostic facilities in the northern Kenya region, poor health-seeking behaviors resulting from cancer-related stigma, among others. These observations of epidemiological EC patterns in ethnic Somali communities are based on the personal clinical experiences of local oncologists and remain to be elucidated.

 There is a need to build on these hypotheses of plausible causes driving the colossal burden of esophageal cancer in Somali communities and across the country. Tailored cancer epidemiological study in northern Kenya and across the country is overdue. Doing so will set precedence in mining local population-based cancer incidence data, which will inform precision oncology services in Kenya. Only then shall we achieve evidence-based cancer care in Kenya.

 Carrying such research will also cement the need to build an invaluable digital database that will inform national preventative health policy changes by categorizing such ethnic communities as a high-risk group for EC and extrapolating similar efforts to other communities that present with similar unique cancer incidences (9, 10)

 It is critically important to set up community cancer centers and reduce the burden of time and financial toxicity stemming from time lost in the diagnosis pathway and logistics costs to the capital city for cancer treatment, which hosts almost all the comprehensive cancer centers in the country.

 Averting these cancer care gaps will improve cancer patients' current dismal survival outcomes and improve the public's confidence in our healthcare institutions, heralding a scientific patriotism and a chance for Kenya to be a regional leader in health care tourism. 

 Implementation of Kenya Cancer Action plan 2019-2030 (1) forwarded by the National Cancer Control Program and political goodwill is needed at the county level for quality cancer care to be realized at the community cancer centers where 90% of the cancer patient are in dire need of life-saving cancer care services.

 It is time to fund esophageal cancer research in Kenya, it is time to educate Kenyans on the increasing incidence of this disease and the importance of early cancer screening, it is time to set up grassroots comprehensive cancers at county levels, and it is time to cushion and subsidize cancer care cost that is becoming synonymous to bankruptcy and untold financial and psychological distress. 

References

1. Health Mo. Kenya-Cancer-Policy-2019-2030. Republic of Kenya. 2019.
2. Odera JO, Odera E, Githang'a J, Walong EO, Li F, Xiong Z, et al. Esophageal cancer in Kenya. Am J Dig Dis (Madison). 2017;4(3):23-33.
3. Patel K, Wakhisi J, Mining S, Mwangi A, Patel R. Esophageal Cancer, the Topmost Cancer at MTRH in the Rift Valley, Kenya, and Its Potential Risk Factors. ISRN Oncol. 2013;2013:503249.
4. Maiyoh GK, Tuei VC. Rising Cancer Incidence and Role of the Evolving Diet in Kenya. Nutr Cancer. 2019;71(4):531-46.
5. Menya D, Kigen N, Oduor M, Maina SK, Some F, Chumba D, et al. Traditional and commercial alcohols and esophageal cancer risk in Kenya. Int J Cancer. 2019;144(3):459-69.
6. Mwachiro MM, Pritchett N, Calafat AM, Parker RK, Lando JO, Murphy G, et al. Indoor wood combustion, carcinogenic exposure and esophageal cancer in southwest Kenya. Environ Int. 2021;152:106485.
7. Mwachiro MM, Parker RK, Pritchett NR, Lando JO, Ranketi S, Murphy G, et al. Investigating tea temperature and content as risk factors for esophageal cancer in an endemic region of Western Kenya: Validation of a questionnaire and analysis of polycyclic aromatic hydrocarbon content. Cancer Epidemiol. 2019;60:60-6.
8. Patel K, Mining S, Wakhisi J, Gheit T, Tommasino M, Martel-Planche G, et al. TP53 mutations, human papilloma virus DNA and inflammation markers in esophageal squamous cell carcinoma from the Rift Valley, a high-incidence area in Kenya. BMC Res Notes. 2011;4:469.
9. Van Loon K, Mwachiro MM, Abnet CC, Akoko L, Assefa M, Burgert SL, et al. The African Esophageal Cancer Consortium: A Call to Action. J Glob Oncol. 2018;4:1-9.
10. Yang CS, Chen XL. Research on esophageal cancer: With personal perspectives from studies in China and Kenya. Int J Cancer. 2021;149(2):264-76.

Bio

Dr. Omar Abdihamid is a Clinical Oncologist.

He is passionate about Global Oncology and cancer care in low- and middle-income countries, particularly cancer awareness and patient education.

His main areas of interest are Gastrointestinal cancers, Breast Cancer, Lung, Head and neck, and Genitourinary Cancers.

Dr. Omar has a keen interest in cancer research and has published multiple SCI publications in peer-reviewed journals.

He is also an editor and a reviewer for several cancer journals.

He is the recipient of the 2021 Journal of Clinical Oncology, ASCO Global Oncology Trainee Journal Reviewer Mentoring Program.