Background and aims Alcohol intake is a strong and well established risk factor for oesophageal squamous cell carcinoma (OSCC), but the association with oesophageal adenocarcinoma (OA) or adjacent tumours of the oesophagogastric junction (OGJA), remains unclear. Therefore, the association of alcohol intake with OSCC, OA, and OGJA was determined in nine case–control studies and two cohort studies of the Barrett's Esophagus and Esophageal Adenocarcinoma Consortium (BEACON).
Materials and methods Information was collected on alcohol intake, age, sex, education, body mass index, gastro-oesophageal reflux, and tobacco smoking from each study. Along with 10 854 controls, 1821 OA, and 1837 OGJA, seven studies also collected OSCC cases (n=1016). Study specific ORs and 95% CIs were calculated from multivariate adjusted logistic regression models for alcohol intake in categories compared to non-drinkers. Summary risk estimates were obtained by random effects models.
Results No increase was observed in the risk of OA or OGJA for increasing levels of any of the alcohol intake measures examined. ORs for the highest frequency category (≥7 drinks per day) were 0.97 (95% CI 0.68 to 1.36) for OA and 0.77 (95% CI = 0.54 to 1.10) for OGJA. Suggestive findings linked moderate intake (eg, 0.5 to <1 drink per day) to decreased risk of OA (OR 0.63, 95% CI 0.41 to 0.99) and OGJA (OR 0.78, 95% CI 0.62 to 0.99). In contrast, alcohol intake was strongly associated with increased risk of OSCC (OR for ≥7 drinks per day 9.62, 95% CI 4.26 to 21.71).
Conclusions In contrast to OSCC, higher alcohol consumption was not associated with increased risk of either OA or OGJA. The apparent inverse association observed with moderate alcohol intake should be evaluated in future prospective studies.
- Alcohol drinking
- oesophageal neoplasms
- stomach neoplasms
- gastric cancer
- oesophageal cancer
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Funding This work was supported in part by the Intramural Program of the National Institutes of Health. The Population Health Study was funded by the Intramural Program of the National Institutes of Health. The Larynx, Oesophagus, and Oral Cavity (LEO) Study was funded by grants R01-CA30022 and R37-CA41530 (both awarded to TLV, David Thomas, Scott Davis, Bonnie Worthington Roberts, Ruth Little, and Mary Rogers). The US Multi-Center Study was funded by grants U01-CA57949 (awarded to TLV), U01-CA57983 (awarded to MDG), and U01-CA57923 (awarded to HAR). The Swedish Esophageal Cancer Study was funded by grant number R01 CA57947–03 (awarded to ON and Hans-Olov Adami). The Los Angeles County Multi-ethnic Case-control Study was funded by grants 3RT-0122 (‘Smoking and Risk of Proximal vs Distal Gastric Cancer’, awarded to AHW) and 10RT-0251 (‘Smoking, microsatellite instability & gastric cancers’, awarded to AHW) from the California Tobacco Related Research Program and grant CA59636 (awarded to LB) from the National Cancer Institute. The Nebraska Health Study was funded by the Intramural Program of the National Institutes of Health. The Nova Scotia Barrett Oesophagus Study was supported by the Nova Scotia Health Research Foundation (‘Molecular mechanisms and lifestyle risk factor interactions in the pathogenesis of human esophageal adenocarcinoma’, N419, awarded to AGC). The Factors Influencing the Barrett's Adenocarcinoma Relationship (FINBAR) study was funded by an Ireland-Northern Ireland Co-operation Research Project Grant sponsored by the Northern Ireland Research & Development Office, and the Health Research Board, Ireland (All-Ireland case-control study of Oesophageal Adenocarcinoma and Barrett's Oesophagus, awarded to LJM and Harry Comber). The Australian Cancer Study was supported by the Queensland Cancer Fund and the National Health and Medical Research Council (NHMRC) of Australia (Program no. 199600, awarded to DCW, ACG, Nicholas K Hayward, Peter G Parsons, David M Purdie, and Penelope M Webb). NIH-AARP was funded by the Intramural Program of the National Institutes of Health. Reported analyses with the Kaiser-Permanente Multiphasic Health check-up Study were funded by NIH grant number R01 DK063616 (Epidemiology and Incidence of Barrett's Oesophagus, Kaiser Permanente, awarded to DAC) and NIH grant R21DKO77742 (Barrett's Oesophagus: Risk Factors in Women, awarded to DAC and Nicholas J Shaheen).
Competing interests None.
Ethics approval Data acquisition was approved by the Institutional Review Board or Research Ethics Committee of each participating institution providing data for the study; permission to participate in the BEACON consortium was also provided by these boards if required by a study's home institution.
Provenance and peer review Not commissioned; externally peer reviewed.