title: Lifetime and baseline alcohol intake and risk of colon and rectal cancers in the European prospective investigation into cancer and nutrition (EPIC).
abstract: 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.
authors.affiliation: International Agency for Research on Cancer (IARC-WHO), Lyon, France.
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authors.lastname: Ferrari
authors.affiliation: International Agency for Research on Cancer (IARC-WHO), Lyon, France.
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authors.affiliation: Department of Epidemiology and Public Health, Imperial College London, London, United Kingdom.
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authors.affiliation: International Agency for Research on Cancer (IARC-WHO), Lyon, France.
authors.forename: Aurelie
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authors.affiliation: International Agency for Research on Cancer (IARC-WHO), Lyon, France.
authors.forename: Nadia
authors.initials: N
authors.lastname: Slimani
authors.affiliation: Institute of Cancer Epidemiology, The Danish Cancer Society, Copenhagen, Denmark.
authors.forename: Anja
authors.initials: A
authors.lastname: Olsen
authors.affiliation: Institute of Cancer Epidemiology, The Danish Cancer Society, Copenhagen, Denmark.
authors.forename: Anne
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authors.affiliation: Department of Clinical Epidemiology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark.
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authors.affiliation: Department of Clinical Epidemiology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark.
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authors.affiliation: Nutrition, Hormones and Cancer Unit, E3N, EMT, Institut Gustave Roussy, Villejuif Cedex, France.
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Boutron-Ruault
authors.affiliation: Nutrition, Hormones and Cancer Unit, E3N, EMT, Institut Gustave Roussy, Villejuif Cedex, France.
authors.forename: Françoise
authors.initials: F
authors.lastname: Clavel-Chapelon
authors.affiliation: Nutrition, Hormones and Cancer Unit, E3N, EMT, Institut Gustave Roussy, Villejuif Cedex, France.
authors.forename: Sophie
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authors.affiliation: Deutsches Krebsforschungszentrum/German Cancer Research Centre, Klinische Epidemiologie/Clinical Epidemiology, C020, AG Ernährungsepidemiologie/Nutritional Epidemiology, Heidelberg, Germany.
authors.forename: Sabine
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authors.affiliation: Deutsches Krebsforschungszentrum/German Cancer Research Centre, Klinische Epidemiologie/Clinical Epidemiology, C020, AG Ernährungsepidemiologie/Nutritional Epidemiology, Heidelberg, Germany.
authors.forename: Jakob
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authors.affiliation: Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbruecke, Germany.
authors.forename: Heiner
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authors.affiliation: Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbruecke, Germany.
authors.forename: Manuela
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authors.affiliation: Department of Hygiene and Epidemiology, Medical School, University of Athens, Greece.
authors.forename: Dimitra
authors.initials: D
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authors.affiliation: Department of Hygiene and Epidemiology, Medical School, University of Athens, Greece.
authors.forename: Antonia
authors.initials: A
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authors.affiliation: Department of Hygiene and Epidemiology, Medical School, University of Athens, Greece.
authors.forename: Christina
authors.initials: C
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authors.affiliation: Molecular and Nutritional Epidemiology Unit, CSPO-Scientific Institute of Tuscany, Florence, Italy.
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authors.forename: Vittorio
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authors.lastname: Krogh
authors.affiliation: Department of Epidemiology and Public Health, Imperial College, London, United Kingdom.|Department of Biomedical Sciences and Human Oncology, University of Torino, Italy.
authors.forename: Paolo
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authors.lastname: Vineis
authors.affiliation: Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy.
authors.forename: Salvatore
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authors.forename: Rosario
authors.initials: R
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authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.
authors.forename: Carla H van
authors.initials: CHV
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authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.
authors.forename: Petra
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authors.lastname: Peeters
authors.affiliation: Cancer Epidemiology, Centre for Nutrition and Health, National Institute of Public Health and the Environment, Bilthoven, The Netherlands.
authors.forename: H Bas
authors.initials: HB
authors.lastname: Bueno-de-Mesquita
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authors.forename: Marga C
authors.initials: MC
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authors.affiliation: Institute of Community Medicine, University of Tromsø, Tromsø, Norway.
authors.forename: Guri
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authors.affiliation: Institute of Community Medicine, University of Tromsø, Tromsø, Norway.
authors.forename: Eiliv
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authors.affiliation: Group of Nutrition, Environmental and Cancer, Department of Epidemiology and Cancer Registry, Catalan Institute of Oncology, Barcelona, Spain.
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authors.initials: DC
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authors.affiliation: Andalusian School of Public Health, Granada, Spain.
authors.forename: Maria-Jose
authors.initials: MJ
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authors.affiliation: Public Health and Health Planning Directorate, Asturias, Spain.
authors.forename: José R
authors.initials: JR
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authors.forename: Pilar
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authors.affiliation: Institutionen för Kliniska Vetenskaper, Kirurgiska Kliniken, Universitetssjukhuset MAS, Malmö, Sweden.
authors.forename: Göran
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authors.lastname: Berglund
authors.affiliation: Institutionen för Kliniska Vetenskaper, Kirurgiska Kliniken, Universitetssjukhuset MAS, Malmö, Sweden.
authors.forename: Jonas
authors.initials: J
authors.lastname: Manjer
authors.affiliation: Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden.
authors.forename: Richard
authors.initials: R
authors.lastname: Palmqvist
authors.affiliation: Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden.
authors.forename: Bethany Van
authors.initials: BV
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authors.affiliation: Cancer Research UK Epidemiology Unit, University of Oxford, Oxford, United Kingdom.
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authors.affiliation: Cancer Research UK Epidemiology Unit, University of Oxford, Oxford, United Kingdom.
authors.forename: Tim
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authors.forename: Sheila
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authors.lastname: Bingham
authors.affiliation: International Agency for Research on Cancer (IARC-WHO), Lyon, France.
authors.forename: Mathieu
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authors.forename: Paolo
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authors.affiliation: Deutsches Krebsforschungszentrum/German Cancer Research Centre, Klinische Epidemiologie/Clinical Epidemiology, C020, AG Ernährungsepidemiologie/Nutritional Epidemiology, Heidelberg, Germany.
authors.forename: Rudolf
authors.initials: R
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authors.affiliation: Department of Epidemiology and Public Health, Imperial College London, London, United Kingdom.
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mesh_terms: 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