Association between wine consumption and cancer: a systematic review and meta-analysis

Background

Alcohol consumption is related to the risk of developing different types of cancer. However, unlike other alcoholic beverages, moderate wine drinking has demonstrated a protective effect on the risk of developing several types of cancer.

Objective

To analyze the association between wine consumption and the risk of developing cancer.

Methods

We searched the MEDLINE (through PubMed), Scopus, Cochrane, and Web of Science databases to conduct this systematic review and meta-analysis. Pooled relative risks (RRs) were calculated using the DerSimonian and Laird methods. I2 was used to evaluate inconsistency, the τ2 test was used to assess heterogeneity, and The Newcastle-Ottawa Quality Assessment Scale were applied to evaluate the risk of bias. This study was previously registered in PROSPERO, with the registration number CRD42022315864.

Results

Seventy-three studies were included in the systematic review, and 26 were included in the meta-analysis. The pooled RR for the effect of wine consumption on the risk of gynecological cancers was 1.03 (95% CI: 0.99, 1.08), that for colorectal cancer was 0.92 (95% CI: 0.82, 1.03), and that for renal cancer was 0.92 (95% CI: 0.81, 1.04). In general, the heterogeneity was substantial.

Conclusion

The study findings reveal no association between wine consumption and the risk of developing any type of cancer. Moreover, wine drinking demonstrated a protective trend regarding the risk of developing pancreatic, skin, lung, and brain cancer as well as cancer in general.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022315864, identifier CRD42022315864 (PROSPERO).

Food Intake and Colorectal Cancer

Colorectal cancer (CRC) accounts for considerable mortalities worldwide. Several modifiable risk factors, including a high intake of certain foods and beverages can cause CRC. This review summarized the latest findings on the intake of various foods, nutrients, ingredients, and beverages on CRC development, with the objective of classifying them as a risk or protective factor. High-risk food items include red meat, processed meat, eggs, high alcohol consumption, sugar-sweetened beverages, and chocolate candy. Food items that are protective include milk, cheese and other dairy products, fruits, vegetables (particularly cruciferous), whole grains, legumes (particularly soy beans), fish, tea (particularly green tea), coffee (particularly among Asians), chocolate, and moderate alcohol consumption (particularly wine). High-risk nutrients/ingredients include dietary fat from animal sources and industrial trans-fatty acids (semisolid/solid hydrogenated oils), synthetic food coloring, monosodium glutamate, titanium dioxide, and high-fructose corn sirup. Nutrients/ingredients that are protective include dietary fiber (particularly from cereals), fatty acids (medium-chain and odd-chain saturated fatty acids and highly unsaturated fatty acids, including omega-3 polyunsaturated fatty acids), calcium, polyphenols, curcumin, selenium, zinc, magnesium, and vitamins A, C, D, E, and B (particularly B6, B9, and B2). A combination of micronutrients and multi-vitamins also appears to be beneficial in reducing recurrent adenoma incidence.

Sex and Tumor-Site Differences in the Association of Alcohol Intake With the Risk of Early-Onset Colorectal Cancer

PURPOSE

Given the increasing incidence of early-onset colorectal cancer (CRC; diagnosed before age 50 years) worldwide, it is important to identify modifiable risk factors. We investigated whether alcohol consumption in the young population correlated with an increased early-onset CRC risk that differed by tumor location and sex.

PATIENTS AND METHODS

We investigated the association between average daily alcohol consumption and the risk of early-onset CRC among 5,666,576 individuals age 20-49 years using data from the Korean National Health Insurance Service (2009-2019). Alcohol consumption levels of nondrinker, light (reference), moderate, and heavy drinker were defined as 0, <10, 10 to <30, and ≥30 g/d for men and 0, <10, 10 to <20, and ≥20 g/d for women, respectively. Multivariate Cox proportional hazards models were used to estimate adjusted hazard ratios (aHRs) with 95% CIs.

RESULTS

We identified 8,314 incident early-onset CRC cases during the follow-up period. Moderate and heavy drinkers showed an increased risk of early-onset CRC compared with light drinkers (aHR, 1.09 [95% CI, 1.02 to 1.16] and aHR, 1.20 [95% CI, 1.11 to 1.29], respectively). Subgroup analysis by tumor location showed positive dose-response significance for early-onset distal colon and rectal cancers, but not for proximal colon cancer. The dose-response association between drinking frequency and risk of early-onset CRC was significant, with a 7%, 14%, and 27% increased risk for 1-2, 3-4, and ≥5 d/wk compared with nondrinkers, respectively.

CONCLUSION

Excessive alcohol consumption increases the risk of CRC onset before age 50 years. Thus, effective interventions are required to discourage alcohol consumption among young people and to tailor CRC screening approaches for high-risk individuals.

Diverse Sphingolipid Profiles in Rectal and Colon Cancer

Colorectal cancer is a heterogenous group of neoplasms showing a variety of clinical and pathological features depending on their anatomical location. Sphingolipids are involved in the formation and progression of cancers, and their changes are an important part of the abnormalities observed during carcinogenesis. Because the course of rectal and colonic cancer differs, the aim of the study was to assess whether the sphingolipid profile is also different in tumors of these two regions. Using a combination of ultra-high-performance liquid chromatography combined with triple quadrupole mass spectrometry, differences in the amounts of cellular sphingolipids were found in colorectal cancer. Sphingosine content was higher in rectal cancer than in adjacent healthy tissue, while the content of two ceramides (C18:0-Cer and C20:0-Cer) was lower. In colon cancer, a higher content of sphingosine, sphinganine, sphingosine-1-phosphate, and two ceramides (C14:0-Cer and C24:0-Cer) was found compared to healthy tissue, but there was no decrease in the amount of any of the assessed sphingolipids. In rectal cancer, the content of sphinganine and three ceramides (C16:0-Cer, C22:0-Cer, C24:0-Cer), as well as the entire pool of ceramides, was significantly lower compared to colon cancer. The S1P/Cer ratio in rectal cancer (S1P/C18:1-Cer, S1P/C20:0-Cer, S1P/C22:0-Cer, S1P/C24:1-Cer) and in colon cancer (S1P/C18:0-Cer, S1P/C18:1-Cer, S1P/C20:0-Cer) was higher than in adjacent healthy tissue and did not differ between the two sites (rectal cancer vs. colonic cancer). It seems that the development of colorectal cancer is accompanied by complex changes in the metabolism of sphingolipids, causing not only qualitative shifts in the ceramide pool of cancer tissue but also quantitative disturbances, depending on the location of the primary tumor.

Longitudinal associations of sociodemographic, lifestyle, and clinical factors with alcohol consumption in colorectal cancer survivors up to 2 years post-diagnosis

Purpose

Alcohol consumption can lead to worse prognosis and mortality among colorectal cancer (CRC) patients. We investigated alcohol consumption of CRC survivors up to 2 years post-diagnosis, and how sociodemographic, lifestyle, and clinical factors were associated longitudinally with these habits.

Methods

We pooled longitudinal data of 910 CRC survivors from the ongoing PROCORE and EnCoRe studies with data collected at diagnosis (baseline) and 3, 6, 12, and 24 months post-diagnosis. Both studies assessed alcohol consumption, including beer, wine, and liquor. Generalized estimated equation models were used to examine changes over time in alcohol consumption and multivariable longitudinal associations of sociodemographic, lifestyle, and clinical factors with alcohol consumption.

Results

At baseline, participants were on average 67 years old, 332 (37%) were female, and alcohol was consumed by 79%. Most survivors (68–71%) drank less at all follow-ups. Beer, wine, and liquor were consumed by 51%, 58%, and 25% at baseline, respectively, and these declined over time. Males consumed more alcohol, and higher education, more physical activity, and not having a (permanent) stoma were associated with consuming more alcohol.

Conclusion

CRC survivors decreased their alcohol consumption in the 2 years post-diagnosis. Future studies should take the significant factors that were associated with alcohol post-diagnosis consumption into account, when they investigate CRC health outcomes or for identifying subgroups for interventions. Males with higher education, more physical activity, and no stoma should be reminded after diagnosis for reducing their alcohol consumption.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00520-021-06104-0.

Effects of low-to-moderate ethanol consumption on colonic growth and gene expression in young adult and middle-aged male rats

Excessive alcohol consumption is a risk factor associated with colorectal cancer; however, some epidemiological studies have reported that moderate alcohol consumption may not contribute additional risk or may provide a protective effect reducing colorectal cancer risk. Prior research highlights the importance of proliferation, differentiation, and apoptosis as parameters to consider when evaluating colonic cell growth and tumorigenesis. The present study investigated whether chronic low-to-moderate ethanol consumption altered these parameters of colonic cell growth and expression of related genes. Twenty-four nondeprived young adult (109 days old) and 24 nondeprived middle-aged (420 days old) Wistar rats were randomly assigned to an ethanol-exposed or a water control group (n = 12/group). The ethanol group was provided voluntary access to a 20% v/v ethanol solution on alternate days for 13 weeks. Colon tissues were collected for quantitative immunohistochemical analyses of cell proliferation, differentiation and apoptosis using Ki-67, goblet cell and TUNEL, respectively. Gene expression of cyclin D1 (Ccnd1), Cdk2, Cdk4, p21waf1/cip1 (Cdkn1a), E-cadherin (Cdh1) and p53 were determined by quantitative real-time polymerase chain reaction in colonic scraped mucosa. Ethanol treatment resulted in a lower cell proliferation index and proliferative zone, and lower Cdk2 expression in both age groups, as well as trends toward lower Ccnd1 and higher Cdkn1a expression. Cell differentiation was modestly but significantly reduced by ethanol treatment only in older animals. Overall, older rats showed decreases in apoptosis and gene expression of Cdk4, Cdh1, and p53 compared to younger rats, but there was no observed effect of ethanol exposure on these measures. These findings suggest that low-to-moderate ethanol consumption improves at least one notable parameter in colonic tumorigenesis (cell proliferation) and associated gene expression regardless of age, however, selectively decreased cell differentiation among older subjects.

Risk Stratification Based on Synchronous Neoplasia and Clinical Physicochemical Characteristics Predicts a Higher Incidence of Metachronous Advanced Neoplasia in Patients Undergoing Colorectal Resection for Colorectal Cancer

Purpose

Patients who undergo primary colorectal cancer (CRC) resection remain at increased risk for metachronous advanced neoplasia (MAN) in the remnant colorectum. This study aimed to investigate the incidence and clinicopathological characteristics predictive of MAN development in the residual colon after surgery.

Patients and Methods

We retrospectively reviewed 450 primary CRC cases referred to our hospital during a 4-year period. Univariate and multivariate analyses were performed to identify risk factors for MAN. The cumulative incidence of MAN was evaluated by the Cox proportional hazards model.

Results

MAN development was confirmed in 78 of the 450 patients (17.3%). Overall 1-, 2-, 3-, and 5-year cumulative probabilities were 0.9%, 4.8%, 9.8%, and 16.1%, respectively, for MAN. Among the clinical and colonoscopic factors at baseline, the independent factors that were significantly associated with MAN were synchronous neoplasia, carcinoembryonic antigen (CEA) level ≥10.0 ng/mL, and index cancer size ≥50 mm. The cumulative probability of MAN was significantly higher for patients with synchronous advanced neoplasia (SAN) than for those without synchronous neoplasia (P = 0.000). A subgroup analysis of patients based on the CEA level and index cancer size indicated that CEA ≥10 ng/mL and index cancer ≥50 mm resulted in a significantly higher cumulative probability of MAN (P = 0.039).

Conclusion

Patients with SAN or high preoperative serum CEA levels and large index cancer are at increased risk for early-onset MAN. More intensive surveillance strategies may be appropriate for these groups. Risk stratification based on synchronous neoplasia and clinical physicochemical characteristics requires further investigations involving modified appropriate postoperative colonoscopic surveillance schedules.

Early-onset colorectal cancer: initial clues and current views

Over the past several decades, the incidence of early-onset colorectal cancer (EOCRC; in patients <50 years old) has increased at an alarming rate. Although robust and scientifically rigorous epidemiological studies have sifted out environmental elements linked to EOCRC, our knowledge of the causes and mechanisms of this disease is far from complete. Here, we highlight potential risk factors and putative mechanisms that drive EOCRC and suggest likely areas for fruitful research. In addition, we identify inconsistencies in the evidence implicating a strong effect of increased adiposity and suggest that certain behaviours (such as diet and stress) might place nonobese and otherwise healthy people at risk of this disease. Key risk factors are reviewed, including the global westernization of diets (usually involving a high intake of red and processed meats, high-fructose corn syrup and unhealthy cooking methods), stress, antibiotics, synthetic food dyes, monosodium glutamate, titanium dioxide, and physical inactivity and/or sedentary behaviour. The gut microbiota is probably at the crossroads of these risk factors and EOCRC. The time course of the disease and the fact that relevant exposures probably occur in childhood raise important methodological issues that are also discussed.

Alcohol, smoking and rectal cancer risk in a Mediterranean cohort of adults: the European Prospective Investigation into Cancer and Nutrition (EPIC)-Italy cohort

OBJECTIVE

Colorectal cancer (CRC) is one of the most diagnosed malignant cancers worldwide. Rectal cancers (Rcs) represent one-third of all CRCs. Cigarette smoking and alcohol drinking are two underestimated risk factors for RC. We aimed to evaluate the role of alcohol consumption and cigarette smoking in modulating RC risk and to estimate the attributable fraction in a Mediterranean population.

METHODS

In the Italian section of the European Prospective Investigation into Cancer and Nutrition, 45,553 healthy adults (31,252 women) were recruited and provided information about lifestyle and dietary habits. During 14.0 years of median follow-up, 154 incident RC cases were identified.

RESULTS

In multivariate models, a increase in RC risk emerged among subjects drinking more than 3 drinks/day, overall (hazard ratio [HR] = 1.74; 95% confidence interval [CI] 1.08-2.80), and in females (HR= 2.80; 95% CI 1.23-6.35), compared with drinkers of less than 1 drink/day. A increase in risk also emerged for current- compared with never-smokers, overall (HR = 1.57; 95% CI 1.06-2.35; P for trend 0.03) and among males (HR = 2.04; 95% CI 1.02-4.07; P for trend 0.045). Overall, 9% (95% CI 4-14%) of RC cases were attributable to drinking more than 3 drinks/day and 12% (95% CI 3-19%) were attributable to current smoke and 20% (95% CI 11-27%) of RC cases were attributable to the independent effects of these two exposures.

CONCLUSION

Our study supports a strategy to avoid a relevant proportion of rectal cancer cases through a combined reduction of alcohol consumption and cigarette smoking.

The interplay between dietary factors, gut microbiome and colorectal cancer: a new era of colorectal cancer prevention

Colorectal cancer is the third most common cancer in the world and its incidence is on the rise. Dietary intervention has emerged as an attractive strategy to curtail its occurrence and progression. Diet is known to influence the gut microbiome, as dietary factors and gut bacteria can act in concert to cause or protect from colorectal cancer. Several studies have presented evidence for such interactions and have pointed out the different ways by which the diet and gut microbiome can be altered to produce beneficial effects. This review article aims to summarize the interrelationship between diet, gut flora and colorectal cancer so that a better preventive approach can be applied.

Alcohol consumption and risk of common cancers: evidence from a cohort of adults from the UK

Background

Recent guidelines from the UK recommend that men and women should drink no more than 14 units of alcohol per week. This recommendation takes into account the link between alcohol and several cancers; however, there is a dearth of high quality evidence from the UK to support this.

Methods

Alcohol consumption using a detailed diary was obtained from 8670 adults representative of the UK population in 1984/5, with follow-up data from cancer registries until 2009. Hazard ratios (HRs) adjusted for several variables including cigarette smoking were calculated for cancers of the breast, lung, colorectum and prostate separately using Cox regression.

Results

Units per week on a typical basis, fitted as a linear term, was associated with breast cancer in women (HR = 1.27 per 10 units/week; 95% CI 1.03-1.58) and lung cancer in men (HR = 1.16; 95% CI 1.06-1.27). Increased risks of lung (HR = 2.23; 95% CI 1.18-4.24) and colorectal (HR = 2.28; 95% CI 1.13-4.57) cancer were seen in men at 15-28 units/week along with higher levels of consumption. Some findings differed by alcohol type.

Conclusions

Overall, alcohol consumption of 15-28 units/week may be harmful in men with respect to common cancers. A linear association between alcohol consumption and risk of breast cancer was observed in women.

Global differences in the prevalence of the CpG island methylator phenotype of colorectal cancer

Background

CpG Island Methylator Phenotype (CIMP) is an epigenetic phenotype in CRC characterized by hypermethylation of CpG islands in promoter regions of tumor suppressor genes, leading to their transcriptional silencing and loss of function. While the prevalence of CRC differs across geographical regions, no studies have compared prevalence of CIMP-High phenotype across regions. The purpose of this project was to compare the prevalence of CIMP across geographical regions after adjusting for variations in methodologies to measure CIMP in a meta-analysis.

Methods

We searched PubMed, Medline, and Embase for articles focusing on CIMP published from 2000 to 2018. Two reviewers independently identified 111 articles to be included in final meta-analysis. We classified methods used to quantify CIMP into 4 categories: a) Classical (MINT marker) Panel group b) Weisenberg-Ogino (W-O) group c) Human Methylation Arrays group and d) Miscellaneous group. We compared the prevalence of CIMP across geographical regions after correcting for methodological variations using meta-regression techniques.

Results

The pooled prevalence of CIMP-High across all studies was 22% (95% confidence interval:21–24%; I² = 94.75%). Pooled prevalence of CIMP-H across Asia, Australia, Europe, North America and South America was 22, 21, 21, 27 and 25%, respectively. Meta-regression analysis identified no significant differences in the prevalence of CIMP-H across geographical regions after correction for methodological variations. In exploratory analysis, we observed variations in CIMP-H prevalence across countries.

Conclusion

Although no differences were found for CIMP-H prevalence across countries, further studies are needed to compare the influence of demographic, lifestyle and environmental factors in relation to the prevalence of CIMP across geographical regions.

Wine consumption and colorectal cancer risk: a meta-analysis of observational studies

There were inconsistent results with respect to the correlation between consumption of wine and the development of colorectal cancer (CRC). We carried out a meta-analysis to investigate this issue. We included observational studies on the aforementioned relationship according to a literature search of Embase and Pubmed from inception till 28 February 2017. The summary relative risk (SRR) and 95% confidence intervals (CI) were calculated using a random-effects model. A total of eight case-control and nine cohort studies were identified, involving 12 110 CRC cases. The study showed that wine drinking was not associated with any greater risk for CRC (SRR=0.99, 95% CI: 0.89-1.10; Pheterogeneity<0.001) compared with nondrinkers. The subgroup analyses indicated that null associations were observed in men and women for colon and rectal cancer. Neither light to moderate (<2 drinks/day; SRR=0.93, 95% CI: 0.80-1.08, I= 69.2%) nor heavy (≥2 drinks/day; SRR=1.00, 95% CI: 0.86-1.16, I= 39.9%) consumption of wine was associated statistically with CRC risk. This meta-analysis suggests that any wine consumption was not associated with the risk of CRC. Null associations were shown in men and women for colon and rectal cancer.

Alcohol Intake and Colorectal Cancer Risk in the Multiethnic Cohort Study

To investigate the association of alcohol intake with colorectal cancer risk according to race/ethnicity as well as sex, lifestyle-related factors, alcoholic beverage type, and anatomical subsite, we analyzed data from 190,698 black, Native Hawaiian, Japanese-American, Latino, and white persons in Hawaii and California in the Multiethnic Cohort Study, with 4,923 incident cases during a 16.7-year follow-up period (1993-2013). In multivariate Cox regression models, the hazard ratio was 1.16 (95% confidence interval (CI): 1.01, 1.34) for 15.0-29.9 g/day of alcohol and 1.28 (95% CI: 1.12, 1.45) for ≥30.0 g/day among men, and 1.06 (95% CI: 0.85, 1.32) and 1.15 (95% CI: 0.92, 1.43), respectively, among women, compared with nondrinkers (P for heterogeneity according to sex = 0.74). An increased risk was apparent among Native Hawaiians, Japanese Americans, Latinos, and white persons and among individuals with body mass index <25.0 (calculated as weight (kg)/height (m)2), never-users of nonsteroidal antiinflammatory drugs, and those with lower intake of dietary fiber and folate. Beer and wine, but not liquor, consumption was positively related to colorectal cancer risk. The association was stronger for rectum and left-colon tumors than for right-colon tumors. Our findings suggest that the positive association between alcohol and colorectal cancer varies according to race/ethnicity, lifestyle factors, alcoholic beverage type, and anatomical subsite of tumors.

Alcohol intake, ADH1B and ADH1C genotypes, and the risk of colorectal cancer by sex and subsite in the Netherlands Cohort Study

The alcohol-colorectal cancer (CRC) association may differ by sex and ADH1B and ADH1C genotypes. ADH enzymes oxidize ethanol to acetaldehyde, both of which are human carcinogens. The Netherlands Cohort Study includes 120 852 participants, aged 55-69 years at baseline (1986), and has 20.3 years follow-up (case-cohort: nsubcohort = 4774; ncases = 4597). The baseline questionnaire included questions on alcohol intake at baseline and 5 years before. Using toenail DNA, available for ~75% of the cohort, we successfully genotyped six ADH1B and six ADH1C SNPs (nsubcohort = 3897; ncases = 3558). Sex- and subsite-specific Cox hazard ratios and 95% confidence intervals for CRC were estimated comparing alcohol categories, genotypes within drinkers and alcohol categories within genotype strata. We used a dominant genetic model and adjusted for multiple testing. Alcohol intake increased CRC risk in both sexes, though in women only in the (proximal) colon when in excess of 30 g/day. In male drinkers, ADH1B rs4147536 increased (distal) colon cancer risk. In female drinkers, ADH1C rs283415 increased proximal colon cancer risk. ADH1B rs3811802 and ADH1C rs4147542 decreased CRC risk in heavy (>30 g/day) and stable drinkers (compared to 5 years before baseline), respectively. Rs3811802 and rs4147542 significantly modified the alcohol-colon cancer association in women (Pfor interaction = 0.004 and 0.02, respectively). A difference in associations between genotype strata was generally clearer in men than women. In conclusion, men showed increased CRC risks across subsites and alcohol intake levels, while only colon cancer risk was increased in women at heavy intake levels. ADH1B rs3811802 and ADH1C rs4147542 significantly modified the alcohol-colon cancer association in women.

Maternal stress and early-onset colorectal cancer

Early-onset colorectal cancer (EOCRC) is defined as colorectal cancer (CRC) diagnosed before the age of 50. Alarmingly, there has been a significant increase in EOCRC diagnoses' worldwide over the past several decades. Emerging data suggest EOCRCs have distinguishing clinical, pathological, biological and molecular features; and thus, are a fundamentally different subtype of CRCs. Unfortunately, there is no simple explanation for the causes of EOCRC. Scientifically rigorous studies are needed to determine what may be driving the challenging epidemiology of EOCRC. We contend here that a reasonable hypothesis is that prenatal risk factors such as maternal stress and associated sleeping disorders influence offspring epigenetic make-up, and shape immune system and gut health contributing to an increased risk for EOCRC.

Higher incidence of metachronous advanced neoplasia in patients with synchronous advanced neoplasia and left-sided colorectal resection for colorectal cancer

BACKGROUND AND AIMS

There is an increased risk of developing metachronous colorectal cancer (CRC) in the remnant colorectum after surgical resection of CRC. We evaluated the incidence of metachronous advanced neoplasia (AN) after surgery for CRC according to resection type and synchronous AN.

METHODS

This cohort study included patients who underwent surgical resection for initial CRC at a tertiary cancer center in Japan between September 2002 and December 2012. The cumulative probability of metachronous AN was calculated using the Kaplan-Meier method and was evaluated by the log-rank test.

RESULTS

Metachronous AN was detected in 145 of 1731 included patients, and the 5-year cumulative probability of metachronous AN was 13.1%. There was no significant difference in the incidence of metachronous AN in the right-sided colorectal resection versus left-sided colorectal resection (LCR) groups (log-rank test P = .151), whereas the incidence of metachronous AN was significantly higher in patients with synchronous AN (log-rank test P < .001). In subgroup analysis of patients according to resection type and synchronous AN, the LCR group with synchronous AN showed a significantly higher incidence of metachronous AN than the other groups (log-rank test P < .001).

CONCLUSIONS

We found that synchronous AN, but not resection type, was independently associated with the incidence of metachronous AN in patients who underwent surgical resection of CRC. In addition, subjects with synchronous AN after LCR had a potentially increased risk for metachronous AN. Thus, it may be useful to perform risk stratification according to synchronous AN and resection type.

Foods and beverages and colorectal cancer risk: a systematic review and meta-analysis of cohort studies, an update of the evidence of the WCRF-AICR Continuous Update Project

Objective

As part of the World Cancer Research Fund International Continuous Update Project, we updated the systematic review and meta-analysis of prospective studies to quantify the dose-response between foods and beverages intake and colorectal cancer risk.

Data sources

PubMed and several databases up to 31 May 2015.

Study selection

Prospective studies reporting adjusted relative risk estimates for the association of specific food groups and beverages and risk of colorectal, colon and rectal cancer.

Data synthesis

Dose-response meta-analyses using random effect models to estimate summary relative risks (RRs).

Results

About 400 individual study estimates from 111 unique cohort studies were included. Overall, the risk increase of colorectal cancer is 12% for each 100 g/day increase of red and processed meat intake (95% CI = 4-21%, I2=70%, pheterogeneity (ph)<0.01) and 7% for 10 g/day increase of ethanol intake in alcoholic drinks (95% CI = 5-9%, I2=25%, ph = 0.21). Colorectal cancer risk decrease in 17% for each 90g/day increase of whole grains (95% CI = 11-21%, I2 = 0%, ph = 0.30, 6 studies) and 13% for each 400 g/day increase of dairy products intake (95% CI = 10-17%, I2 = 18%, ph = 0.27, 10 studies). Inverse associations were also observed for vegetables intake (RR per 100 g/day =0.98 (95% CI = 0.96-0.99, I2=0%, ph = 0.48, 11 studies) and for fish intake (RR for 100 g/day = 0.89 (95% CI = 0.80-0.99, I2=0%, ph = 0.52, 11 studies), that were weak for vegetables and driven by one study for fish. Intakes of fruits, coffee, tea, cheese, poultry and legumes were not associated with colorectal cancer risk.

Conclusions

Our results reinforce the evidence that high intake of red and processed meat and alcohol increase the risk of colorectal cancer. Milk and whole grains may have a protective role against colorectal cancer. The evidence for vegetables and fish was less convincing.

Colorectal Cancer and Alcohol Consumption-Populations to Molecules

Colorectal cancer (CRC) is a major cause of morbidity and mortality, being the third most common cancer diagnosed in both men and women in the world. Several environmental and habitual factors have been associated with the CRC risk. Alcohol intake, a common and rising habit of modern society, is one of the major risk factors for development of CRC. Here, we will summarize the evidence linking alcohol with colon carcinogenesis and possible underlying mechanisms. Some epidemiologic studies suggest that even moderate drinking increases the CRC risk. Metabolism of alcohol involves ethanol conversion to its metabolites that could exert carcinogenic effects in the colon. Production of ethanol metabolites can be affected by the colon microbiota, another recently recognized mediating factor to colon carcinogenesis. The generation of acetaldehyde and alcohol's other metabolites leads to activation of cancer promoting cascades, such as DNA-adduct formation, oxidative stress and lipid peroxidation, epigenetic alterations, epithelial barrier dysfunction, and immune modulatory effects. Not only does alcohol induce its toxic effect through carcinogenic metabolites, but alcoholics themselves are predisposed to a poor diet, low in folate and fiber, and circadian disruption, which could further augment alcohol-induced colon carcinogenesis.

Relationship between Alcohol Purchasing Time and Alcohol Use Disorder in South Korea

Objectives

Currently, time of alcohol purchase is not part of the policies to regulate alcohol consumption in South Korea. This study was conducted to determine the relationship between alcohol purchasing time and alcohol use disorder.

Methods

The survey for this study was conducted in geographically diverse regions of South Korea in 2012. Respondents’ purchasing behaviors for both on-licensed (i.e., allows for consumption within the premises) and off-licensed (i.e., where alcohol is consumed off the premises) outlets and time of alcohol consumption were collected. Alcohol consumption patterns were examined using the Rapid Alcohol Problem Screen 4 (RAPS4). Data were also analyzed by age, gender and purchasing time.

Results

Results showed that among the off-licensed premises, supermarkets appear to be the most popular venue while for on-licensed premises; alcohol was generally consumed inside hotels/pubs regardless of age and gender of the purchaser. Purchasing of alcohol was highest during the day and early evening period (9:00 a.m. to 9:59 p.m.). Females are most likely to abuse alcohol than males during the early morning period and is that period after 12:00 midnight.

Conclusion

Analysis suggests that the survey instrument used in the International Alcohol Control Study is being used to collect data on alcohol purchasing time consumption; therefore, the potential is there to provide accurate results to contribute appropriate policy responses to reduce alcohol related-harm.

Common variants in glucuronidation enzymes and membrane transporters as potential risk factors for colorectal cancer: a case control study

Background

Associations between polymorphisms of UDP-glucuronosyltransferases (UGTs) or efflux transporters (e.g., P-glycoprotein and MRP2) and different types of cancer have been described, whereas the role of influx transporters (e.g. OATP1B1 and OATP2B1) has been seldom explored. The GenColon study investigated potential associations between variant alleles of UGTs, efflux and influx transporters and CRC.

Methods

Three hundred CRC cases were matched with 300 controls for age, sex and enrolment site. Fifteen SNPs in UGT1A6–9, UGT2B7, ABCB1, ABCC2, SLCO1B1 and SLCO2B1 genes were characterized using Taqman® PCR. Using multivariate conditional logistic regression, we investigated the relationships between CRC and “environmental” risk factors (physical activity, housing and working areas, consumption of red meat, tobacco, alcohol); genetic polymorphisms, in the study population and in the subgroups with “environmental” risk factors.

Results

No significant association was observed for the analyzed SNPs (or haplotypes). However, an increased CRC risk was found in carriers of the UGT1A8 rs1042597-G variant allele (additive risk OR = 3.39[1.29–8.89], p = 0.02951) in the subgroup of meat-consumers (n = 84), and in carriers of the ABCB1 rs1045642-T (exon26) variant allele (additive risk; OR = 1.89[1.10–3.39], p = 0.0257) in the “never alcohol consumption subgroup” (n = 125). In addition, as previously reported, the following CRC risk factors were identified: absence of physical activity (OR = 6.35[3.70–10.9], p < 0.0001), living or working in rural or mix area (OR = 2.50[1.48–4.23], p = 0.0006 and OR = 2.99[1.63–5.48], p = 0.004, respectively) and tobacco exposure >30 years (3.37[1.63–6.96], p = 0.0010).

Conclusions

Variant genotypes of influx transporters (OATP1B1 and 2B1) were not associated with CRC. This study confirmed the influence of lifestyle factors, but not the previously reported detrimental effect of SNPs in intestinal UGTs or efflux transporters, except for a UGT1A8 variant in subjects consuming meat and the exon 26 SNP of ABCB1 in the never alcohol consumption subgroup.

Trial registration

Registered in Direction Générale de la Santé the 1st July 2008 under the number DGS2008–0144.

Electronic supplementary material

The online version of this article (10.1186/s12885-017-3728-0) contains supplementary material, which is available to authorized users.

Alcohol, smoking and the risk of premalignant and malignant colorectal neoplasms

Colorectal cancer (CRC) is the third most common cancer worldwide and has a complex aetiology consisting of environmental and genetic factors. In this review, we evaluate the roles of alcohol and tobacco smoking in colorectal neoplasia. Alcohol intake and tobacco smoking are associated with modest, but significantly, increased risks of CRC, adenomatous and serrated polyps. There is consistent evidence of dose-response relationships for both alcohol and smoking, and risk of these neoplasms. Alcohol and smoking appear to be more strongly associated with colorectal polyp than CRC development, suggesting roles in the initiation of neoplastic growths. These lifestyle factors also seem more strongly related to adenomas and sessile serrated lesions than hyperplastic polyps, but further confirmation is required. The gastroenterology community has an important, yet currently underexploited, role to play addressing the modifiable factors associated with CRC and polyps. These behaviours include, but are not limited to, alcohol and smoking.

Screening by Total Colonoscopy Following Fecal Immunochemical Tests and Determinants of Colorectal Neoplasia in Japanese Men With Alcohol Dependence

Aims

Alcohol consumption increases the risk of colorectal adenoma and cancer. The fecal immunochemical test (FIT) is a widely used screening method for detecting colorectal neoplasia. We evaluated the results of screening and risk factors for colorectal neoplasia in individuals with alcohol dependence.

Methods

Total colonoscopic screening was performed for 1006 Japanese men with alcohol dependence (462 FIT-positive and 544 FIT-negative). Advanced neoplasia was defined as neoplasia ≥10 mm, villous or tubulovillous adenoma, high-grade adenoma, or carcinoma.

Results

The detection rates for non-advanced adenoma, advanced neoplasia and intramucosal or invasive carcinoma were 38.7%, 39.4% and 9.7% for the FIT-positive group, and 33.3%, 10.8% and 2.2% for the FIT-negative group, respectively. Advanced neoplasia, especially carcinoma, was detected more frequently in the distal colon than in the proximal colon in the FIT-positive group. The respective multivariate odds ratios (ORs; 95% confidence interval) for non-advanced adenoma and advanced neoplasia were 2.83 (2.06–3.88) and 9.13 (6.19–13.5) for a positive FIT (vs. negative), 1.68 (1.39–2.02) and 1.83 (1.45–2.30) for age (per +10 years), 1.54 (1.06–2.23) and 1.88 (1.17–3.03) for current smoking (vs. non-smokers), and 1.35 (0.96–1.92) and 1.59 (1.02–2.48) for the presence of marked macrocytosis (mean corpuscular volume ≥106 fl vs. <106 fl). Genetic polymorphisms of alcohol dehydrogenase-1B and aldehyde dehydrogenase-2 did not affect the risk of colorectal neoplasia.

Conclusion

The detection rate for advanced colorectal neoplasia was extremely high in the FIT-positive group but remained high even in the FIT-negative group. An older age, smoking and macrocytosis were predictors of advanced colorectal neoplasia.

Short summary

Total colonoscopic screening was performed for 1006 Japanese alcoholic men (462 fecal immunochemical test [FIT]-positive and 544 FIT-negative). The detection rate for advanced colorectal neoplasia was extremely high in the FIT-positive group (39.4%) and high in the FIT-negative group (10.8%). Ageing, smoking and macrocytosis were predictors of advanced colorectal neoplasia.

The clinical course of alcoholic cirrhosis: development of comorbid diseases. A Danish nationwide cohort study

BACKGROUND & AIMS

We aimed to determine associations between alcoholic cirrhosis and incidence of comorbidity, and to describe the clinical course of alcoholic cirrhosis in terms of comorbidity development. The comorbid diseases we studied were acute myocardial infarction, heart failure, peripheral arterial disease, chronic obstructive pulmonary disease, chronic kidney disease, epilepsy, diabetes and cancer.

METHODS

This was a registry-based nationwide historical cohort study. We included 10 650 Danish citizens diagnosed with alcoholic cirrhosis at age 45-69 years in 1994-2014 and 43 150 age- and gender-matched persons. None of them had the comorbid diseases we studied at inclusion. We compared rates and cumulative risks of comorbidity development between patients and controls.

RESULTS

Patients with alcoholic cirrhosis had a higher rate of comorbidity (hazard ratio for any comorbidity = 3.74, 95% CI 3.56-3.94), including all the non-cancer comorbidities (hazard ratio for any non-cancer comorbidity = 4.33, 95% CI 4.06-4.62) except acute myocardial infarction. They also had a higher rate of developing cancer (hazard ratio = 2.94, 95% CI 2.70-3.19). Still, relatively few patients actually lived to experience development of non-cancer (10-year risk: 21.4% vs. 13.2% for controls) or cancer comorbidity (10-year risk: 10.9% vs. 10.0%) because they died before they developed any comorbid disease. Hepatocellular carcinoma and oropharyngeal cancer were the only two comorbidities that were much more likely to develop in patients than in controls.

CONCLUSIONS

Alcoholic cirrhosis promotes development of several comorbid diseases, but only few patients with alcoholic cirrhosis live long enough to actually develop them.

Colorectal cancer incidence in 5 Asian countries by subsite: An analysis of Cancer Incidence in Five Continents (1998-2007)

Colorectal cancer is the fourth most common cancer in Asia. However, the trends in colorectal cancer incidence by subsite have not been analyzed across Asian countries. We used the most recent, high quality data from 6 cancer registries for two 5-year periods, 1998-2002 and 2003-2007, from Cancer Incidence in Five Continents to estimate colorectal cancer incidence by subsite in 5 Asian countries. Cases with overlapping lesions or otherwise unspecified colon cancer were re-distributed as proximal or distal colon cancer. Age-standardized incidence rates (ASRs) per 100,000 population and incidence rate ratios from 1998 to 2002 to 2003-2007 were calculated for each subsite. For 2003-2007, men in Miyagi, Japan, had the highest ASR for cancer in the proximal colon, distal colon and rectum. Men of Jewish ancestry in Israel had a high ASR for proximal and distal colon cancer, but the lowest ASR for rectal cancer. The proportion of rectal cancer was highest among Korean men (51.39%) and lowest among Israeli women (26.6%). From 1998-2002 to 2003-2007, rectal cancer incidence did not significantly change in most registries, except for men in Miyagi, Japan, and both sexes in Korea. However, during the same period cancer incidence in the proximal and distal colon increased in most registries. In conclusion, there was substantial variation in subsite distributions of colorectal cancer in Asian registries and increases in overall incidence of colorectal cancer could be attributed to increases in colon cancer.

Possible Mechanisms of Ethanol-Mediated Colorectal Carcinogenesis: The Role of Cytochrome P4502E1, Etheno-DNA Adducts, and the Anti-Apoptotic Protein Mcl-1

BACKGROUND

Chronic alcohol consumption is a risk factor for colorectal cancer. The mechanisms by which ethanol (EtOH) exerts its carcinogenic effect on the colorectal mucosa are not clear and may include oxidative stress with the action of reactive oxygen species (ROS) generated through EtOH metabolism via cytochrome P4502E1 (CYP2E1) leading to carcinogenic etheno-DNA adducts. ROS may also induce apoptosis. However, the effect of chronic EtOH consumption on CYP2E1, etheno-DNA adducts as well as anti-apoptotic proteins in the colorectal mucosa of heavy drinkers without colorectal inflammation is still not known.

METHODS

Rectal biopsies from 32 alcoholics (>60 g EtOH/d) and from 12 controls (<20 g EtOH/d) were histologically examined, and immunohistochemistry for CYP2E1 and etheno-DNA adducts was performed. Apoptosis (cleaved PARP) as well as anti-apoptotic proteins including Bcl-x_L , Bcl-2, and Mcl-1 were immunohistochemically determined.

RESULTS

No significant difference in mucosal CYP2E1 or etheno-DNA adducts was observed between alcoholics and control patients. However, CYP2E1 and etheno-DNA adducts correlated significantly when both groups were combined (p < 0.001). In addition, although apoptosis was found not to be significantly affected by EtOH, the anti-apoptotic protein Mcl-1, but neither Bcl-x_L nor Bcl-2, was found to be significantly increased in heavy drinkers as compared to controls (p = 0.014).

CONCLUSIONS

Although colorectal CYP2E1 was not found to be significantly increased in alcoholics, CYP2E1 correlated overall with the level of etheno-DNA adducts in the colorectal mucosa, which identifies CYP2E1 as an important factor in colorectal carcinogenesis. Most importantly, however, is the up-regulation of the anti-apoptotic protein Mcl-1 in heavy drinkers counteracting apoptosis and possibly stimulating cancer development.

Development of a Novel Scoring System for Predicting the Risk of Colorectal Neoplasia: A Retrospective Study

OBJECTIVE

The purpose of this study was to develop a novel scoring system to screen subjects who have a high risk for colorectal neoplasia.

STUDY DESIGN AND SETTING

We retrospectively analyzed 1061 subjects undergoing total colonoscopy (TCS) for the first time at Gihoku Kosei Hospital. The characteristics and habits of the subjects were analyzed using a multivariate logistic regression analysis. The risk score was established according to each odds ratio of the individual risk factors, and the correlations between the sum of the risk scores and the prevalence of colorectal neoplasia for each individual were evaluated.

RESULTS

Age 45-59 (risk score: 2 points) and ≥60 (3 points), male gender (1 point), and habitual alcohol consumption ≥21g daily (1 point) were extracted as the significant risk factors for colorectal neoplasia. When the risk groups were determined by summing up these risk scores, the prevalence rates of colorectal neoplasia were 8.8% for the low risk group (0-2 points), 30.5% for the low-moderate risk group (3 points), 39.1% for the high-moderate risk group (4 points), and 57.6% for the high risk group (5 points). In comparison with the low risk group, the odds ratio of the low-moderate risk, the high-moderate risk, and the high risk groups were 4.6, 6.7, and 14.1 folds, respectively.

CONCLUSION

Our scoring system, which linearly correlates with the prevalence rate of colorectal neoplasia, may be an effective tool for screening the subjects who have a high risk for colorectal neoplasia. These subjects, therefore, should be recommended to undergo TCS.

The Association between Glyceraldehyde-Derived Advanced Glycation End-Products and Colorectal Cancer Risk

BACKGROUND

A large proportion of colorectal cancers are thought to be associated with unhealthy dietary and lifestyle exposures, particularly energy excess, obesity, hyperinsulinemia, and hyperglycemia. It has been suggested that these processes stimulate the production of toxic reactive carbonyls from sugars such as glyceraldehyde. Glyceraldehyde contributes to the production of a group of compounds known as glyceraldehyde-derived advanced glycation end-products (glycer-AGEs), which may promote colorectal cancer through their proinflammatory and pro-oxidative properties. The objective of this study nested within a prospective cohort was to explore the association of circulating glycer-AGEs with risk of colorectal cancer.

METHODS

A total of 1,055 colorectal cancer cases (colon n = 659; rectal n = 396) were matchced (1:1) to control subjects. Circulating glycer-AGEs were measured by a competitive ELISA. Multivariable conditional logistic regression models were used to calculate ORs and 95% confidence intervals (95% CI), adjusting for potential confounding factors, including smoking, alcohol, physical activity, body mass index, and diabetes status.

RESULTS

Elevated glycer-AGEs levels were not associated with colorectal cancer risk (highest vs. lowest quartile, 1.10; 95% CI, 0.82-1.49). Subgroup analyses showed possible divergence by anatomical subsites (OR for colon cancer, 0.83; 95% CI, 0.57-1.22; OR for rectal cancer, 1.90; 95% CI, 1.14-3.19; Pheterogeneity = 0.14).

CONCLUSIONS

In this prospective study, circulating glycer-AGEs were not associated with risk of colon cancer, but showed a positive association with the risk of rectal cancer.

IMPACT

Further research is needed to clarify the role of toxic products of carbohydrate metabolism and energy excess in colorectal cancer development.

Moderate Alcohol Consumption and Colorectal Cancer Risk

BACKGROUND

Heavy alcohol drinking is a risk factor for colorectal cancer (CRC); previous studies have shown a linear dose-dependent association between alcohol intake and CRC. However, some studies suggest that moderate alcohol consumption may have a protective effect, similar to that seen in cardiovascular disease. Other factors may interact with alcohol and contribute additional risk for CRC. We aimed to determine the association between moderate alcohol consumption, limited to 30 g of alcohol per day, by beverage type on CRC risk and to assess the effects of other factors that interact with alcohol to influence CRC risk.

METHODS

The PubMed database was used to find articles published between 2008 and 2014 related to alcohol and CRC. Twenty-one relevant articles were evaluated and summarized, including 11 articles reporting on CRC risk associated with moderate intake and 10 articles focusing on genetic interactions associated with alcohol and CRC risk.

RESULTS

The association between alcohol and increased risk for CRC was found when intakes exceeded 30 g/d alcohol. Nonsignificant results were consistently reported for intakes <30 g/d. Additional risks for CRC were found to be related to obesity and folate status for regular alcohol consumers. Some significant results suggest that the development of CRC is dependent on the interaction of gene and environment.

CONCLUSIONS

The association between the amount of alcohol consumed and the incidence of CRC was not significant at moderate intake levels. Moderate alcohol consumption was associated with a reduced CRC risk in study populations with greater adherence to a Mediterranean diet, where wine contributed substantially to the alcoholic beverage consumed. Other factors such as obesity, folate deficiency, and genetic susceptibility may contribute additional CRC risk for those consuming alcohol. To minimize CRC risk, appropriate recommendations should encourage intakes below 30 g of alcohol each day.

Role of MCP-1 in alcohol-induced aggressiveness of colorectal cancer cells

Epidemiological studies demonstrate that alcohol consumption is associated with an increased risk of colorectal cancer (CRC). In addition to promoting carcinogenesis, alcohol may also accelerate the progression of existing CRC. We hypothesized that alcohol may enhance the aggressiveness of CRC. In this study, we investigated the effect of alcohol on the migration/invasion and metastasis of CRC. Alcohol increased the migration/invasion of colorectal cancer cells (DLD1, HCT116, HT29, and SW480) in a concentration-dependent manner. Among these colon cancer cell lines, HCT116 cells were most responsive while HT29 cells were the least responsive to ethanol-stimulated cell migration/invasion. These in vitro results were supported by animal studies which demonstrated that ethanol enhanced the metastasis of colorectal cancer cells to the liver and lung. Monocyte chemoattractant protein-1 (MCP-1) is a chemokine that plays an important role in regulating tumor microenvironment and metastasis. Alcohol increased the expression of MCP-1 and its receptor CCR2 at both protein and mRNA levels. The pattern of alcohol-induced alterations in MCP-1 expression was consistent with its effect on migration/invasion; HCT116 cells displayed the highest up-regulation of MCP-1/CCR2 in response to alcohol exposure. An antagonist of CCR2 blocked alcohol-stimulated migration. Alcohol caused an initial cytosolic accumulation of β-catenin and its subsequent nuclear translocation by inhibiting GSK3β activity. Alcohol stimulated the activity of MCP-1 gene promoter in a β-catenin-dependent manner. Furthermore, knock-down of MCP-1/CCR2 or β-catenin was sufficient to inhibit alcohol-induced cell migration/invasion. Together, these results suggested that alcohol may promote the metastasis of CRC through modulating GSK3β/β-catenin/MCP-1 pathway.

Population based study of the association between binge drinking and mortality from cancer of oropharynx and esophagus in Korean men: the Kangwha cohort study

We assessed the association between frequency of heavy binge drinking and mortality from oropharynx and esophagus cancer after controlling for the total volume of alcohol intake among Korean men. The cohort comprised 2,677 male residents in Kangwha County, aged 55 or older in March 1985, for their upper digestive tract cancer mortality for 20.8 years up to December 31, 2005. For daily binge drinkers versus non-drinkers, the hazard ratios (95% Cls) for mortality were 4.82 (1.36, 17.1) and 6.75 (1.45, 31.4) for oropharyngeal and esophageal cancers, respectively. Even after adjusting for the volume of alcohol intake, we found the hazard ratios for frequency of binge drinking and mortality of oropharyngeal or esophageal cancer to not change appreciably: the hazard ratios were 4.90 (1.00, 27.0) and 7.17 (1.02, 50.6), respectively. For esophageal cancer, there was a strong dose-response relationship. The frequency of heavy binge drinking and not just the volume of alcohol intake may increase the risk of mortality from upper digestive tract cancer, particularly esophageal cancer in Korean men. These findings need to be confirmed in further studies with a larger sample size.

Alcohol consumption, cigarette smoking and the risk of subtypes of head-neck cancer: results from the Netherlands Cohort Study

BACKGROUND

Prospective data on alcohol consumption, cigarette smoking and risk of head-neck cancer (HNC) subtypes, i.e. oral cavity cancer (OCC), oro-/hypopharyngeal cancer (OHPC), and laryngeal cancer (LC), are limited. We investigated these associations within the second largest prospective study on this topic so far, the Netherlands Cohort Study.

METHODS

120,852 participants completed a questionnaire on diet and other cancer risk factors in 1986. After 17.3 years of follow-up, 395 HNC (110 OCC, 83 OHPC, and 199 LC) cases and 4288 subcohort members were available for case-cohort analysis using Cox proportional hazards models.

RESULTS

For total HNC, the multivariable adjusted incidence rate ratio (RR) was 2.74 (95% confidence interval (CI) 1.85-4.06) for those drinking ≥30 g ethanol/day compared with abstainers; in subtypes, RRs were 6.39 for OCC, 3.52 for OHPC, and 1.54 for LC. Compared with never cigarette smokers, current cigarette smokers had a RR of 4.49 (95%CI 3.11-6.48) for HNC overall, and 2.11 for OCC, 8.53 for OHPC, and 8.07 for LC. A significant, positive, multiplicative interaction between categories of alcohol consumption and cigarette smoking was found for HNC overall (P interaction 0.03).

CONCLUSIONS

Alcohol consumption and cigarette smoking were independently associated with risk of HNC overall, with a positive, multiplicative interaction. The strength of these associations differed among HNC-subtypes: OCC was most strongly associated with alcohol consumption but most weakly with cigarette smoking, whereas LC was not statistically significantly associated with alcohol consumption.

Polymorphisms in alcohol metabolism genes ADH1B and ALDH2, alcohol consumption and colorectal cancer

BACKGROUND

Colorectal cancer (CRC) is a leading cause of cancer death worldwide. Epidemiological risk factors for CRC included alcohol intake, which is mainly metabolized to acetaldehyde by alcohol dehydrogenase and further oxidized to acetate by aldehyde dehydrogenase; consequently, the role of genes in the alcohol metabolism pathways is of particular interest. The aim of this study is to analyze the association between SNPs in ADH1B and ALDH2 genes and CRC risk, and also the main effect of alcohol consumption on CRC risk in the study population.

METHODOLOGY/PRINCIPAL FINDINGS

SNPs from ADH1B and ALDH2 genes, included in alcohol metabolism pathway, were genotyped in 1694 CRC cases and 1851 matched controls from the Molecular Epidemiology of Colorectal Cancer study. Information on clinicopathological characteristics, lifestyle and dietary habits were also obtained. Logistic regression and association analysis were conducted. A positive association between alcohol consumption and CRC risk was observed in male participants from the Molecular Epidemiology of Colorectal Cancer study (MECC) study (OR = 1.47; 95%CI = 1.18-1.81). Moreover, the SNPs rs1229984 in ADH1B gene was found to be associated with CRC risk: under the recessive model, the OR was 1.75 for A/A genotype (95%CI = 1.21-2.52; p-value = 0.0025). A path analysis based on structural equation modeling showed a direct effect of ADH1B gene polymorphisms on colorectal carcinogenesis and also an indirect effect mediated through alcohol consumption.

CONCLUSIONS/SIGNIFICANCE

Genetic polymorphisms in the alcohol metabolism pathways have a potential role in colorectal carcinogenesis, probably due to the differences in the ethanol metabolism and acetaldehyde oxidation of these enzyme variants.

Alcohol interacts with genetic alteration of the Hippo tumor suppressor pathway to modulate tissue growth in Drosophila

Alcohol-mediated cancers represent more than 3.5% of cancer-related deaths, yet how alcohol promotes cancer is a major open question. Using Drosophila, we identified novel interactions between dietary ethanol and loss of tumor suppressor components of the Hippo Pathway. The Hippo Pathway suppresses tumors in flies and mammals by inactivating transcriptional co-activator Yorkie, and the spectrum of cancers associated with impaired Hippo signaling overlaps strikingly with those associated with alcohol. Therefore, our findings may implicate loss of Hippo Pathway tumor suppression in alcohol-mediated cancers. Ethanol enhanced overgrowth from loss of the expanded, hippo, or warts tumor suppressors but, surprisingly, not from over-expressing the yorkie oncogene. We propose that in parallel to Yorkie-dependent overgrowth, impairing Hippo signaling in the presence of alcohol may promote overgrowth via additional alcohol-relevant targets. We also identified interactions between alcohol and Hippo Pathway over-activation. We propose that exceeding certain thresholds of alcohol exposure activates Hippo signaling to maintain proper growth control and prevent alcohol-mediated mis-patterning and tissue overgrowth.

Colon and rectal cancer survival by tumor location and microsatellite instability: the Colon Cancer Family Registry

BACKGROUND

Cancers in the proximal colon, distal colon, and rectum are frequently studied together; however, there are biological differences in cancers across these sites, particularly in the prevalence of microsatellite instability.

OBJECTIVE

We assessed the differences in survival by colon or rectal cancer site, considering the contribution of microsatellite instability to such differences.

DESIGN

This is a population-based prospective cohort study for cancer survival.

SETTINGS

This study was conducted within the Colon Cancer Family Registry, an international consortium. Participants were identified from population-based cancer registries in the United States, Canada, and Australia.

PATIENTS

Information on tumor site, microsatellite instability, and survival after diagnosis was available for 3284 men and women diagnosed with incident invasive colon or rectal cancer between 1997 and 2002, with ages at diagnosis ranging from 18 to 74.

MAIN OUTCOME MEASURES

Cox regression was used to calculate hazard ratios for the association between all-cause mortality and tumor location, overall and by microsatellite instability status.

RESULTS

Distal colon (HR, 0.59; 95% CI, 0.49-0.71) and rectal cancers (HR, 0.68; 95% CI, 0.57-0.81) were associated with lower mortality than proximal colon cancer overall. Compared specifically with patients with proximal colon cancer exhibiting no/low microsatellite instability, patients with distal colon and rectal cancers experienced lower mortality, regardless of microsatellite instability status; patients with proximal colon cancer exhibiting high microsatellite instability had the lowest mortality.

LIMITATIONS

Study limitations include the absence of stage at diagnosis and cause-of-death information for all but a subset of study participants. Some patient groups defined jointly by tumor site and microsatellite instability status are subject to small numbers.

CONCLUSION

Proximal colon cancer survival differs from survival for distal colon and rectal cancer in a manner apparently dependent on microsatellite instability status. These findings support the premise that proximal colon, distal colon, and rectal cancers are clinicopathologically distinct.

Alcohol-attributable cancer deaths and years of potential life lost in the United States

OBJECTIVES

Our goal was to provide current estimates of alcohol-attributable cancer mortality and years of potential life lost (YPLL) in the United States.

METHODS

We used 2 methods to calculate population-attributable fractions. We based relative risks on meta-analyses published since 2000, and adult alcohol consumption on data from the 2009 Alcohol Epidemiologic Data System, 2009 Behavioral Risk Factor Surveillance System, and 2009-2010 National Alcohol Survey.

RESULTS

Alcohol consumption resulted in an estimated 18,200 to 21,300 cancer deaths, or 3.2% to 3.7% of all US cancer deaths. The majority of alcohol-attributable female cancer deaths were from breast cancer (56% to 66%), whereas upper airway and esophageal cancer deaths were more common among men (53% to 71%). Alcohol-attributable cancers resulted in 17.0 to 19.1 YPLL for each death. Daily consumption of up to 20 grams of alcohol (≤ 1.5 drinks) accounted for 26% to 35% of alcohol-attributable cancer deaths.

CONCLUSIONS

Alcohol remains a major contributor to cancer mortality and YPLL. Higher consumption increases risk but there is no safe threshold for alcohol and cancer risk. Reducing alcohol consumption is an important and underemphasized cancer prevention strategy.

Subsite-specific dietary risk factors for colorectal cancer: a review of cohort studies

Objective. A shift in the total incidence from left- to right-sided colon cancer has been reported and raises the question as to whether lifestyle risk factors are responsible for the changing subsite distribution of colon cancer. The present study provides a review of the subsite-specific risk estimates for the dietary components presently regarded as convincing or probable risk factors for colorectal cancer: red meat, processed meat, fiber, garlic, milk, calcium, and alcohol. Methods. Studies were identified by searching PubMed through October 8, 2012 and by reviewing reference lists. Thirty-two prospective cohort studies are included, and the estimates are compared by sex for each risk factor. Results. For alcohol, there seems to be a stronger association with rectal cancer than with colon cancer, and for meat a somewhat stronger association with distal colon and rectal cancer, relative to proximal colon cancer. For fiber, milk, and calcium, there were only minor differences in relative risk across subsites. No statement could be given regarding garlic. Overall, many of the subsite-specific risk estimates were nonsignificant, irrespective of exposure. Conclusion. For some dietary components the associations with risk of cancer of the rectum and distal colon appear stronger than for proximal colon, but not for all.

Alcohol consumption and mortality in the Korean Multi-Center Cancer Cohort Study

Objectives

To examine the association between alcohol consumption habit, types of beverages, alcohol consumption quantity, and overall and cancer-specific mortality among Korean adults.

Methods

The alcohol consumption information of a total of 16 320 participants who were 20 years or older from the Korean Multi-center Cancer Cohort were analyzed to examine the association between alcohol consumption habit and mortality (median follow-up of 9.3 years). The Cox proportional hazard model was used to estimate the hazard ratio (HR) of alcohol consumption to mortality adjusting for age, sex, geographic areas, education, smoking status, and body mass index.

Results

Alcohol drinkers showed an increased risk for total mortality compared with never drinkers (HR, 1.72; 95% confidence interval [CI], 1.38 to 2.14 for past drinkers; HR, 1.21; 95% CI, 1.06 to 1.39 for current drinkers), while past drinkers only were associated with higher risk for cancer deaths (HR, 1.84; 95% CI, 1.34 to 2.53). The quantity of alcohol consumed per week showed a J-shaped association with risk of mortality. Relative to light drinkers (0.01 to 90 g/wk), never drinkers and heavy drinkers (>504 g/wk) had an increased risk for all-cause and cancer deaths: (HR, 1.18; 95% CI, 0.96 to 1.45) and (HR, 1.39; 95% CI, 1.05 to 1.83) for all-cause mortality; and (HR, 1.55; 95% CI, 1.15 to 2.11) and (HR, 2.07; 95% CI, 1.39 to 3.09) for all cancer mortality, respectively. Heavy drinkers (>504 g/wk) showed an elevated risk for death from stomach and liver cancers.

Conclusions

The present study supports the existence of a J-shaped association between alcohol consumption quantity and the risk of all-cause and cancer deaths. Heavy drinkers had an increased risk of death from cancer overall and liver and stomach cancer.

Alcohol consumption and digestive tract cancer

PURPOSE OF REVIEW

The data indicating that alcohol is an important factor increasing the risk to develop gastrointestinal cancer are consolidating. The purpose of this review is to summarize current evidence.

RECENT FINDINGS

Acetaldehyde is the first metabolite of ethanol metabolism and has direct carcinogenic and mutagenic effects by modifying DNA via generation of DNA adducts. Oxidative stress has a prominent role in triggering chronic inflammation and carcinogenesis through formation of reactive oxygen species. Recently published large prospective cohort studies with sufficient statistical power and meta-analyses could refine the knowledge regarding the impact of alcohol on gastrointestinal cancer. Functional genetic variants of alcohol-metabolizing enzymes proved to be associated with increased risk for esophageal and gastric cancer.The highest risk increase for malignancy was observed in the upper aerodigestive tract (oral cavity, pharynx, larynx) and esophagus (squamous cell carcinoma), weaker correlations were established regarding gastric, pancreatic, and colorectal neoplasias.

SUMMARY

Alcohol overconsumption is a serious avoidable risk factor for the development of gastrointestinal tract cancer, both alone but even more in combination with other risk factors such as tobacco and obesity.

Health behaviors of early-stage non-small cell lung cancer survivors

INTRODUCTION

Lung cancer survivors are at risk for cancer recurrence and other chronic illnesses related predominantly to prior tobacco use and older age. Optimal quality of post-treatment care requires greater knowledge of survivors' adherence to behavioral health recommendations. This study reports the rates of smoking, physical activity, alcohol use, cancer screenings, and routine primary care visits in non-small cell lung cancer (NSCLC) survivors.

METHODS

Stage IA and IB NSCLC survivors (N = 183, mean age = 69.0 years) with no evidence of disease 1-6 years post-treatment completed standard survey items regarding health and cancer screening behaviors.

RESULTS

Most survivors (83.5%) had a history of smoking, but 64.8% quit prior to diagnosis and only 5.5% continued to smoke. Alcohol intake recommendations were exceeded by 5.4% and 17.3% of men and women, respectively. In a typical week, 23.1% met physical activity guidelines. Regarding cancer screenings, 89.3% were adherent to colorectal cancer screening guidelines. Among women, 72.0% had a mammogram within the previous year and 81.5% had a pap test in the previous 3 years; among men, 86.7% had a prostate-specific antigen test in the previous year. Almost all (97.3%) had seen a primary care provider in the past year.

DISCUSSIONS/CONCLUSIONS

The majority of lung cancer survivors were adherent to health promotion recommendations, but few engaged in the recommended level of physical activity.

IMPLICATIONS FOR CANCER SURVIVORS

Physical and pulmonary rehabilitation interventions may help lung cancer survivors maintain sufficient levels of physical activity, which can have numerous benefits for older adults.

Subsite-specific colorectal cancer risk in the colorectal endoscopy era

BACKGROUND

Colorectal endoscopy (sigmoidoscopy and colonoscopy) is thought to reduce colorectal cancer (CRC) risk. Since the 1980s, its use has increased in the United States, which may be a reason for decreasing CRC incidence rates.

OBJECTIVE

To investigate the plausibility of a contribution of colorectal endoscopy use to the decrease in CRC risk.

DESIGN

Descriptive analysis of temporal trends.

SETTING

U.S. population from 1978 to 2007.

MAIN OUTCOME MEASUREMENTS

Using incidence data from the Surveillance, Epidemiology and End Results Program, we assessed the subsite-specific cumulative risk of CRC developing until age 79 years.

RESULTS

The cumulative risk of proximal CRC remained relatively stable over the observation period, varying between 2.09% (95% CI, 2.06%-2.11%) and 2.66% (95% CI,2.62%-2.69%) for men and between 1.90% (95% CI, 1.88%-1.93%) and 2.24% (95% CI, 2.21%-2.27%) for women. By contrast, the cumulative risk of distal CRC decreased from 4.68% (95% CI, 4.64%-4.73%) to 3.03% (95% CI, 3.00%-3.06%) for men and from 3.15% (95% CI, 3.11%-3.18%) to 1.93% (95% CI, 1.91%-1.95%) for women, which was largely attributable to the reduced cumulative risk of cancer in the sigmoid colon. The observed pattern was restricted to the population aged 50 to 79 years, whereas the magnitude of the decrease was greater for older age groups and similar across stages.

LIMITATIONS

The study is based on aggregated registry data only; therefore, no inferences about causal effects can be drawn.

CONCLUSIONS

The results show a major reduction of CRC risk, particularly in the sigmoid colon. Increased use of colorectal endoscopy in the population aged 50 years and older along with environmental factors may have contributed to the decreasing risk.

Site-specific risk factors for colorectal cancer in a Korean population

We investigated the association of colorectal cancer risk factors with different colorectal cancer subsites to assess etiological differences for cancers of the proximal colon, distal colon, and rectum. Included in this study were 869,725 men and 395,501 women who participated in a health examination provided by the Korean National Health System between 1996 and 1997. During up to 7 years of follow-up, 4,144 incident colorectal cancer cases were detected (3,051 men and 1,093 women). Greater height was associated with elevated risk for distal colon cancer and rectal cancer in both men and women. Family history of cancer was associated with higher risk for cancers of the proximal colon in men and distal colon in both men and women. Frequent alcohol consumption and consuming high amounts of alcohol were associated with elevated risk for distal colon cancer in men and higher risk for rectal cancer in women. Frequent meat consumption was associated with risk for proximal colon cancer in men and for rectal cancer in women. Our findings suggest that risk factors for colorectal cancer are different by subsites of colon and rectum, as well as by sex.

Site-specific risk factors for colorectal cancer in a Korean population

We investigated the association of colorectal cancer risk factors with different colorectal cancer subsites to assess etiological differences for cancers of the proximal colon, distal colon, and rectum. Included in this study were 869,725 men and 395,501 women who participated in a health examination provided by the Korean National Health System between 1996 and 1997. During up to 7 years of follow-up, 4,144 incident colorectal cancer cases were detected (3,051 men and 1,093 women). Greater height was associated with elevated risk for distal colon cancer and rectal cancer in both men and women. Family history of cancer was associated with higher risk for cancers of the proximal colon in men and distal colon in both men and women. Frequent alcohol consumption and consuming high amounts of alcohol were associated with elevated risk for distal colon cancer in men and higher risk for rectal cancer in women. Frequent meat consumption was associated with risk for proximal colon cancer in men and for rectal cancer in women. Our findings suggest that risk factors for colorectal cancer are different by subsites of colon and rectum, as well as by sex.

Case-control study for colorectal cancer genetic susceptibility in EPICOLON: previously identified variants and mucins

Background

Colorectal cancer (CRC) is the second leading cause of cancer death in developed countries. Familial aggregation in CRC is also important outside syndromic forms and, in this case, a polygenic model with several common low-penetrance alleles contributing to CRC genetic predisposition could be hypothesized. Mucins and GALNTs (N-acetylgalactosaminyltransferase) are interesting candidates for CRC genetic susceptibility and have not been previously evaluated. We present results for ten genetic variants linked to CRC risk in previous studies (previously identified category) and 18 selected variants from the mucin gene family in a case-control association study from the Spanish EPICOLON consortium.

Methods

CRC cases and matched controls were from EPICOLON, a prospective, multicenter, nationwide Spanish initiative, comprised of two independent stages. Stage 1 corresponded to 515 CRC cases and 515 controls, whereas stage 2 consisted of 901 CRC cases and 909 controls. Also, an independent cohort of 549 CRC cases and 599 controls outside EPICOLON was available for additional replication. Genotyping was performed for ten previously identified SNPs in ADH1C, APC, CCDN1, IL6, IL8, IRS1, MTHFR, PPARG, VDR and ARL11, and 18 selected variants in the mucin gene family.

Results

None of the 28 SNPs analyzed in our study was found to be associated with CRC risk. Although four SNPs were significant with a P-value < 0.05 in EPICOLON stage 1 [rs698 in ADH1C (OR = 1.63, 95% CI = 1.06-2.50, P-value = 0.02, recessive), rs1800795 in IL6 (OR = 1.62, 95% CI = 1.10-2.37, P-value = 0.01, recessive), rs3803185 in ARL11 (OR = 1.58, 95% CI = 1.17-2.15, P-value = 0.007, codominant), and rs2102302 in GALNTL2 (OR = 1.20, 95% CI = 1.00-1.44, P-value = 0.04, log-additive 0, 1, 2 alleles], only rs3803185 achieved statistical significance in EPICOLON stage 2 (OR = 1.34, 95% CI = 1.06-1.69, P-value = 0.01, recessive). In the joint analysis for both stages, results were only significant for rs3803185 (OR = 1.12, 95% CI = 1.00-1.25, P-value = 0.04, log-additive 0, 1, 2 alleles) and borderline significant for rs698 and rs2102302. The rs3803185 variant was not significantly associated with CRC risk in an external cohort (MCC-Spain), but it still showed some borderline significance in the pooled analysis of both cohorts (OR = 1.08, 95% CI = 0.98-1.18, P-value = 0.09, log-additive 0, 1, 2 alleles).

Conclusions

ARL11, ADH1C, GALNTL2 and IL6 genetic variants may have an effect on CRC risk. Further validation and meta-analyses should be undertaken in larger CRC studies.

Racial differences in colorectal cancer incidence and mortality in the Women's Health Initiative

BACKGROUND

Colorectal cancer (CRC) incidence and mortality rates are higher in African-Americans as compared with other racial/ethnic groups. The women's health initiative (WHI) study sample was used to determine whether differences in CRC risk factors explain racial/ethnic differences in incidence and mortality.

METHODS

The WHI is a longitudinal study of postmenopausal women recruited from 40 centers. Baseline questionnaires were used to collect sociodemographic and health status information. All CRC diagnoses were centrally adjudicated. Cox regression models were used to compute hazard ratios (HRs) and 95% confidence intervals (CIs) for invasive CRC by race/ethnicity.

RESULTS

The study sample included 131,481 (83.7%) White, 14,323 (9.1%) African-American, 6,362 (4.1%) Hispanic, 694 (0.4%) Native American and 4,148 (2.6%) Asian/Pacific Islanders. After a mean follow-up of 10.8 years (SD 2.9), CRC incidence was the highest in African-Americans (annualized rate = 0.14%), followed by Whites and Native Americans (0.12% each), Asian/Pacific Islanders (0.10%), and Hispanics (0.08%). After adjustment for age and trial assignment, Hispanics had a lower risk compared with Whites, HR 0.73 (95% CI: 0.54-0.97) (P = 0.03), and African-Americans had a marginally greater risk, HR 1.16 (95% CI: 0.99-1.34), P = 0.06. Multivariable adjustment attenuated the difference in incidence between African-Americans and Whites (HR 0.99, 95% CI: 0.82-1.20), while strengthening the lower HR for Hispanics (HR 0.68, 95% CI: 0.48-0.97).

CONCLUSIONS

African-American/White differences in CRC risk are likely due to sociodemographic/cultural factors other than race.

IMPACT

A number of modifiable exposures could be a focus for reducing CRC risk in African-Americans.

Lowering the Risk of Rectal Cancer among Habitual Beer Drinkers by Dietary Means

Whole-life beer consumption and a quantitative measurement of several dietary micronutrients consumed in adult life were obtained from the dietary and alcohol data of the case-control arm of the population-based Melbourne Colorectal Cancer Study. There was a statistically significant risk, adjusted for other established risk factors, among habitual beer drinkers (AOR 1.75, 95% CI 1.28–2.41) with a significant positive dose-response effect (AOR trend 1.34, 95% CI 1.16–1.55). Among beer consumers the data were interpreted as showing an attenuation of this risk with consumption of the four micronutrients involved in methylation: folate, methionine, vitamins B6 and B12, and the four micronutrients examined with antioxidant properties: selenium, vitamins E, C, and lycopene. The strongest effects were noted with vitamins E, C, and lycopene, and the weakest with methionine and selenium. Whilst not condoning excessive beer drinking, the regular consumption of foods rich in these micronutrients may provide a simple and harmless preventative strategy among persistent habitual beer drinkers and deserves further study with larger study numbers.