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Meta-analysis of 16 studies of the association of alcohol with colorectal cancer.

Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA. Department of Epidemiology, University of Washington School of Public Health, Seattle, WA. Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD. Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD. Division of Clinical Epidemiology and Aging Research, Deutsches Krebsforschungszentrum, Heidelberg, Germany. Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany. German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany. Division of Research, Kaiser Permanente Medical Research Program, Oakland, CA. Epidemiology Research Program, American Cancer Society, New York, NY. Division of Public Health Sciences, Washington University in St Louis, St. Louis, MO. Unit of Genetic Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany. Division of Gastroenterology, Massachusetts General Hospital, Boston, MA. Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA. Center for Community Health Integration, Case Western Reserve University School of Medicine, Cleveland, OH. Centre for Epidemiology and Biostatistics, School of Population & Global Health, University of Melbourne, Melbourne, VIC, Australia. Cancer Epidemiology Center, The Cancer Council Victoria, Melbourne, VIC, Australia. Department of Epidemiology and Nutrition, Harvard School of Public Health, Boston, MA. Department of Medicine, Harvard Medical School, Boston, MA. SWOG Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA. Division of Epidemiology, Department of Population Health, New York University School of Medicine, New York, NY. Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany. Department of Epidemiology, Harvard School of Public Health, Boston, MA. Department of Medicine, Massachusetts General Hospital, Boston, MA. Institute of Environmental Medicine, Karolinska Institutet, Solna, Sweden. Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI. Department of Family Medicine, University of Virginia, Charlottesville, VA. Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland. Cancer Epidemiology & Intelligence Division, Cancer Council Victoria, Melbourne, VIC, Australia. Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN. Melvin and Bren Simon Cancer Center, Indiana University, Indianapolis, IN. Behavioral and Epidemiology Research Group, American Cancer Society, New York, NY. Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA. Department of Oncologic Pathology, Dana-Farber Cancer Institute, Boston, MA. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA. Broad Institute of MIT and Harvard, Cambridge, MA. Clinical Epidemiology Unit, Memorial University Faculty of Medicine, St. John's, NL, Canada. Fred Hutchinson Cancer Research Center, Seattle, WA. Centre for Public Health Research, Massey University, Wellington, New Zealand. Department of Medicine and Epidemiology, University of Pittsburgh Medical Center, Hermitage, PA. Department of Internal Medicine, University of Utah Health Sciences Center, Salt Lake City, UT. Public Health Sciences Division, Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, WA. Markey Cancer Center, Lexington, KY. Department of Epidemiology, University of Kentucky, Lexington, KY. Department of Surgical Sciences, Unity of Orthopedics, Uppsala University, Uppsala, Sweden. Discipline of Genetics, Memorial University of Newfoundland, St. John's, NL, Canada.

International journal of cancer. 2020;(3):861-873
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Abstract

Alcohol consumption is an established risk factor for colorectal cancer (CRC). However, while studies have consistently reported elevated risk of CRC among heavy drinkers, associations at moderate levels of alcohol consumption are less clear. We conducted a combined analysis of 16 studies of CRC to examine the shape of the alcohol-CRC association, investigate potential effect modifiers of the association, and examine differential effects of alcohol consumption by cancer anatomic site and stage. We collected information on alcohol consumption for 14,276 CRC cases and 15,802 controls from 5 case-control and 11 nested case-control studies of CRC. We compared adjusted logistic regression models with linear and restricted cubic splines to select a model that best fit the association between alcohol consumption and CRC. Study-specific results were pooled using fixed-effects meta-analysis. Compared to non-/occasional drinking (≤1 g/day), light/moderate drinking (up to 2 drinks/day) was associated with a decreased risk of CRC (odds ratio [OR]: 0.92, 95% confidence interval [CI]: 0.88-0.98, p = 0.005), heavy drinking (2-3 drinks/day) was not significantly associated with CRC risk (OR: 1.11, 95% CI: 0.99-1.24, p = 0.08) and very heavy drinking (more than 3 drinks/day) was associated with a significant increased risk (OR: 1.25, 95% CI: 1.11-1.40, p < 0.001). We observed no evidence of interactions with lifestyle risk factors or of differences by cancer site or stage. These results provide further evidence that there is a J-shaped association between alcohol consumption and CRC risk. This overall pattern was not significantly modified by other CRC risk factors and there was no effect heterogeneity by tumor site or stage.

Methodological quality

Publication Type : Meta-Analysis

Metadata

MeSH terms : Colorectal Neoplasms ; Ethanol