Estimation of New Cancers Attributable to Alcohol, Tobacco, and Human Papillomavirus Infection in Edo State, Nigeria

Abstract

PURPOSE: Cancer burden in sub-Saharan Africa is high, driven by infections and behavioral risks. Nigeria had Africa's second-highest number of new cancers in 2022. This study estimated the proportion of new cancers attributable to alcohol, tobacco, and human papillomavirus (HPV) infection in Edo State, Nigeria. METHODS: We analyzed cancer incidence data from the Edo-Benin Cancer Registry (EBCR; 2009-2018) for cancer sites associated with alcohol consumption, tobacco use, and HPV infection, as outlined in the International Agency for Research on Cancer Monographs. For each site, we calculated the number of attributable cancers and the population attributable fraction for the three exposures by sex, using country-specific exposure prevalence and relative risk estimates from previous research. RESULTS: Between 2009 and 2018, the EBCR reported 4,937 cancer cases (2,069 men [41.9%] and 2,868 women [58.1%]). Nine alcohol-associated sites accounted for 30.1% of all cases (12.3% in men and 43% in women), 13 tobacco-related sites accounted for 27.5% (18.4% in men and 34.1% in women), and six HPV-related sites accounted for 15.2% (4% in men and 34.1% in women). Of alcohol-associated cancers (n = 1,488), 25.6% (381/1,488) were attributable to alcohol use; 5.3% (72/1,359) of smoking-related cancers were attributable to tobacco use, and high-risk HPV genotypes were estimated to cause 77.5% (581/750) of HPV-related cancers. CONCLUSION: Our study suggests that nearly three fourths of HPV- and about one fourth of alcohol-associated cancers could be prevented through targeted and evidence-based interventions in Edo State, Nigeria. These findings highlight the need for strengthening both individual and policy-level prevention efforts, prioritizing high-impact risk factors to achieve measurable reductions in cancer burden.