Esophageal Cancer Among Bantu in the Transkei2

This is a report on a 5-year survey of esophageal cancer occurring among South African Bantu domiciled in reserves of the Transkeian Territories. Available information suggests that the disease was unknown 25 years ago; today, however, esophageal cancer is particularly rife in scattered circumscribed localities. The population investigated was 1.6 million and 1,882 cases were registered, 1,036 men and 846 women. Sixty percent of cases were diagnosed as esophageal cancer on irrefutable radiological evidence and about one third was confirmed as squamous carcinoma by biopsy or cytological examinations. The remaining 40 percent was diagnosed on clinical grounds only. A majority of the tumors was situated in the middle-third esophagus, but in older patients relatively more of their tumors occurred in the lower third. Crude morbidity and mortality rates are given, as well as mortality rates for males and females in half-decade age groups. Females show a peak mortality at 50 years of age, whereas the mortality curve for males continues to rise steeply to 60 years and beyond. Seventy-two instances (147 persons) are recorded of esophageal cancer affecting 2 or more non-blood-related members of the same homestead. Local habits, customs, and food were closely examined and are described under possible factors of environmental carcinogenization.