Population based cohort study of the association between alcohol intake and cancer of the upper digestive tract

BMJ 1998;317:844-848 ( 26 September )

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Population based cohort study of the association between alcohol intake and cancer of the upper digestive tract

Editorial by Sabroe

Morten Grønbæk, senior research fellow, ^a Ulrik Becker, chief physician, ^b Ditte Johansen, statistician, ^a Hanne Tønnesen, senior research fellow, ^c Gorm Jensen, chief physician, ^d Thorkild I A Sørensen, professor. ^a

^a Copenhagen Centre for Prospective Population Studies, Danish Epidemiology Science Centre at the Institute of Preventive Medicine, Kommunehospitalet, 1399CopenhagenK, Denmark, ^b Alcohol Unit, Department of Medical Gastroenterology, Hvidovre University Hospital, 2650 Hvidovre, Denmark, ^c Department of Surgical Gastroenterology, Hvidovre University Hospital, 2650 Hvidovre, Denmark , ^d Copenhagen City Heart Study, Epidemiological Research Unit, Bispebjerg University Hospital, 2400 Copenhagen NV, Denmark

Correspondence to: Dr Grønbæk mg{at}ipm.hosp.dk

Objective: To examine the relation between different types of alcoholic drinks and upper digestive tract cancers (oropharyngealand oesophageal).
Design: Population based study with baseline assessment of intake of beer, wine, and spirits, smoking habits, educationallevel, and 2-19 years' follow up on risk of upper digestive tractcancer.
Setting: Denmark.
Subjects: 15 117 men and 13 063 women aged 20 to 98 years.
Main outcome measure: Number and time of identification of incident upper digestive tract cancer during follow up.
Results: During a mean follow up of 13.5 years, 156 subjects developed upper digestive tract cancer. Compared with non-drinkers (drinkers of <1 drink/week), subjects who drank 7-21beers or spirits a week but no wine were at a risk of 3.0 (95% confidence interval 1.5 to 6.1), whereas those who had the sametotal alcohol intake but with wine as $>=$ 30% of their intake hada risk of 0.5 (0.2 to 1.4). Drinkers of >21 beers and spiritsbut no wine had a relative risk of 5.2 (2.7 to 10.2) comparedwith non-drinkers, whereas those who drank the same amount, butincluded wine in their alcohol intake, had a relative risk of1.7 (0.6 to 4.4).
Conclusion: A moderate intake of wine probably does not increase the risk of upper digestive tract cancer, whereasa moderate intake of beer or spirits increases the risk considerably.

Key messages

Alcohol is a strong risk factor for oropharyngeal and oesophageal cancer
The carcinogenic effect of alcohol has been assumed to be independent of type of alcohol drunk
Resveratrol, a substance in grapes and wine, has been shown to inhibit the initiation, promotion, and progression of cancer
Wine drinkers may be at a lower risk of developing upper digestive tract cancer than drinkers who have a similar intake of beer or spirits

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Alcohol intake and cancer of the upper digestive tract: Carlo La Vecchia, Silvia Franceschi, Adriano Favero, Renato Talamini, Eva Negri, K K Cheng, C Cummins, R Maric, Vaughan Reed, Rebecca Fitzgerald, Christine Caygill, Morten Grønbæk, and Thorkild I A Sørensen
BMJ 1999 318: 1289. [Extract] [Full Text]

Beer and spirits, but not wine, raise the risk of upper digestive tract cancer
BMJ 1998 317: 0. [Full Text]

Alcohol and cancer: Svend Sabroe
BMJ 1998 317: 827-830. [Extract] [Full Text] [PDF]

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