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

Sarah McNabb; Tabitha A. Harrison; Demetrius Albanes; Sonja I. Berndt; Hermann Brenner; Bette J. Caan; Peter T. Campbell; Yin Cao; Jenny Chang-Claude; Andrew Chan; Zhengyi Chen; Dallas R. English; Graham G. Giles; Edward L. Giovannucci; Phyllis J. Goodman; Richard B. Hayes; Michael Hoffmeister; Eric J. Jacobs; Amit D. Joshi; Susanna C. Larsson; Loïc Le Marchand; Li Li; Yi Lin; Satu Männistö; Roger L. Milne; Hongmei Nan; Christina C. Newton; Shuji Ogino; Patrick S. Parfrey; Paneen S. Petersen; John D. Potter; Robert E. Schoen; Martha L. Slattery; Yu Ru Su; Catherine M. Tangen; Thomas C. Tucker; Stephanie J. Weinstein; Emily White; Alicja Wolk; Michael O. Woods; Amanda I. Phipps; Ulrike Peters

doi:10.1002/ijc.32377

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

Sarah McNabb, Tabitha A. Harrison, Demetrius Albanes, Sonja I. Berndt, Hermann Brenner, Bette J. Caan, Peter T. Campbell, Yin Cao, Jenny Chang-Claude, Andrew Chan, Zhengyi Chen, Dallas R. English, Graham G. Giles, Edward L. Giovannucci, Phyllis J. Goodman, Richard B. Hayes, Michael Hoffmeister, Eric J. Jacobs, Amit D. Joshi, Susanna C. LarssonLoïc Le Marchand, Li Li, Yi Lin, Satu Männistö, Roger L. Milne, Hongmei Nan, Christina C. Newton, Shuji Ogino, Patrick S. Parfrey, Paneen S. Petersen, John D. Potter, Robert E. Schoen, Martha L. Slattery, Yu Ru Su, Catherine M. Tangen, Thomas C. Tucker, Stephanie J. Weinstein, Emily White, Alicja Wolk, Michael O. Woods, Amanda I. Phipps, Ulrike Peters

Research output: Contribution to journal › Article › peer-review

66 Scopus citations

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.

Original language	English (US)
Pages (from-to)	861-873
Number of pages	13
Journal	International Journal of Cancer
Volume	146
Issue number	3
DOIs	https://doi.org/10.1002/ijc.32377
State	Published - Feb 1 2020
Externally published	Yes

Keywords

alcohol
colon cancer
colorectal cancer
rectal cancer

ASJC Scopus subject areas

Oncology
Cancer Research

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1002/ijc.32377

Cite this

McNabb, S., Harrison, T. A., Albanes, D., Berndt, S. I., Brenner, H., Caan, B. J., Campbell, P. T., Cao, Y., Chang-Claude, J., Chan, A., Chen, Z., English, D. R., Giles, G. G., Giovannucci, E. L., Goodman, P. J., Hayes, R. B., Hoffmeister, M., Jacobs, E. J., Joshi, A. D., ... Peters, U. (2020). Meta-analysis of 16 studies of the association of alcohol with colorectal cancer. International Journal of Cancer, 146(3), 861-873. https://doi.org/10.1002/ijc.32377

McNabb, S, Harrison, TA, Albanes, D, Berndt, SI, Brenner, H, Caan, BJ, Campbell, PT, Cao, Y, Chang-Claude, J, Chan, A, Chen, Z, English, DR, Giles, GG, Giovannucci, EL, Goodman, PJ, Hayes, RB, Hoffmeister, M, Jacobs, EJ, Joshi, AD, Larsson, SC, Le Marchand, L, Li, L, Lin, Y, Männistö, S, Milne, RL, Nan, H, Newton, CC, Ogino, S, Parfrey, PS, Petersen, PS, Potter, JD, Schoen, RE, Slattery, ML, Su, YR, Tangen, CM, Tucker, TC, Weinstein, SJ, White, E, Wolk, A, Woods, MO, Phipps, AI & Peters, U 2020, 'Meta-analysis of 16 studies of the association of alcohol with colorectal cancer', International Journal of Cancer, vol. 146, no. 3, pp. 861-873. https://doi.org/10.1002/ijc.32377

@article{22dbe99de1114d5697f9d70ad644e92c,

title = "Meta-analysis of 16 studies of the association of alcohol with colorectal cancer",

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.",

keywords = "alcohol, colon cancer, colorectal cancer, rectal cancer",

author = "Sarah McNabb and Harrison, {Tabitha A.} and Demetrius Albanes and Berndt, {Sonja I.} and Hermann Brenner and Caan, {Bette J.} and Campbell, {Peter T.} and Yin Cao and Jenny Chang-Claude and Andrew Chan and Zhengyi Chen and English, {Dallas R.} and Giles, {Graham G.} and Giovannucci, {Edward L.} and Goodman, {Phyllis J.} and Hayes, {Richard B.} and Michael Hoffmeister and Jacobs, {Eric J.} and Joshi, {Amit D.} and Larsson, {Susanna C.} and {Le Marchand}, Lo{\"i}c and Li Li and Yi Lin and Satu M{\"a}nnist{\"o} and Milne, {Roger L.} and Hongmei Nan and Newton, {Christina C.} and Shuji Ogino and Parfrey, {Patrick S.} and Petersen, {Paneen S.} and Potter, {John D.} and Schoen, {Robert E.} and Slattery, {Martha L.} and Su, {Yu Ru} and Tangen, {Catherine M.} and Tucker, {Thomas C.} and Weinstein, {Stephanie J.} and Emily White and Alicja Wolk and Woods, {Michael O.} and Phipps, {Amanda I.} and Ulrike Peters",

note = "Funding Information: The studies included in this analysis are part of the Genetics and Epidemiology of Colorectal Cancer Consortium (GECCO) and Colorectal Transdisciplinary (CORECT) Study. GECCO is supported by the National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services (U01 CA137088; R01 CA059045; R01 CA120582). The authors would like to thank all those at the GECCO Coordinating Center for helping bring together the data and people that made this project possible. The authors also acknowledge Deanna Stelling, Mark Tho-rnquist, Greg Warnick, Carolyn Hutter and team members at COMPASS (Comprehensive Center for the Advancement of Scientific Strategies) at the Fred Hutchinson Cancer Research Center for their work harmonizing the GECCO epidemiological data set. The CORECT Study is supported by the National Cancer Institute, National Institutes of Health under RFA # CA-09-002 (U19 CA148107). The content of this article does not necessarily reflect the views or policies of the National Cancer Institute or any of the collaborating centers in CORECT, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government or CORECT. ATBC: The ATBC Study is supported by the Intramural Research Program of the U.S. National Cancer Institute, NIH and by U.S. Public Health Service contract HHSN261201500005C from the National Cancer Institute, Department of Health and Human Services. COLO2&3: This work is supported by the National Institutes of Health (R01 CA60987). CPS-II: The American Cancer Society funds the creation, maintenance and updating of the Cancer Prevention Study-II (CPS-II) cohort. This study was conducted with Institutional Review Board approval. The authors thank the CPS-II participants and Study Management Group for their invaluable contributions to this research. The authors would also like to acknowledge the contribution to this study from central cancer registries supported through the Centers for Disease Control and Prevention National Program of Cancer Registries, and cancer registries supported by the National Cancer Institute Surveillance Epidemiology and End Results program. DACHS: This work is supported by the German Research Council (Deutsche Forschungsgemeinschaft, BR 1704/6-1, BR 1704/6-3, BR 1704/6-4, BR 1704/6-6 and CH 117/1-1), and the German Federal Ministry of Education and Research (01KH0404, 01ER0814 and 01GL1712). The authors thank all participants and cooperating clinicians, and Ute Handte-Daub, Utz Benscheid, Muhabbet Celik and Ursula Eilber for excellent technical assistance. DALS: This work is supported by the National Institutes of Health (R01 CA48998 to M.L.S.). HPFS and NHS: HPFS is supported by the National Institutes of Health (P01 CA055075, UM1 CA167552, U01 CA167552, R01 CA137178, R01 CA151993, R35 CA197735, K07 CA190673 and P50 CA127003). NHS is supported by the National Institutes of Health (R01 CA137178, P01 CA087969, UM1 CA186107, R01 CA137178, R01 CA151993, R35 CA197735, K07 CA190673 and P50 CA127003). The authors would like to acknowledge Qin (Carolyn) Guo and Lixue Zhu who assisted in programming for NHS and HPFS. The authors would like to thank the participants and staff of the Nurses{\textquoteright} Health Study and the Health Professionals Follow-up Study, for their valuable contributions as well as the following state cancer registries for their help: AL, AZ, AR, CA, CO, CT, DE, FL, GA, ID, IL, IN, IA, KY, LA, ME, MD, MA, MI, NE, NH, NJ, NY, NC, ND, OH, OK, OR, PA, RI, SC, TN, TX, VA, WA, WY. The authors assume full responsibility for analyses and interpretation of these data. Kentucky: This work was supported by the following grant support: (i) Clinical Investigator Award from Damon Runyon Cancer Research Foundation (CI-8) and (ii) NCI R01CA136726; and, the authors would like to acknowledge the staff at the Kentucky Cancer Registry. MCCS: The Melbourne Collaborative Cohort Study (MCCS) cohort recruitment was funded by VicHealth and Cancer Council Victoria. The MCCS was further Funding Information: Key words: alcohol, colorectal cancer, colon cancer, rectal cancer Abbreviations: AIC: Akaike information criterion; BIC: Bayesian information criterion; BMI: body mass index; CI: confidence interval; CORECT: Colorectal Transdisciplinary; CRC: colorectal cancer; GECCO: Genetics and Epidemiology of Colorectal Cancer Consortium; NSAIDS: nonsteroidal anti-inflammatory drugs; OR: odds ratio; RR: relative risk Grant sponsor: Australian National Health and Medical Research Council; Grant numbers: 1074383, 396414; Grant sponsor: Canadian Institutes of Health Research; Grant number: CRT 43821; Grant sponsor: Cancer Council Victoria; Grant sponsor: Damon Runyon Cancer Research Foundation; Grant number: CI-8; Grant sponsor: Division of Cancer Prevention, National Cancer Institute; Grant sponsor: German Federal Ministry of Education and Research; Grant numbers: 01ER0814, 01GL1712, 01KH0404; Grant sponsor: German Research Council; Grant numbers: BR 1704/6-4, BR 1704/6-1, BR 1704/6-3, BR 1704/6-6, CH 117/1-1; Grant sponsor: Karolinska Institutet; Grant number: Distinguished Professor Award; Grant sponsor: National Cancer Institute; Grant numbers: 5UM1CA182883, HHSN261201500005C, R01 CA059045, R01 CA120582, R01CA136726, RFA # CA-09-002 U19 CA148107, U01 CA137088, U10CA37429; Grant sponsor: National Cancer Institute of Canada; Grant numbers: 18223, 18226; Grant sponsor: National Heart, Lung, and Blood Institute; Grant numbers: HHSN268201100001C, HHSN268201100002C, HHSN268201100003C, HHSN268201100004C, HHSN268201100046C, HHSN271201100004C; Grant sponsor: National Institutes of Health; Grant numbers: K07 CA190673, P01 CA055075, P01 CA087969, P50 CA127003, R01 CA137178, R01 CA151993, R01 CA48998, R01 CA60987, R35 CA197735, U01 CA164973, U01 CA167552, U01 CA74783, UM1 CA167552, UM1 CA186107; Grant sponsor: Swedish Cancer Foundation; Grant sponsor: Swedish Research Council /Infrastructure Grant; Grant sponsor: Victorian Health Promotion Foundation DOI: 10.1002/ijc.32377 History: Received 1 Nov 2018; Accepted 13 Mar 2019; Online 29 Apr 2019. Correspondence to: Sarah McNabb, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N. M4-B402, Seattle, WA 98109-1024, USA, Fax: 206-667-7850, E-mail: smcnabb@fredhutch.org Funding Information: The studies included in this analysis are part of the Genetics and Epidemiology of Colorectal Cancer Consortium (GECCO) and Colorectal Transdisciplinary (CORECT) Study. GECCO is supported by the National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services (U01 CA137088; R01 CA059045; R01 CA120582). The authors would like to thank all those at the GECCO Coordinating Center for helping bring together the data and people that made this project possible. The authors also acknowledge Deanna Stelling, Mark Thornquist, Greg Warnick, Carolyn Hutter and team members at COMPASS (Comprehensive Center for the Advancement of Scientific Strategies) at the Fred Hutchinson Cancer Research Center for their work harmonizing the GECCO epidemiological data set. The CORECT Study is supported by the National Cancer Institute, National Institutes of Health under RFA # CA-09-002 (U19 CA148107). The content of this article does not necessarily reflect the views or policies of the National Cancer Institute or any of the collaborating centers in CORECT, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government or CORECT. Funding Information: supported by Australian National Health and Medical Research Council grants 209057, 396414 and 1074383 and by infrastructure provided by Cancer Council Victoria. Cases and their vital status were ascertained through the Victorian Cancer Registry and the Australian Institute of Health and Welfare, including the National Death Index and the Australian Cancer Database. The MCCS was made possible by the contribution of many people, including the original investigators, the teams that recruited the participants and continue working on follow-up and the many thousands of Melbourne residents who continue to participate in the study. MEC: This work is supported by the National Institutes of Health (U01 CA164973). NFCCR: This work was supported by an Interdisciplinary Health Research Team award from the Canadian Institutes of Health Research (CRT 43821); the National Institutes of Health, U.S. Department of Health and Human Services (U01 CA74783) and National Cancer Institute of Canada grants (18223 and 18226). Funding was provided to M.O.W, by the Canadian Cancer Society Research Institute. PLCO: PLCO is supported by the Intramural Research Program of the Division of Cancer Epidemiology and Genetics and supported by contracts from the Division of Cancer Prevention, National Cancer Institute, NIH, DHHS. The authors thank Christine Berg and Philip Prorok, Division of Cancer Prevention, National Cancer Institute, the Screening Center investigators and staff or the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial, Tom Riley and staff, Information Management Services, Inc., Barbara O{\textquoteright}Brien and staff, Westat, Inc. and Bill Kopp and staff, SAIC-Frederick. Most importantly, the authors Publisher Copyright: Published 2019. This article is a U.S. Government work and is in the public domain in the USA.",

year = "2020",

month = feb,

day = "1",

doi = "10.1002/ijc.32377",

language = "English (US)",

volume = "146",

pages = "861--873",

journal = "International Journal of Cancer",

issn = "0020-7136",

publisher = "Wiley-Liss Inc.",

number = "3",

}

TY - JOUR

T1 - Meta-analysis of 16 studies of the association of alcohol with colorectal cancer

AU - McNabb, Sarah

AU - Harrison, Tabitha A.

AU - Albanes, Demetrius

AU - Berndt, Sonja I.

AU - Brenner, Hermann

AU - Caan, Bette J.

AU - Campbell, Peter T.

AU - Cao, Yin

AU - Chang-Claude, Jenny

AU - Chan, Andrew

AU - Chen, Zhengyi

AU - English, Dallas R.

AU - Giles, Graham G.

AU - Giovannucci, Edward L.

AU - Goodman, Phyllis J.

AU - Hayes, Richard B.

AU - Hoffmeister, Michael

AU - Jacobs, Eric J.

AU - Joshi, Amit D.

AU - Larsson, Susanna C.

AU - Le Marchand, Loïc

AU - Li, Li

AU - Lin, Yi

AU - Männistö, Satu

AU - Milne, Roger L.

AU - Nan, Hongmei

AU - Newton, Christina C.

AU - Ogino, Shuji

AU - Parfrey, Patrick S.

AU - Petersen, Paneen S.

AU - Potter, John D.

AU - Schoen, Robert E.

AU - Slattery, Martha L.

AU - Su, Yu Ru

AU - Tangen, Catherine M.

AU - Tucker, Thomas C.

AU - Weinstein, Stephanie J.

AU - White, Emily

AU - Wolk, Alicja

AU - Woods, Michael O.

AU - Phipps, Amanda I.

AU - Peters, Ulrike

N1 - Funding Information: The studies included in this analysis are part of the Genetics and Epidemiology of Colorectal Cancer Consortium (GECCO) and Colorectal Transdisciplinary (CORECT) Study. GECCO is supported by the National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services (U01 CA137088; R01 CA059045; R01 CA120582). The authors would like to thank all those at the GECCO Coordinating Center for helping bring together the data and people that made this project possible. The authors also acknowledge Deanna Stelling, Mark Tho-rnquist, Greg Warnick, Carolyn Hutter and team members at COMPASS (Comprehensive Center for the Advancement of Scientific Strategies) at the Fred Hutchinson Cancer Research Center for their work harmonizing the GECCO epidemiological data set. The CORECT Study is supported by the National Cancer Institute, National Institutes of Health under RFA # CA-09-002 (U19 CA148107). The content of this article does not necessarily reflect the views or policies of the National Cancer Institute or any of the collaborating centers in CORECT, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government or CORECT. ATBC: The ATBC Study is supported by the Intramural Research Program of the U.S. National Cancer Institute, NIH and by U.S. Public Health Service contract HHSN261201500005C from the National Cancer Institute, Department of Health and Human Services. COLO2&3: This work is supported by the National Institutes of Health (R01 CA60987). CPS-II: The American Cancer Society funds the creation, maintenance and updating of the Cancer Prevention Study-II (CPS-II) cohort. This study was conducted with Institutional Review Board approval. The authors thank the CPS-II participants and Study Management Group for their invaluable contributions to this research. The authors would also like to acknowledge the contribution to this study from central cancer registries supported through the Centers for Disease Control and Prevention National Program of Cancer Registries, and cancer registries supported by the National Cancer Institute Surveillance Epidemiology and End Results program. DACHS: This work is supported by the German Research Council (Deutsche Forschungsgemeinschaft, BR 1704/6-1, BR 1704/6-3, BR 1704/6-4, BR 1704/6-6 and CH 117/1-1), and the German Federal Ministry of Education and Research (01KH0404, 01ER0814 and 01GL1712). The authors thank all participants and cooperating clinicians, and Ute Handte-Daub, Utz Benscheid, Muhabbet Celik and Ursula Eilber for excellent technical assistance. DALS: This work is supported by the National Institutes of Health (R01 CA48998 to M.L.S.). HPFS and NHS: HPFS is supported by the National Institutes of Health (P01 CA055075, UM1 CA167552, U01 CA167552, R01 CA137178, R01 CA151993, R35 CA197735, K07 CA190673 and P50 CA127003). NHS is supported by the National Institutes of Health (R01 CA137178, P01 CA087969, UM1 CA186107, R01 CA137178, R01 CA151993, R35 CA197735, K07 CA190673 and P50 CA127003). The authors would like to acknowledge Qin (Carolyn) Guo and Lixue Zhu who assisted in programming for NHS and HPFS. The authors would like to thank the participants and staff of the Nurses’ Health Study and the Health Professionals Follow-up Study, for their valuable contributions as well as the following state cancer registries for their help: AL, AZ, AR, CA, CO, CT, DE, FL, GA, ID, IL, IN, IA, KY, LA, ME, MD, MA, MI, NE, NH, NJ, NY, NC, ND, OH, OK, OR, PA, RI, SC, TN, TX, VA, WA, WY. The authors assume full responsibility for analyses and interpretation of these data. Kentucky: This work was supported by the following grant support: (i) Clinical Investigator Award from Damon Runyon Cancer Research Foundation (CI-8) and (ii) NCI R01CA136726; and, the authors would like to acknowledge the staff at the Kentucky Cancer Registry. MCCS: The Melbourne Collaborative Cohort Study (MCCS) cohort recruitment was funded by VicHealth and Cancer Council Victoria. The MCCS was further Funding Information: Key words: alcohol, colorectal cancer, colon cancer, rectal cancer Abbreviations: AIC: Akaike information criterion; BIC: Bayesian information criterion; BMI: body mass index; CI: confidence interval; CORECT: Colorectal Transdisciplinary; CRC: colorectal cancer; GECCO: Genetics and Epidemiology of Colorectal Cancer Consortium; NSAIDS: nonsteroidal anti-inflammatory drugs; OR: odds ratio; RR: relative risk Grant sponsor: Australian National Health and Medical Research Council; Grant numbers: 1074383, 396414; Grant sponsor: Canadian Institutes of Health Research; Grant number: CRT 43821; Grant sponsor: Cancer Council Victoria; Grant sponsor: Damon Runyon Cancer Research Foundation; Grant number: CI-8; Grant sponsor: Division of Cancer Prevention, National Cancer Institute; Grant sponsor: German Federal Ministry of Education and Research; Grant numbers: 01ER0814, 01GL1712, 01KH0404; Grant sponsor: German Research Council; Grant numbers: BR 1704/6-4, BR 1704/6-1, BR 1704/6-3, BR 1704/6-6, CH 117/1-1; Grant sponsor: Karolinska Institutet; Grant number: Distinguished Professor Award; Grant sponsor: National Cancer Institute; Grant numbers: 5UM1CA182883, HHSN261201500005C, R01 CA059045, R01 CA120582, R01CA136726, RFA # CA-09-002 U19 CA148107, U01 CA137088, U10CA37429; Grant sponsor: National Cancer Institute of Canada; Grant numbers: 18223, 18226; Grant sponsor: National Heart, Lung, and Blood Institute; Grant numbers: HHSN268201100001C, HHSN268201100002C, HHSN268201100003C, HHSN268201100004C, HHSN268201100046C, HHSN271201100004C; Grant sponsor: National Institutes of Health; Grant numbers: K07 CA190673, P01 CA055075, P01 CA087969, P50 CA127003, R01 CA137178, R01 CA151993, R01 CA48998, R01 CA60987, R35 CA197735, U01 CA164973, U01 CA167552, U01 CA74783, UM1 CA167552, UM1 CA186107; Grant sponsor: Swedish Cancer Foundation; Grant sponsor: Swedish Research Council /Infrastructure Grant; Grant sponsor: Victorian Health Promotion Foundation DOI: 10.1002/ijc.32377 History: Received 1 Nov 2018; Accepted 13 Mar 2019; Online 29 Apr 2019. Correspondence to: Sarah McNabb, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N. M4-B402, Seattle, WA 98109-1024, USA, Fax: 206-667-7850, E-mail: smcnabb@fredhutch.org Funding Information: The studies included in this analysis are part of the Genetics and Epidemiology of Colorectal Cancer Consortium (GECCO) and Colorectal Transdisciplinary (CORECT) Study. GECCO is supported by the National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services (U01 CA137088; R01 CA059045; R01 CA120582). The authors would like to thank all those at the GECCO Coordinating Center for helping bring together the data and people that made this project possible. The authors also acknowledge Deanna Stelling, Mark Thornquist, Greg Warnick, Carolyn Hutter and team members at COMPASS (Comprehensive Center for the Advancement of Scientific Strategies) at the Fred Hutchinson Cancer Research Center for their work harmonizing the GECCO epidemiological data set. The CORECT Study is supported by the National Cancer Institute, National Institutes of Health under RFA # CA-09-002 (U19 CA148107). The content of this article does not necessarily reflect the views or policies of the National Cancer Institute or any of the collaborating centers in CORECT, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government or CORECT. Funding Information: supported by Australian National Health and Medical Research Council grants 209057, 396414 and 1074383 and by infrastructure provided by Cancer Council Victoria. Cases and their vital status were ascertained through the Victorian Cancer Registry and the Australian Institute of Health and Welfare, including the National Death Index and the Australian Cancer Database. The MCCS was made possible by the contribution of many people, including the original investigators, the teams that recruited the participants and continue working on follow-up and the many thousands of Melbourne residents who continue to participate in the study. MEC: This work is supported by the National Institutes of Health (U01 CA164973). NFCCR: This work was supported by an Interdisciplinary Health Research Team award from the Canadian Institutes of Health Research (CRT 43821); the National Institutes of Health, U.S. Department of Health and Human Services (U01 CA74783) and National Cancer Institute of Canada grants (18223 and 18226). Funding was provided to M.O.W, by the Canadian Cancer Society Research Institute. PLCO: PLCO is supported by the Intramural Research Program of the Division of Cancer Epidemiology and Genetics and supported by contracts from the Division of Cancer Prevention, National Cancer Institute, NIH, DHHS. The authors thank Christine Berg and Philip Prorok, Division of Cancer Prevention, National Cancer Institute, the Screening Center investigators and staff or the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial, Tom Riley and staff, Information Management Services, Inc., Barbara O’Brien and staff, Westat, Inc. and Bill Kopp and staff, SAIC-Frederick. Most importantly, the authors Publisher Copyright: Published 2019. This article is a U.S. Government work and is in the public domain in the USA.

PY - 2020/2/1

Y1 - 2020/2/1

N2 - 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.

AB - 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.

KW - alcohol

KW - colon cancer

KW - colorectal cancer

KW - rectal cancer

UR - http://www.scopus.com/inward/record.url?scp=85067671970&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85067671970&partnerID=8YFLogxK

U2 - 10.1002/ijc.32377

DO - 10.1002/ijc.32377

M3 - Article

C2 - 31037736

AN - SCOPUS:85067671970

SN - 0020-7136

VL - 146

SP - 861

EP - 873

JO - International Journal of Cancer

JF - International Journal of Cancer

IS - 3

ER -

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

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