African Esophageal Cancer Consortium (AfrECC)

Overview

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Esophageal cancer is the seventh most common cause of cancer worldwide and the sixth most common cause of cancer-related death worldwide. Esophageal cancer kills 400,000 people every year, most of whom live in two distinct geographic bands across central Asia and along the eastern Africa corridor extending from Ethiopia to South Africa. In these high-risk areas, nearly all cases are esophageal squamous cell carcinoma (ESCC).

ESCC symptoms, such as dysphagia (difficulty swallowing) and weight loss, develop late. Most patients present with advanced disease, and survival is usually poor (3-6 months). Afflicted patients are readily identifiable in surgical and medical hospital wards, profoundly wasted and holding spittoon cups to manage secretions.

NCI investigators and others have performed many etiologic, genetic, early detection, and treatment studies of ESCC in central Asia, but this disease remains essentially unstudied in East Africa. To address this research gap, NCI and others have created the African Esophageal Cancer Consortium (AfrECC) which supports fieldwork and case-control studies in different settings in East Africa.

AfrECC Collaborating Centers

Over the past few years, African Esophageal Cancer Consortium (AfrECC) members have begun quality studies, in collaborating centers:

• Addis Ababa, Ethiopia (IARC and Addis Ababa University)
• Eldoret, Kenya (IARC and Moi University)
• Bomet, Kenya (NCI and Tenwek Hospital)
• Moshi, Tanzania (IARC and Kilimanjaro Christian Medical Center)
• Dar es Salaam, Tanzania (UCSF and Muhimbili University)
• Lilongwe, Malawi (NCI and the UNC-Malawi Project)
• Blantyre, Malawi (IARC and Queen Elizabeth Central Hospital)
• Lusaka, Zambia (University Teaching Hospital and Queen Mary University of London)
• Johannesburg and Cape Town, South Africa (University of the Witwatersrand and University of Cape Town)

Consortium Objectives

Research

To coordinate etiologic and molecular studies of ESCC in this high-risk population:

• Data are being collected using an mHealth application tailored to the consortium, which increases efficiency, eliminates transcription mistakes, and allows real-time QC and supervision of field activities from any location.
• Unified data entry on mobile devices instantly harmonizes data and facilitates an internationally-coordinated effort.
• Case-control studies are in various stages of implementation at institutions in collaboration with the Oesophageal Squamous Cell Carcinoma African Prevention Research (ESCCAPE).
• Case-control studies will examine the etiological effects of dietary, lifestyle, and environmental risk factors for ESCC.
• Future molecular and genomic research is also planned, including a coordinated GWAS study.

Clinical Capacity Building

To improve outcomes for early detection, treatment, and palliation of this cancer:

• The consortium established an in-region training center to teach stent placement and other endoscopic and surgical skills with the support of the American Society for Gastrointestinal Endoscopy.
• An important priority at all sites is provision of self-expanding metal stents (SEMS) for ESCC palliation. The consortium is actively working with international partners to provide affordable stents in Africa.
• Studies are being conducted exploring secondary prevention strategies through screening for the asymptomatic precursor lesion, esophageal squamous dysplasia (ESD).
• Central coordination is encouraging sites to learn from one another and spread technical research expertise.
• Biospecimen procedures and tumor biobanks are being standardized.
• A survey of regional endoscopy capacity is being conducted.

Esophageal Stent Workshop in Ethiopia

Ethiopian endoscopists learning esophageal stent placement.

Endoscopists learning about esophageal stents.

Ethiopian endoscopists receiving esophageal dilator sets. 

Ethiopian gastroenterology fellows graduating from their fellowship program.

Advocacy and Awareness

To raise awareness (both in Africa and elsewhere) of the importance of ESCC for physicians, at-risk populations, and policymakers:

• Education among at-risk populations and physicians to promote earlier presentations for clinical care, earlier diagnosis, and referrals to centers equipped to provide the necessary treatment or palliation.
• Advocacy for local ministries of health and international funding agencies is critical for the provision of resources to increase access to relevant therapies and to support the necessary research to drive development of evidence-based policies for prevention and palliation.

AfrECC Steering Committee

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AfrECC Steering Committee members and their current terms include:

• Valerie McCormack (2024-2028)
• Geoffrey Buckle (2024-2028)
• Gift Mulima (2024-2028)
• Blandina Mmbaga (2022-2026)
• Violet Kayamba (2022-2026)
• Beatrice Mushi (2022-2026)
• Mark Topazian (2022-2026)

AfrECC Working Group Leads

Etiology Working Group co-chairs: Katherine Van Loon, Hannah Simba

Clinical Working Group co-chairs: Lucien Ferndale, Yona Ringo

Remote Mentoring Working Group co-chairs: Jerry Waye, Alan Barkun

Number of AfrECC Members by Country

Membership Documents

AfrECC Bylaws (pdf, 147KB)

AfrECC Membership Application (pdf, 181KB)

Dates of Upcoming AfrECC Meetings 

AfrECC General Membership Meetings
June 5, 2024; August 7, 2024; October 2, 2024; December 4, 2024

AfrECC Steering Committee Meetings
May 22, 2024; July 24, 2024; September 18, 2024; November 20, 2024

AfrECC Etiology Working Group Meetings
May 29, 2024

AfrECC Clinical Working Group Meetings
TBD

AfrECC/Pentax Meetings
June 4, 2024; August 6, 2024; October 1, 2024; December 3, 2024

AfrECC Publications and Contact Information

Browse updated AfrECC Publications (pdf, 182KB).

For more information, contact Laura Boyer.