Lifetime and baseline alcohol intake and risk of colon and rectal cancers in the European prospective investigation into cancer and nutrition (EPIC).
Alcohol consumption may be associated with risk of colorectal cancer (CRC), but the epidemiological evidence for an association with specific anatomical subsites, types of alcoholic beverages and current vs. lifetime alcohol intake is inconsistent. Within the European Prospective Investigation into Cancer and Nutrition (EPIC), 478,732 study subjects free of cancer at enrolment between 1992 and 2000 were followed up for an average of 6.2 years, during which 1,833 CRC cases were observed. Detailed information on consumption of alcoholic beverages at baseline (all cases) and during lifetime (1,447 CRC cases, 69% of the cohort) was collected from questionnaires. Cox proportional hazard models were used to examine the alcohol-CRC association. After adjustment for potential confounding factors, lifetime alcohol intake was significantly positively associated to CRC risk (hazard ratio, HR=1.08, 95%CI=1.04-1.12 for 15 g/day increase), with higher cancer risks observed in the rectum (HR=1.12, 95%CI=1.06-1.18) than distal colon (HR=1.08, 95%CI=1.01-1.16), and proximal colon (HR=1.02, 95%CI=0.92-1.12). Similar results were observed for baseline alcohol intake. When assessed by alcoholic beverages at baseline, the CRC risk for beer (HR=1.38, 95%CI=1.08-1.77 for 20-39.9 vs. 0.1-2.9 g/day) was higher than wine (HR=1.21, 95%CI=1.02-1.44), although the two risk estimates were not significantly different from each other. Higher HRs for baseline alcohol were observed for low levels of folate intake (1.13, 95%CI=1.06-1.20 for 15 g/day increase) compared to high folate intake (1.03, 95%CI=0.98-1.09). In this large European cohort, both lifetime and baseline alcohol consumption increase colon and rectum cancer risk, with more apparent risk increases for alcohol intakes greater than 30 g/day.
Ferrari
Pietro
P
International Agency for Research on Cancer (IARC-WHO), Lyon, France.
Jenab
Mazda
M
International Agency for Research on Cancer (IARC-WHO), Lyon, France.
Norat
Teresa
T
Department of Epidemiology and Public Health, Imperial College London, London, United Kingdom.
Moskal
Aurelie
A
International Agency for Research on Cancer (IARC-WHO), Lyon, France.
Slimani
Nadia
N
International Agency for Research on Cancer (IARC-WHO), Lyon, France.
Olsen
Anja
A
Institute of Cancer Epidemiology, The Danish Cancer Society, Copenhagen, Denmark.
Tjønneland
Anne
A
Institute of Cancer Epidemiology, The Danish Cancer Society, Copenhagen, Denmark.
Overvad
Kim
K
Department of Clinical Epidemiology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark.
Jensen
Majken K
MK
Department of Clinical Epidemiology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark.
Boutron-Ruault
Marie-Christine
MC
Nutrition, Hormones and Cancer Unit, E3N, EMT, Institut Gustave Roussy, Villejuif Cedex, France.
Clavel-Chapelon
Françoise
F
Nutrition, Hormones and Cancer Unit, E3N, EMT, Institut Gustave Roussy, Villejuif Cedex, France.
Morois
Sophie
S
Nutrition, Hormones and Cancer Unit, E3N, EMT, Institut Gustave Roussy, Villejuif Cedex, France.
Rohrmann
Sabine
S
Deutsches Krebsforschungszentrum/German Cancer Research Centre, Klinische Epidemiologie/Clinical Epidemiology, C020, AG Ernährungsepidemiologie/Nutritional Epidemiology, Heidelberg, Germany.
Linseisen
Jakob
J
Deutsches Krebsforschungszentrum/German Cancer Research Centre, Klinische Epidemiologie/Clinical Epidemiology, C020, AG Ernährungsepidemiologie/Nutritional Epidemiology, Heidelberg, Germany.
Boeing
Heiner
H
Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbruecke, Germany.
Bergmann
Manuela
M
Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbruecke, Germany.
Kontopoulou
Dimitra
D
Department of Hygiene and Epidemiology, Medical School, University of Athens, Greece.
Trichopoulou
Antonia
A
Department of Hygiene and Epidemiology, Medical School, University of Athens, Greece.
Kassapa
Christina
C
Department of Hygiene and Epidemiology, Medical School, University of Athens, Greece.
Masala
Giovanna
G
Molecular and Nutritional Epidemiology Unit, CSPO-Scientific Institute of Tuscany, Florence, Italy.
Krogh
Vittorio
V
Nutritional Epidemiology Unit, National Cancer Institute, Milan, Italy.
Vineis
Paolo
P
Department of Epidemiology and Public Health, Imperial College, London, United Kingdom.|Department of Biomedical Sciences and Human Oncology, University of Torino, Italy.
Panico
Salvatore
S
Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy.
Tumino
Rosario
R
Cancer Registry, Azienda Ospedaliera "Civile M.P. Arezzo," Ragusa, Italy.
Gils
Carla H van
CHV
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.
Peeters
Petra
P
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.
Bueno-de-Mesquita
H Bas
HB
Cancer Epidemiology, Centre for Nutrition and Health, National Institute of Public Health and the Environment, Bilthoven, The Netherlands.
Ocké
Marga C
MC
Cancer Epidemiology, Centre for Nutrition and Health, National Institute of Public Health and the Environment, Bilthoven, The Netherlands.
Skeie
Guri
G
Institute of Community Medicine, University of Tromsø, Tromsø, Norway.
Lund
Eiliv
E
Institute of Community Medicine, University of Tromsø, Tromsø, Norway.
Agudo
Antonio
A
Group of Nutrition, Environmental and Cancer, Department of Epidemiology and Cancer Registry, Catalan Institute of Oncology, Barcelona, Spain.
Ardanaz
Eva
E
Public Health Institute of Navarra, Pamplona, Spain.
López
Dolores C
DC
Epidemiology Department, Murcia Health Council, Murcia, Spain.
Sanchez
Maria-Jose
MJ
Andalusian School of Public Health, Granada, Spain.
Quirós
José R
JR
Public Health and Health Planning Directorate, Asturias, Spain.
Amiano
Pilar
P
Public Health Division of Gipuzkoa, Health Department of the Basque Country, Donostia-San Sebastian, Spain.
Berglund
Göran
G
Institutionen för Kliniska Vetenskaper, Kirurgiska Kliniken, Universitetssjukhuset MAS, Malmö, Sweden.
Manjer
Jonas
J
Institutionen för Kliniska Vetenskaper, Kirurgiska Kliniken, Universitetssjukhuset MAS, Malmö, Sweden.
Palmqvist
Richard
R
Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden.
Guelpen
Bethany Van
BV
Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden.
Allen
Naomi
N
Cancer Research UK Epidemiology Unit, University of Oxford, Oxford, United Kingdom.
Key
Tim
T
Cancer Research UK Epidemiology Unit, University of Oxford, Oxford, United Kingdom.
Bingham
Sheila
S
MRC Centre for Nutritional Epidemiology in Cancer Prevention and Survival, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom.
Mazuir
Mathieu
M
International Agency for Research on Cancer (IARC-WHO), Lyon, France.
Boffetta
Paolo
P
International Agency for Research on Cancer (IARC-WHO), Lyon, France.
Kaaks
Rudolf
R
Deutsches Krebsforschungszentrum/German Cancer Research Centre, Klinische Epidemiologie/Clinical Epidemiology, C020, AG Ernährungsepidemiologie/Nutritional Epidemiology, Heidelberg, Germany.
Riboli
Elio
E
Department of Epidemiology and Public Health, Imperial College London, London, United Kingdom.
D000428:Alcohol Drinking / Q000009:adverse effects*; D003110:Colonic Neoplasms / Q000453:epidemiology*; D005060:Europe; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment; D012004:Rectal Neoplasms / Q000453:epidemiology*; D012307:Risk Factors; D012727:Sex Characteristics; D013997:Time Factors