Canqing Yu, PhD *; Haijing Tang, PhD *; Yu Guo, MSc; Zheng Bian, MSc; Ling Yang, PhD; Yiping Chen, DPhil; Aiyu Tang, MD; Xue Zhou, PhD; Xu Yang, PhD; Junshi Chen, MD; Zhengming Chen, DPhil; Jun Lv, PhD; Liming Li, MD, MPH; on behalf of the China Kadoorie Biobank Collaborative Group †
Acknowledgment: The authors thank the study participants and members of the survey teams in each of the 10 regional centers, as well as the project development and management teams based in Beijing, Oxford, and the regional centers.
Grant Support: By the National Natural Science Foundation of China (grants 81530088, 81390540, 81390544, and 81390541) and National Key Research and Development Program of China (grants 2016YFC0900500, 2016YFC0900501, and 2016YFC0900504). The CKB baseline survey and first re-survey were supported by a grant from the Kadoorie Charitable Foundation in Hong Kong. The long-term follow-up is supported by Wellcome Trust, United Kingdom (grants 202922/Z/16/Z, 088158/Z/09/Z, and 104085/Z/14/Z), and the Chinese Ministry of Science and Technology (grant 2011BAI09B01).
Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-2000.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.
Reproducible Research Statement:Study protocol: Cohort description and questionnaires are available at www.p3gobservatory.org/questionnaire/list.htm. Statistical code: Available from Dr. Lv (e-mail, email@example.com). Data set: See study Web site (www.ckbiobank.org) for data access policy and procedures.
Requests for Single Reprints: Jun Lv, PhD, or Liming Li, MD, MPH, Department of Epidemiology and Biostatistics, Peking University Health Science Center, 38 Xueyuan Road, Beijing 100191, China; e-mail, firstname.lastname@example.org or email@example.com.
Current Author Addresses: Drs. C. Yu, J. Lv, and L. Li: Department of Epidemiology and Biostatistics, Peking University Health Science Center, 38 Xueyuan Road, Beijing 100191, China.
Drs. H. Tang and X. Yang: School of Software, Beijing Institute of Technology, 5 South Zhongguancun Street, Beijing 100081, China.
Drs. Y. Guo and Z. Bian: Chinese Academy of Medical Sciences, Beijing 102300, China.
Drs. L. Yang, Y. Chen, and Z. Chen: Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford OX3 7LF, United Kingdom.
Dr. A. Tang: Suzhou Center for Disease Control and Prevention, Suzhou 215006, China.
Dr. X. Zhou: Heilongjiang Center for Disease Control and Prevention, Harbin 150030, China.
Dr. J. Chen: China National Center for Food Safety Risk Assessment, Beijing 100738, China.
Author Contributions: Conception and design: J. Lv, L. Li.
Analysis and interpretation of the data: C. Yu, H. Tang, X. Yang, J. Lv.
Drafting of the article: C. Yu, J. Lv.
Critical revision for important intellectual content: J. Lv, L. Li.
Final approval of the article: C. Yu, H. Tang, Y. Guo, Z. Bian, L. Yang, Y. Chen, A. Tang, X. Zhou, X. Yang, J. Chen, Z. Chen, J. Lv, L. Li.
Obtaining of funding: J. Chen. Z. Chen, L. Li.
Administrative, technical, or logistic support: Y. Guo, J. Chen, Z. Chen, L. Li.
Collection and assembly of data: Y. Guo, Z. Bian, L. Yang, Y. Chen, A. Tang, X. Zhou.
This article has been corrected. The original version (PDF) is appended to this article as a Supplement.
Although consumption of tea at high temperatures has been suggested as a risk factor for esophageal cancer, an association has not been observed consistently, and whether any relationship is independent of alcohol and tobacco exposure has not been evaluated.
To examine whether high-temperature tea drinking, along with the established risk factors of alcohol consumption and smoking, is associated with esophageal cancer risk.
China Kadoorie Biobank, a prospective cohort study established during 2004 to 2008.
10 areas across China.
456 155 persons aged 30 to 79 years. Those who had cancer at baseline or who reduced consumption of tea, alcohol, or tobacco before baseline were excluded.
The usual temperature at which tea was consumed, other tea consumption metrics, and lifestyle behaviors were self-reported once, at baseline. Outcome was esophageal cancer incidence up to 2015.
During a median follow-up of 9.2 years, 1731 incident esophageal cancer cases were documented. High-temperature tea drinking combined with either alcohol consumption or smoking was associated with a greater risk for esophageal cancer than hot tea drinking alone. Compared with participants who drank tea less than weekly and consumed fewer than 15 g of alcohol daily, those who drank burning-hot tea and 15 g or more of alcohol daily had the greatest risk for esophageal cancer (hazard ratio [HR], 5.00 [95% CI, 3.64 to 6.88]). Likewise, the HR for current smokers who drank burning-hot tea daily was 2.03 (CI, 1.55 to 2.67).
Tea consumption was self-reported once, at baseline, leading to potential nondifferential misclassification and attenuation of the association.
Drinking tea at high temperatures is associated with an increased risk for esophageal cancer when combined with excessive alcohol or tobacco use.
National Natural Science Foundation of China and National Key Research and Development Program.
Yu C, Tang H, Guo Y, et al, on behalf of the China Kadoorie Biobank Collaborative Group. Hot Tea Consumption and Its Interactions With Alcohol and Tobacco Use on the Risk for Esophageal Cancer: A Population-Based Cohort Study. Ann Intern Med. [Epub ahead of print 6 February 2018]168:489–497. doi: 10.7326/M17-2000
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Published: Ann Intern Med. 2018;168(7):489-497.
Published at www.annals.org on 6 February 2018
Cardiology, Coronary Risk Factors, Esophageal Disorders, Gastroenterology/Hepatology, Gastrointestinal Cancer.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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