title: Alcohol and lung cancer risk among never smokers: A pooled analysis from the international lung cancer consortium and the SYNERGY study.
abstract: It is not clear whether alcohol consumption is associated with lung cancer risk. The relationship is likely confounded by smoking, complicating the interpretation of previous studies. We examined the association of alcohol consumption and lung cancer risk in a large pooled international sample, minimizing potential confounding of tobacco consumption by restricting analyses to never smokers. Our study included 22 case-control and cohort studies with a total of 2548 never-smoking lung cancer patients and 9362 never-smoking controls from North America, Europe and Asia within the International Lung Cancer Consortium (ILCCO) and SYNERGY Consortium. Alcohol consumption was categorized into amounts consumed (grams per day) and also modelled as a continuous variable using restricted cubic splines for potential non-linearity. Analyses by histologic sub-type were included. Associations by type of alcohol consumed (wine, beer and liquor) were also investigated. Alcohol consumption was inversely associated with lung cancer risk with evidence most strongly supporting lower risk for light and moderate drinkers relative to non-drinkers (>0-4.9 g per day: OR = 0.80, 95% CI = 0.70-0.90; 5-9.9 g per day: OR = 0.82, 95% CI = 0.69-0.99; 10-19.9 g per day: OR = 0.79, 95% CI = 0.65-0.96). Inverse associations were found for consumption of wine and liquor, but not beer. The results indicate that alcohol consumption is inversely associated with lung cancer risk, particularly among subjects with low to moderate consumption levels, and among wine and liquor drinkers, but not beer drinkers. Although our results should have no relevant bias from the confounding effect of smoking we cannot preclude that confounding by other factors contributed to the observed associations. Confounding in relation to the non-drinker reference category may be of particular importance.
authors.affiliation: Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada.
authors.forename: Gordon
authors.initials: G
authors.lastname: Fehringer
authors.affiliation: Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada.|International Agency for Research on Cancer, Lyon, France.|Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, Alberta, Canada.
authors.forename: Darren R
authors.initials: DR
authors.lastname: Brenner
authors.affiliation: Department of Epidemiology, School of Public Health, UCLA, Los Angeles, CA.
authors.forename: Zuo-Feng
authors.initials: ZF
authors.lastname: Zhang
authors.affiliation: Department of Family and Preventive Medicine, School of Medicine, University of Utah, Salt Lake City, UT.
authors.forename: Yuan-Chin Amy
authors.initials: YA
authors.lastname: Lee
authors.affiliation: Division of Molecular Medicine, Aichi Cancer Center Research Institute, Nagoya, Japan.
authors.forename: Keitaro
authors.initials: K
authors.lastname: Matsuo
authors.affiliation: Division Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan.
authors.forename: Hidemi
authors.initials: H
authors.lastname: Ito
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD.
authors.forename: Qing
authors.initials: Q
authors.lastname: Lan
authors.affiliation: Division of Epidemiology, Public Health and Primary Care, Faculty of Medicine, Imperial College London, London, United Kingdom.
authors.forename: Paolo
authors.initials: P
authors.lastname: Vineis
authors.affiliation: International Agency for Research on Cancer, Lyon, France.
authors.forename: Mattias
authors.initials: M
authors.lastname: Johansson
authors.affiliation: Department of Public Health, Section for Epidemiology, Aarhus University, Denmark.
authors.forename: Kim
authors.initials: K
authors.lastname: Overvad
authors.affiliation: Department of Epidemiology and Biostatistics, Imperial College, London, United Kingdom.
authors.forename: Elio
authors.initials: E
authors.lastname: Riboli
authors.affiliation: Hellenic Health Foundation, Athens, Greece.|World Health Organization Collaborating Center for Food and Nutrition Policies, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece.
authors.forename: Antonia
authors.initials: A
authors.lastname: Trichopoulou
authors.affiliation: Unit of Cancer Epidemiology, Piedmont Children Cancer Registry, Città della Salute e della Scienza di Torino Hospital and CPO Piemonte, Turin, Italy.
authors.forename: Carlotta
authors.initials: C
authors.lastname: Sacerdote
authors.affiliation: Department of Environmental Epidemiology, INSERM, Villejuif, U170, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Stucker
authors.affiliation: Mount Sinai School of Medicine, The Tisch Cancer Institute, New York, NY.
authors.forename: Paolo
authors.initials: P
authors.lastname: Boffetta
authors.affiliation: International Agency for Research on Cancer, Lyon, France.
authors.forename: Paul
authors.initials: P
authors.lastname: Brennan
authors.affiliation: Harvard School of Public Health, Massachusetts General Hospital/Harvard Medical School, Boston, MA.
authors.forename: David C
authors.initials: DC
authors.lastname: Christiani
authors.affiliation: Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Yun-Chul
authors.initials: YC
authors.lastname: Hong
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD.
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Landi
authors.affiliation: Departments of Epidemiology and Environmental Health Sciences, School of Public Health and Comprehensive Cancer Center, University of Michigan, Ann Arbor, MI.
authors.forename: Hal
authors.initials: H
authors.lastname: Morgenstern
authors.affiliation: Karmanos Cancer Institute, Wayne State University, Detroit, MI.
authors.forename: Ann G
authors.initials: AG
authors.lastname: Schwartz
authors.affiliation: Karmanos Cancer Institute, Wayne State University, Detroit, MI.
authors.forename: Angela S
authors.initials: AS
authors.lastname: Wenzlaff
authors.affiliation: Department of Community Medicine and Epidemiology, Carmel Medical Center and Bruce Rappaport Faculty of Medicine, Israel Institute of Technology and Clalit Health Services National Cancer Control Center, Haifa, Israel.
authors.forename: Gad
authors.initials: G
authors.lastname: Rennert
authors.affiliation: Public Health Ontario, Toronto, Canada.
authors.forename: John R
authors.initials: JR
authors.lastname: McLaughlin
authors.affiliation: Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, MD.
authors.forename: Curtis C
authors.initials: CC
authors.lastname: Harris
authors.affiliation: College of Public Health, The Ohio State University, Columbus, OH.
authors.forename: Susan
authors.initials: S
authors.lastname: Olivo-Marston
authors.affiliation: Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Irene
authors.initials: I
authors.lastname: Orlow
authors.affiliation: Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Bernard J
authors.initials: BJ
authors.lastname: Park
authors.affiliation: Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.|Weill Cornell Medical College, Cornell University, New York, NY.
authors.forename: Marjorie
authors.initials: M
authors.lastname: Zauderer
authors.affiliation: Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain.|CIBER de Epidemiología y Salud Pública, Madrid, Spain.
authors.forename: Juan M
authors.initials: JM
authors.lastname: Barros Dios
authors.affiliation: Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain.|CIBER de Epidemiología y Salud Pública, Madrid, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Ruano Raviña
authors.affiliation: University of Montreal Hospital Research Center (CRCHUM) and School of Public Health, Montreal, Canada.
authors.forename: Jack
authors.initials: J
authors.lastname: Siemiatycki
authors.affiliation: University of Montreal Hospital Research Center (CRCHUM) and School of Public Health, Montreal, Canada.
authors.forename: Anita
authors.initials: A
authors.lastname: Koushik
authors.affiliation: Department of Pharmaceutical Sciences, College of Pharmacy, Washington State University, Spokane, Washington.
authors.forename: Philip
authors.initials: P
authors.lastname: Lazarus
authors.affiliation: IUOPA, University Institute of Oncology, University of Oviedo, and CIBERESP, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Fernández-Somoano
authors.affiliation: IUOPA, University Institute of Oncology, University of Oviedo, and CIBERESP, Spain.
authors.forename: Adonina
authors.initials: A
authors.lastname: Tardon
authors.affiliation: University of Hawaii Cancer Center, Honolulu, Hawaii.
authors.forename: Loic
authors.initials: L
authors.lastname: Le Marchand
authors.affiliation: Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 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.
authors.forename: Hermann
authors.initials: H
authors.lastname: Brenner
authors.affiliation: Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
authors.forename: Kai-Uwe
authors.initials: KU
authors.lastname: Saum
authors.affiliation: Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Duell
authors.affiliation: Norris Cotton Cancer Center, Geisel School of Medicine, Dartmouth College, Lebanon, USA.
authors.forename: Angeline S
authors.initials: AS
authors.lastname: Andrew
authors.affiliation: The Nofer Institute of Occupational Medicine (NIOM), Lodz, Poland.
authors.forename: Neonila
authors.initials: N
authors.lastname: Szeszenia-Dabrowska
authors.affiliation: Department of Cancer Epidemiology and Prevention, Cancer Center Maria Sklodowska-Curie Institute of Oncology, Warsaw, Poland.
authors.forename: Jolanta
authors.initials: J
authors.lastname: Lissowska
authors.affiliation: Institute of Carcinogenesis, Blokhin Cancer Research Center, Russian Academy of Medical Sciences, Moscow, Russia.
authors.forename: David
authors.initials: D
authors.lastname: Zaridze
authors.affiliation: National Institute of Environmental Health, Budapest, Hungary.
authors.forename: Peter
authors.initials: P
authors.lastname: Rudnai
authors.affiliation: Specialized Institute of Hygiene and Epidemiology, Banská Bystrica, Slovakia.
authors.forename: Eleonora
authors.initials: E
authors.lastname: Fabianova
authors.affiliation: National Institute of Public Health, Bucharest, Romania.
authors.forename: Dana
authors.initials: D
authors.lastname: Mates
authors.affiliation: Masaryk Memorial Cancer Institute, Brno, Czech Republic.
authors.forename: Lenka
authors.initials: L
authors.lastname: Foretova
authors.affiliation: Palacky University, Olomouc, Czech Republic.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Janout
authors.affiliation: Institute of Hygiene and Epidemiology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Bencko
authors.affiliation: Institute of Hygiene and Epidemiology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic.
authors.forename: Ivana
authors.initials: I
authors.lastname: Holcatova
authors.affiliation: Epidemiology Unit, Department of Preventive Medicine, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy.|Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.
authors.forename: Angela Cecilia
authors.initials: AC
authors.lastname: Pesatori
authors.affiliation: Epidemiology Unit, Department of Preventive Medicine, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Dario
authors.identifier: 0000-0002-8935-3843
authors.initials: D
authors.lastname: Consonni
authors.affiliation: International Agency for Research on Cancer, Lyon, France.|The Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Ann
authors.initials: A
authors.lastname: Olsson
authors.affiliation: International Agency for Research on Cancer, Lyon, France.
authors.forename: Kurt
authors.initials: K
authors.lastname: Straif
authors.affiliation: Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada.
authors.forename: Rayjean J
authors.initials: RJ
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mesh_terms: D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects*; D000434:Alcoholic Beverages / Q000009:adverse effects; D001208:Asia / Q000453:epidemiology; D016022:Case-Control Studies; D015331:Cohort Studies; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000453:epidemiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009656:North America / Q000453:epidemiology; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*
keywords: alcohol; beer; liquor; lung cancer; wine