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Alcohol Intake and Colorectal Cancer: A Pooled Analysis of 8 Cohort Studies

Eunyoung Cho, ScD; Stephanie A. Smith-Warner, PhD; John Ritz, PhD; Piet A. van den Brandt, PhD; Graham A. Colditz, MD, DrPh; Aaron R. Folsom, MD; Jo L. Freudenheim, PhD; Edward Giovannucci, MD; R. Alexandra Goldbohm, PhD; Saxon Graham, PhD; Lars Holmberg, MD, PhD; Dong-Hyun Kim, MD, PhD; Nea Malila, MD; Anthony B. Miller, MB, BCh; Pirjo Pietinen, DSc; Thomas E. Rohan, MB, BS; Thomas A. Sellers, PhD; Frank E. Speizer, MD; Walter C. Willett, MD; Alicja Wolk, DrMedSci; and David J. Hunter, MB, BS
[+] Article, Author, and Disclosure Information

From Channing Laboratory, Brigham and Women's Hospital, Harvard Medical School, Harvard School of Public Health, and Harvard Center for Cancer Prevention, Boston, Massachusetts; Maastricht University, Maastricht, and TNO Nutrition and Food Research Institute, Zeist, the Netherlands; University of Minnesota, Minneapolis, Minnesota; State University of New York, Buffalo, and Albert Einstein College of Medicine, Bronx, New York; Regional Oncologic Center, Uppsala, and National Institute of Environmental Medicine, Stockholm, Sweden; College of Medicine, Hallym University, Chunchon, South Korea; Finnish Cancer Registry and National Public Health Institute, Helsinki, Finland; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; and H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.

Acknowledgments: The authors thank Shiaw-Shyuan Yaun for assistance with data analysis.

Grant Support: By research grants CA55075 and CA78548 from the National Institutes of Health and by the National Colorectal Cancer Research Alliance.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Eunyoung Cho, ScD, Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 181 Longwood Avenue, Boston, MA 02115; e-mail, eunyoung.cho@channing.harvard.edu.

Current Author Addresses: Drs. Cho, Colditz, Giovannucci, Speizer, Willett, and Hunter: Channing Laboratory, 181 Longwood Avenue, Boston, MA 02115.

Drs. Smith-Warner and Ritz: Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115.

Dr. van den Brandt: Department of Epidemiology, Universiteit Maastricht, PO Box 616 NL-6200 MD Maastricht, the Netherlands.

Dr. Folsom: Division of Epidemiology, University of Minnesota, School of Public Health, Suite 300, 1300 Second Street, Minneapolis, MN 55454-1015.

Drs. Freudenheim and Graham: Department of Social and Preventive Medicine, State University of New York at Buffalo, 270 Farber Hall, 3435 Main Street, Buffalo, NY 14214-3000.

Dr. Goldbohm: Department of Epidemiology, TNO Nutrition and Food Research Institute, Ultrechtseweg 48, PO Box 360, 3700 AJ Zeist, the Netherlands.

Dr. Holmberg: Regional Oncologic Centre, SE-751 85 Uppsala, Sweden.

Dr. Kim: Department of Social and Preventive Medicine, Hallym, University College of Medicine, 1 Okchon-dong, Chunchon, Kangwon-do 200-702, South Korea.

Dr. Malila: Finnish Cancer Registry, Liisankatu 21 B, 00170 Helsinki, Finland.

Dr. Miller: Department of Preventive Medicine and Biostatistics, Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, Ontario M5S 1A6, Canada.

Dr. Pietinen: Department of Epidemiology and Health Promotion, National Public Health Institute, Mannerheimintie 166, FIN-00300 Helsinki, Finland.

Dr. Rohan: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461.

Dr. Sellers: H. Lee Moffitt Cancer Center and Research Institute at the University of South Florida, 12902 Magnolia Drive, Tampa, FL 33612.

Dr. Wolk: Division of Nutritional Epidemiology, National Institute of Environmental Medicine, Karolinska Institute, S-171 77 Stockholm, Sweden.

Author Contributions: Conception and design: E. Cho, A. Wolk, E. Giovannucci, W. Willett, P.A. van den Brandt, R.A. Goldbohm, D. Hunter.

Analysis and interpretation of the data: E. Cho, T.E. Rohan, E. Giovannucci, J. Ritz, W. Willett, J.L. Freudenheim, P.A. van den Brandt, D. Hunter, D.-H. Kim, L. Holmberg.

Drafting of the article: E. Cho, T.E. Rohan, D.-H. Kim.

Critical revision of the article for important intellectual content: S. Smith-Warner, T.E. Rohan, A. Wolk, T.A. Sellers, A.R. Folsom, E. Giovannucci, J. Ritz, W. Willett, P.A. van den Brandt, R.A. Goldbohm, P. Pietinen, N. Malila, D. Hunter, A.B. Miller, L. Holmberg.

Final approval of the article: S. Smith-Warner, T.E. Rohan, A. Wolk, G.A. Colditz, A.R. Folsom, E. Giovannucci, J. Ritz, W. Willett, J.L. Freudenheim, P.A. van den Brandt, R.A. Goldbohm, P. Pietinen, N. Malila, D. Hunter, D.-H. Kim, A.B. Miller, L. Holmberg.

Provision of study materials or patients: T.E. Rohan, A. Wolk, A.R. Folsom, E. Giovannucci, J.L. Freudenheim, P.A. van den Brandt, R.A. Goldbohm, D. Hunter, A.B. Miller, L. Holmberg.

Statistical expertise: G.A. Colditz, J. Ritz, W. Willett.

Obtaining of funding: A. Wolk, T.A. Sellers, E. Giovannucci, W. Willett, R.A. Goldbohm, D. Hunter.

Administrative, technical, or logistic support: G.A. Colditz, W. Willett, L. Holmberg.

Collection and assembly of data: E. Cho, S. Smith-Warner, T.A. Sellers, E. Giovannucci, J.L. Freudenheim, P.A. van den Brandt, R.A. Goldbohm, P. Pietinen, N. Malila, D. Hunter, L. Holmberg.

Ann Intern Med. 2004;140(8):603-613. doi:10.7326/0003-4819-140-8-200404200-00007
Text Size: A A A

Background: Epidemiologic studies have generally reported positive associations between alcohol consumption and risk for colorectal cancer. However, findings related to specific alcoholic beverages or different anatomic sites in the large bowel have been inconsistent.

Objective: To examine the relationship of total alcohol intake and intake from specific beverages to the incidence of colorectal cancer and to evaluate whether other potential risk factors modify the association.

Design: Pooled analysis of primary data from 8 cohort studies in 5 countries.

Setting: North America and Europe.

Participants: 489 979 women and men with no history of cancer other than nonmelanoma skin cancer at baseline.

Measurements: Alcohol intake was assessed in each study at baseline by using a validated food-frequency questionnaire.

Results: During a maximum of 6 to 16 years of follow-up across the studies, 4687 cases of colorectal cancer were documented. In categorical analyses, increased risk for colorectal cancer was limited to persons with an alcohol intake of 30 g/d or greater (approximately ≥ 2 drinks/d), a consumption level reported by 4% of women and 13% of men. Compared with nondrinkers, the pooled multivariate relative risks were 1.16 (95% CI, 0.99 to 1.36) for persons who consumed 30 to less than 45 g/d and 1.41 (CI, 1.16 to 1.72) for those who consumed 45 g/d or greater. No significant heterogeneity by study or sex was observed. The association was evident for cancer of the proximal colon, distal colon, and rectum. No clear difference in relative risks was found among specific alcoholic beverages.

Limitations: The study included only one measure of alcohol consumption at baseline and could not investigate lifetime alcohol consumption, alcohol consumption at younger ages, or changes in alcohol consumption during follow-up. It also could not examine drinking patterns or duration of alcohol use.

Conclusions: A single determination of alcohol intake correlated with a modest relative elevation in colorectal cancer rate, mainly at the highest levels of alcohol intake.


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Study-specific and pooled multivariate relative risks for colorectal cancer for alcohol intake of 30 g/d or greater versus 0 g/d.P

The black squares and horizontal lines show the study-specific relative risks and 95% CIs. The area of the black squares indicates the study-specific weight in the pooled analysis. The diamond represents the pooled relative risk and 95% CI. ATBC = Alpha-Tocopherol Beta-Carotene Cancer Prevention Study; CNBSS = Canadian National Breast Screening Study; HPFS = Health Professionals Follow-up Study; IWHS = Iowa Women's Health Study; NLCS = Netherlands Cohort Study; NYS = New York State Cohort; NHS = Nurses' Health Study. The Sweden Mammography Cohort was not included because no patients with colorectal cancer and only 36 persons without colorectal cancer consumed 30 or more g of alcohol daily. for test for between-study heterogeneity > 0.2.

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Summary for Patients

Alcohol Consumption and the Risk for Colorectal Cancer

The summary below is from the full report titled “Alcohol Intake and Colorectal Cancer: A Pooled Analysis of 8 Cohort Studies.” It is in the 20 April 2004 issue of Annals of Internal Medicine (volume 140, pages 603-613). The authors are E. Cho, S.A. Smith-Warner, J. Ritz, P.A. van den Brandt, G.A. Colditz, A.R. Folsom, J.L. Freudenheim, E. Giovannucci, R.A. Goldbohm, S. Graham, L. Holmberg, D.-H. Kim, N. Malila, A.B. Miller, P. Pietinen, T.E. Rohan, T.A. Sellers, F.E. Speizer, W.C. Willett, A. Wolk, and D.J. Hunter.


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