Oesophageal cancer is the 6th leading cause of cancer death worldwide. It kills 500,000 people every year, most of whom live in two distinct geographic bands across central Asia and along the eastern coast of Africa from Ethiopia to South Africa. In these high-risk areas, nearly all cases are oesophageal squamous cell carcinoma (ESCC). In 2016, African and international groups performing etiological and clinical research on ESCC in Africa formed the African Esophageal Cancer Consortium (AfrECC). The aims of this consortium are to raise awareness of the importance of ESCC in Africa; to coordinate etiologic studies of environmental and genetic risk factors; to address the clinical burden of ESCC by capacity building and clinical studies of early detection, treatment, and palliation; and to support young African researchers. AfrECC currently has 10 collaborating sites in 6 countries (Ethiopia, Kenya, Tanzania, Malawi, Zamia, and South Africa), and has bimonthly conference calls and in-person meetings every two years. Current activities include 7 case-control studies, 5 of which are using harmonized questionnaires and an mHealth app for real-time electronic data capture, with a total enrollment of 2400 cases and controls; a joint genome-wide association study (GWAS) with an initial analysis of 2000 cases and controls; biobanking at several sites for future genomic studies; endoscopic capacity surveys in 4 countries to evaluate current capabilities and training needs; a palliative care initiative to improve access to affordable esophageal stents and stent insertion training; and post-treatment quality of life and survival studies. The presentations in this session will highlight some of these activities.

Genome-wide association studies (GWAS) have been very successful in identifying genetic variants and genes that are associated with the risk of many cancers, including oesophageal cancer. However most such studies were conducted in European or Asian populations. Oesophageal squamous cell carcinoma (OSCC) is by far the most common form of oesophageal cancer in Africa, but genetic data in African populations has been limited to the study of selected variants in modest sample sizes. GWAS has been used to identify multiple risk loci for OSCC in non-African populations, especially in China. We have now carried out a GWAS for OSCC in the Black population of South Africa to search for genetic risk factors in an indigenous African population. We genotyped 1550 OSCC cases and 2793 controls on the H3 Africa GWAS array, which contains 2.3 million single nucleotide polymorphisms (SNPs) which are enriched for African genomic content. After quality control, 1.66 million SNPs were used for imputation to a total of 14.8 million SNPs using the Wellcome Sanger Institute imputation pipeline and the African Genome reference panel. Imputed SNPs were tested for association with OSCC using a linear mixed model test (GEMMA), with correction for population structure using Principal Component Analysis (PLINK) and relatedness (GEMMA). Genetic variants in several genomic regions were associated with OSCC (P<10-6), some of which may be African-specific. Several regions previously associated with OSCC in other populations were not associated in the South African Black population. A GWAS is ongoing in cases and controls from East Africa, which will permit future replication studies and meta-analysis in larger African sample sizes.

INTRODUCTION Oesophageal cancer (OEC) is the eighth most common cancer worldwide and the sixth most common cause of cancer-related death, causing 400,000 deaths annually. More than 80% of deaths from EC occur in developing countries, with particularly high incidence and mortality in central Asia and the eastern coast of Africa. In sub-Saharan Africa, EC causes 21,000 deaths annually, with patients often dying of starvation or dehydration, unable to eat or swallow.
CONTEXT The AfrECC consortium has been partnering in collaboration with Boston Scientific, the largest US stent maker, to supply quality, FDA-approved self expanding metal stents (SEMS) to EC patients at a subsidized cost. Charges for placing stents currently vary in different hospitals, and these costs will remain, but the significant reduction in the cost of the stent devices will make the overall procedure much more affordable and will enable many more EC patients to have dignified palliation and life-sustaining nutrition. SEMS offer excellent palliation with minimal complications, and this reduction in cost for the devices should make stenting an option in all counties in the country. Capacity development As part of the collaboration, there will be technology transfer to African endoscopists and health workers. This will entail training in stent placement and care and follow-up of patients who get these stents. AfrECC is now working closely with in country professional societies, Tenwek Hospital, Boston Scientific, American Society for Gastrointestinal Endoscopy (ASGE) the Clinton Health Access Initiative, University of California in San Francisco (UCSF), The American Cancer Society (ACS) and other international collaborators to develop training curriculum and quality control mechanisms for larger scale SEMS placement training of surgeons and gastroenterologists who currently perform endoscopy. There have been stent training in Kenya, Tanzania, Zambia and recently Malawi.