Alcohol intake and colorectal cancer risk: A dose–response meta-analysis of published cohort studies
Corresponding Author
Aurélie Moskal
Nutrition and Hormones Group, International Agency for Research on Cancer, Lyon, France
Fax: +33-4-7214-2520.
Epidemiological Research & Surveillance Unit in Transport, Occupation and Environment (UMRESTTE), French Research Institute on Transport & Safety (INRETS), 25 Avenue F. Mitterrand, Case 24, 69675 Bron Cedex, FranceSearch for more papers by this authorTeresa Norat
Nutrition and Hormones Group, International Agency for Research on Cancer, Lyon, France
Search for more papers by this authorPietro Ferrari
Nutrition and Hormones Group, International Agency for Research on Cancer, Lyon, France
Search for more papers by this authorElio Riboli
Department of Epidemiology and Public Health, Imperial College London, London, United Kingdom
Search for more papers by this authorCorresponding Author
Aurélie Moskal
Nutrition and Hormones Group, International Agency for Research on Cancer, Lyon, France
Fax: +33-4-7214-2520.
Epidemiological Research & Surveillance Unit in Transport, Occupation and Environment (UMRESTTE), French Research Institute on Transport & Safety (INRETS), 25 Avenue F. Mitterrand, Case 24, 69675 Bron Cedex, FranceSearch for more papers by this authorTeresa Norat
Nutrition and Hormones Group, International Agency for Research on Cancer, Lyon, France
Search for more papers by this authorPietro Ferrari
Nutrition and Hormones Group, International Agency for Research on Cancer, Lyon, France
Search for more papers by this authorElio Riboli
Department of Epidemiology and Public Health, Imperial College London, London, United Kingdom
Search for more papers by this authorAbstract
The epidemiologic evidence support that alcohol intake might be associated with increased colorectal cancer risk. However, the results by anatomic site in the large bowel are inconsistent. We conducted a meta-analysis of prospective cohort studies published between 1990 and June 2005 on the relationship between alcohol intake and colon and rectal cancer. We quantified associations with colon and rectal cancer using meta-analysis of relative risk (RR) associated to the highest versus the lowest category of alcohol intake and meta-analysis of study-specific dose–response slopes using fixed or random effect models depending on the heterogeneity of effects among studies. Sixteen prospective cohort studies including more than 6,300 patients with colorectal cancer were eligible for inclusion. High alcohol intake was significantly associated with increased risk of colon (RR = 1.50; 95% CI = 1.25, 1.79) and rectal cancer (RR = 1.63; 95% CI = 1.35, 1.97) when comparing the highest with the lowest category of alcohol intake, equivalent to a 15% increase of risk of colon or rectal cancer for an increase of 100 g of alcohol intake per week. The relationship did not differ significantly by anatomical site (colon, rectum). Using meta-regression analysis, we identified geographical area where the study was conducted as a possible source of between-study heterogeneity of effects among studies. Lifestyle recommendations for prevention of colorectal cancer should consider limiting alcohol intake. © 2006 Wiley-Liss, Inc.
References
- 1 Rehm J, Room R, Graham K, Monteiro M, Gmel G, Sempos CT. The relationship of average volume of alcohol consumption and patterns of drinking to burden of disease: an overview. Addiction 2003; 98: 1209–28.
- 2 Corrao G, Rubbiati L, Bagnardi V, Zambon A, Poikolainen K. Alcohol and coronary heart disease: a meta-analysis. Addiction 2000; 95: 1505–23.
- 3 Room R, Babor T, Rehm J. Alcohol and public health. Lancet 2005; 365: 519–30.
- 4 Boffetta P, Hashibe M. Alcohol and cancer. Lancet Oncol 2006; 7: 149–56.
- 5 Alcohol drinking. IARC Working Group, Lyon, 13–20 October 1987. IARC Monogr Eval Carcinog Risks Hum 1988; 44: 1–378.
- 6 Kune GA, Vitetta L. Alcohol consumption and the etiology of colorectal cancer: a review of the scientific evidence from 1957 to 1991. Nutr Cancer 1992; 18: 97–111.
- 7 Potter JD, Slattery ML, Bostick RM, Gapstur SM. Colon cancer: a review of the epidemiology. Epidemiol Rev 1993; 15: 499–545.
- 8 Glade MJ. Food, nutrition, and the prevention of cancer: a global perspective. American Institute for Cancer Research/World Cancer Research Fund, American Institute for Cancer Research, 1997. Nutrition 1999; 15: 523–6.
- 9 Bagnardi V, Blangiardo M, La Vecchia C, Corrao G. A meta-analysis of alcohol drinking and cancer risk. Br J Cancer 2001; 85: 1700–5.
- 10 Corrao G, Bagnardi V, Zambon A, La Vecchia C. A meta-analysis of alcohol consumption and the risk of 15 diseases. Prev Med 2004; 38: 613–19.
- 11 Longnecker MP, Orza MJ, Adams ME, Vioque J, Chalmers TC. A meta-analysis of alcoholic beverage consumption in relation to risk of colorectal cancer. Cancer Causes Control 1990; 1: 59–68.
- 12 Cho E, Smith-Warner SA, Ritz J, van den Brandt PA, Colditz GA, Folsom AR, Freudenheim JL, Giovannucci E, Goldbohm RA, Graham S, Holmberg L, Kim DH et al. Alcohol intake and colorectal cancer: a pooled analysis of 8 cohort studies. Ann Intern Med 2004; 140: 603–13.
- 13 Flood A, Caprario L, Chaterjee N, Lacey JV,Jr, Schairer C, Schatzkin A. Folate, methionine, alcohol, and colorectal cancer in a prospective study of women in the United States. Cancer Causes Control 2002; 13: 551–61.
- 14 Pedersen A, Johansen C, Gronbaek M. Relations between amount and type of alcohol and colon and rectal cancer in a Danish population based cohort study. Gut 2003; 52: 861–7.
- 15 Shimizu N, Nagata C, Shimizu H, Kametani M, Takeyama N, Ohnuma T, Matsushita S. Height, weight, and alcohol consumption in relation to the risk of colorectal cancer in Japan: a prospective study. Br J Cancer 2003; 88: 1038–43.
- 16 Otani T, Iwasaki M, Yamamoto S, Sobue T, Hanaoka T, Inoue M, Tsugane S, Group.JPHC-bPS. Alcohol consumption, smoking, and subsequent risk of colorectal cancer in middle-aged and elderly Japanese men and women: Japan Public Health Center-based prospective study. Cancer Epidemiol Biomarkers Prev 2003; 12: 1492–500.
- 17 Su LJ, Arab L. Alcohol consumption and risk of colon cancer: evidence from the national health and nutrition examination survey I epidemiologic follow-up study. Nutr Cancer 2004; 50: 111–19.
- 18 Sanjoaquin MA, Appleby PN, Thorogood M, Mann JI, Key TJ. Nutrition, lifestyle and colorectal cancer incidence: a prospective investigation of 10998 vegetarians and non-vegetarians in the United Kingdom. Br J Cancer 2004 12;90: 118–21.
- 19 Chen K, Jiang Q, Ma X, Li Q, Yao K, Yu W, Zheng S. Alcohol drinking and colorectal cancer: a population-based prospective cohort study in China. Eur J Epidemiol 2005; 20: 149–54.
- 20 Wakai K, Kojima M, Tamakoshi K, Watanabe Y, Hayakawa N, Suzuki K, Hashimoto S, Kawado M, Tokudome S, Suzuki S, Ozasa K, Toyoshima H et al. Alcohol consumption and colorectal cancer risk: findings from the JACC Study. J Epidemiol 2005; 15 ( Suppl 2): S173–S179.
- 21 Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin 2005; 55: 74–108.
- 22 Greenland S. Quantitative methods in the review of epidemiologic literature. Epidemiol Rev 1987; 9: 1–30.
- 23 Berlin JA, Longnecker MP, Greenland S. Meta-analysis of epidemiologic dose-response data. Epidemiology 1993; 4: 218–28.
- 24 Greenland S, Longnecker MP. Methods for trend estimation from summarized dose-response data, with applications to meta-analysis. Am J Epidemiol 1992; 135: 1301–9.
- 25 Giovannucci E, Stampfer MJ, Colditz GA, Rimm EB, Trichopoulos D, Rosner BA, Speizer FE, Willett WC. Folate, methionine, and alcohol intake and risk of colorectal adenoma. J Natl Cancer Inst 1993; 85: 875–84.
- 26 Murata M, Takayama K, Choi BC, Pak AW. A nested case-control study on alcohol drinking, tobacco smoking, and cancer. Cancer Detect Prev 1996; 20: 557–65.
- 27 Chyou PH, Nomura AM, Stemmermann GN. A prospective study of colon and rectal cancer among Hawaii Japanese men. Ann Epidemiol 1996; 6: 276–82.
- 28 Glynn SA, Albanes D, Pietinen P, Brown CC, Rautalahti M, Tangrea JA, Taylor PR, Virtamo J. Alcohol consumption and risk of colorectal cancer in a cohort of Finnish men. Cancer Causes Control 1996; 7: 214–23.
- 29 Gapstur SM, Potter JD, Folsom AR. Alcohol consumption and colon and rectal cancer in postmenopausal women. Int J Epidemiol 1994; 23: 50–7.
- 30 Goldbohm RA, van den Brandt PA, Van't, V, Dorant E, Sturmans F, Hermus RJ. Prospective study on alcohol consumption and the risk of cancer of the colon and rectum in the Netherlands. Cancer Causes Control 1994; 5: 95–104.
- 31 Giovannucci E, Rimm EB, Ascherio A, Stampfer MJ, Colditz GA, Willett WC. Alcohol, low-methionine–low-folate diets, and risk of colon cancer in men. J Natl Cancer Inst 1995 15;87: 265–73.
- 32 Der Simonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986; 7: 177–88.
- 33 Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003; 327: 557–60.
- 34 Egger M, Davey SG, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997; 315: 629–34.
- 35 Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics 1994; 50: 1088–101.
- 36
Singh PN,
Fraser GE.
Dietary risk factors for colon cancer in a low-risk population.
Am J Epidemiol
1998
15;148:
761–74.
10.1093/oxfordjournals.aje.a009697 Google Scholar
- 37 Harnack L, Jacobs DR,Jr, Nicodemus K, Lazovich D, Anderson K, Folsom AR. Relationship of folate, vitamin B-6, vitamin B-12, and methionine intake to incidence of colorectal cancers. Nutr Cancer 2002; 43: 152–8.
- 38 Wei EK, Giovannucci E, Wu K, Rosner B, Fuchs CS, Willett WC, Colditz GA. Comparison of risk factors for colon and rectal cancer. Int J Cancer 2004; 108: 433–42.
- 39 Stemmermann GN, Nomura AM, Chyou PH, Yoshizawa C. Prospective study of alcohol intake and large bowel cancer. Dig Dis Sci 1990; 35: 1414–20.
- 40 Murata M, Tagawa M, Watanabe S, Kimura H, Takeshita T, Morimoto K. Genotype difference of aldehyde dehydrogenase 2 gene in alcohol drinkers influences the incidence of Japanese colorectal cancer patients. Jpn J Cancer Res 1999; 90: 711–19.
- 41 Tiemersma EW, Wark PA, Ocke MC, Bunschoten A, Otten MH, Kok FJ, Kampman E. Alcohol consumption, alcohol dehydrogenase 3 polymorphism, and colorectal adenomas. Cancer Epidemiol Biomarkers Prev 2003; 12: 419–25.
- 42 Potter JD. Colorectal cancer: molecules and populations. J Natl Cancer Inst 1999; 91: 916–32.
- 43 Doll R. The benefit of alcohol in moderation. Drug Alcohol Rev 1998; 17: 353–63.
- 44 Danaei G, Hoorn SV, Lopez AD, Murray CJ, Ezzati M. Causes of cancer in the world: comparative risk assessment of nine behavioural and environmental risk factors. Lancet 2005; 366: 1784–93.