We read Arnold et al’s article1 with interest and wanted to extend this work to Africa. A high incidence of oesophageal squamous cell carcinoma (OSCC) has been reported in African countries from Kenya to South Africa2 where early-onset (age <45 years) OSCC accounts for 30% of cases in the region. As such, we examined the cumulative lifetime and age-specific incidences of OSCC in Africa. We identified patients with OSCC in three major African cancer registries, using the 2013–2017 Cancer Incidence in Five Continents Volume XII (CI5-XII) database and calculated the age-specific, cumulative lifetime and cumulative early-onset incidence of early-onset OSCC, all of which will allow us to account for the underlying age structure of the population.

We identified 1022 patients diagnosed with OSCC between 2013 and 2017, of which 47.2% (n=482) were females and 12.3% (n=126) were <45 years old consistent with early-onset OSCC (figure 1). Region-level proportions of early-onset OSCC cases varied from 7.6% (26/340) in Eastern Cape, South Africa, to 15.6% (60/384) in Nairobi, Kenya. The cumulative lifetime incidence and cumulative incidence3 of early-onset OSCC were 1508 and 33 cases per 100 000 person-year, respectively, and early-onset OSCC only accounted for 2.2% of cumulative lifetime incidence …