Tea and coffee drinking and ovarian cancer risk: results from the Netherlands Cohort Study and a meta-analysis

Association between coffee and tea consumption and ovarian cancer incidence: A prospective analysis in the PLCO dataset

Epidemiological evidence regarding the relationship between coffee and tea consumption and the risk of ovarian cancer (OC) is inconsistent. Therefore, we aimed to quantitatively investigate this topic in a large prospective cohort study. This cohort study included 24,715 individuals recruited from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trials between 1993 and 2001. The data used for our analysis included the latest follow-up information collected up to 2015. Coffee intake of ≥4 cups/day (hazard ratio [HR], 0.586; 95% confidence interval [CI]: 0.356-0.966) or caffeine intake of 458.787 mg/day (HR, 0.607; 95% CI: 0.411-0.895) were associated with the lowest HR of incident OC in the fully adjusted model. Participants who consumed varying amounts of tea did not exhibit a statistically significant reduction in the risk of OC. Our findings suggest that a higher consumption of coffee or caffeine is associated with a reduced risk of OC. However, no statistically significant association was observed between tea consumption and the risk of OC.

Coffee Consumption and Cancer Risk: An Assessment of the Health Implications Based on Recent Knowledge

A significant number of studies suggest that coffee consumption reduces cancer risk. This beneficial effect is usually ascribed to the presence of polyphenolic antioxidants and anti-inflammatory agents, including caffeine, cafestol, kahweol, and chlorogenic acids. To summarize recent literature on this subject, we performed a bibliographic search in PubMed and Embase over the period January 2005 to December 2020 to identify cohort studies and meta-analysis (with data collection ensuring quality of selected reports) that could provide quantitative data on the relationship between coffee consumption and common cancers. The totality of eligible scientific articles supports the evidence that coffee intake is inversely associated with risk of hepatocellular cancer and, to a slight extent, risk of breast cancer among postmenopausal women. As to the association with other organs, including the esophagus, pancreas, colorectum, kidneys, bladder, ovaries, and prostate, the results are less clear as reports reveal conflicting results or statistically nonsignificant data. Therefore, this overview does not provide broad-based conclusions. Important uncertainties include general study design, inhomogeneous patient sampling, different statistical analysis (deliberate), misreporting of socioeconomic status, education, coffee-brewing methods, consumption of caffeinated or decaffeinated coffee, smoking habits, and alcohol intake. Clearly, more epidemiologic research needs to be conducted before solid science-based recommendations can be made with regard to coffee consumption.

Diet and ovarian cancer risk: An umbrella review of systematic reviews and meta-analyses of cohort studies

BACKGROUND & AIMS

Diet may play an important role in the etiology of ovarian cancer (OC). We aimed to evaluate the strength and credibility of evidence pertaining to dietary risk factors for OC.

METHODS

We comprehensively searched PubMed, Web of Science, Cochrane, CINAHL, JBI Database of Systematic Reviews and Implementation Reports, PROSPERO and EMBASE databases to identify related systematic reviews and meta-analyses of prospective cohort studies. This study had been registered at PROSPERO. The registration number is CRD42020187651. For each association, we estimated the summary effect size using fixed and random effects models, the 95% confidence interval and the 95% prediction interval. We assessed heterogeneity, evidence of small-study effects, and excess significance bias.

RESULTS

A total of 22 systematic reviews and meta-analyses were included in the present study. These previous reports evaluated 184 individual studies, which proposed a total of 36 associations between dietary factors and OC risk. Out of the 36 associations, there were no strong, highly suggestive and suggestive evidence, only four (black tea, skim/low-fat milk, lactose, and calcium) were determined to be supported by weak evidence. OC risk was inversely associated with intake of black tea or calcium, and positively associated with intake of skim/low-fat milk or lactose.

CONCLUSIONS

Our studies revealed that four associations between OC risk and dietary factors (black tea, skim/low-fat milk, lactose, and calcium) were supported by weak evidence. The remaining 32 associations were not confirmed. Additional studies are needed to carefully evaluate the relationship between dietary factors and OC risk.

Association between dietary intake and risk of ovarian cancer: a systematic review and meta-analysis

PURPOSE

It is unclear how dietary intake influences the ovarian cancer. The present paper sets out to systematically review and meta-analyze research on dietary intake to identify cases having high- or low-risk ovarian cancer.

METHODS

Scopus, PubMed, and Wiley Online Libraries were searched up to the date November 24, 2019. Two reviewers were requested to independently extract study characteristics and to assess the bias and applicability risks with reference to the study inclusion criteria. Meta-analyses were performed to specify the relationship between dietary intake and the risk of ovarian cancer identifying 97 cohort studies.

RESULTS

No significant association was found between dietary intake and risk of ovarian cancer. The results of subgroup analyses indicated that green leafy vegetables (RR = 0.91, 95%, 0.85-0.98), allium vegetables (RR = 0.79, 95% CI 0.64-0.96), fiber (RR = 0.89, 95% CI 0.81-0.98), flavonoids (RR = 0.83, 95% CI 0.78-0.89) and green tea (RR = 0.61, 95% CI 0.49-0.76) intake could significantly reduce ovarian cancer risk. Total fat (RR = 1.10, 95% CI 1.02-1.18), saturated fat (RR = 1.11, 95% CI 1.01-1.22), saturated fatty acid (RR = 1.19, 95% CI 1.04-1.36), cholesterol (RR = 1.13, 95% CI 1.04-1.22) and retinol (RR = 1.14, 95% CI 1.00-1.30) intake could significantly increase ovarian cancer risk. In addition, acrylamide, nitrate, water disinfectants and polychlorinated biphenyls were significantly associated with an increased risk of ovarian cancer.

CONCLUSION

These results could support recommendations to green leafy vegetables, allium vegetables, fiber, flavonoids and green tea intake for ovarian cancer prevention.

Caffeine, Type of Coffee, and Risk of Ovarian Cancer: A Dose-Response Meta-Analysis of Prospective Studies

CONTEXT

Prospective studies on caffeine and different types of coffee intake in relation to the risk of ovarian cancer have shown conflicting results.

OBJECTIVE

The aim of the present study was to perform a dose-response meta-analysis of cohort studies on the association between dietary caffeine intake, different types of coffee consumption, and the risk of ovarian cancer.

DATA SOURCES

PubMed/Medline, ISI Web of Science, Scopus, and EMBASE were searched to identify relevant studies reported until October 2018.

STUDY SELECTION

Prospective cohort studies that had considered caffeine or different types of coffee as the exposure variable and ovarian cancer as the main outcome variable or as one of the outcome variables were included in our systematic review and meta-analysis. Two of us independently screened 9344 publications. A total of 14 cohort studies were included in the meta-analysis.

DATA EXTRACTION

Two of us independently extracted the data. Any disagreements were resolved in consultation with the principal investigator.

RESULTS

Combining 13 effect sizes, we found no substantial association between coffee consumption and risk of ovarian cancer [risk ratio (RR), 1.08; 95% CI, 0.89 to 1.33]. Also, one additional cup daily of coffee consumption was marginally associated with an increased risk of ovarian cancer (RR, 1.02; 95% CI, 0.99 to 1.05; P = 0.21; I2 = 0.0%; Pheterogeneity = 0.68). No statistically significant association was observed between caffeine intake or caffeinated or decaffeinated coffee consumption and the risk of ovarian cancer.

CONCLUSIONS

We found no statistically significant association between caffeine intake or different types of coffee and the risk of ovarian cancer.

Coffee and caffeine intake and risk of ovarian cancer: a systematic review and meta-analysis

Background

Results from earlier publications on the association of coffee and caffeine and risk of ovarian cancer are inconsistent.

Objective

To evaluate the link between coffee, caffeine, caffeinated coffee, and decaffeinated coffee consumption and risk of ovarian cancer.

Methods

We searched PubMed/Medline, ISI Web of Science, Scopus, and Google Scholar to identify relevant publications up to April 2018. All case–control studies that considered coffee, caffeine, caffeinated coffee, or decaffeinated coffee as the exposure variables and ovarian cancer as the main outcome variable or as one of the outcomes were included in the systematic review. Publications in which odds ratios (ORs) or rate or risk ratios (RRs) and 95% confidence intervals (CIs) were reported, were included in the meta-analysis.

Results

A total of 22 case–control studies were included in the systematic review, and 20 studies in the meta-analysis. Overall, 40 140 participants, including 8568 patients with ovarian cancer, aged ≥ 17 years were included. Combining 21 effect sizes from 18 studies, no significant association was observed between total coffee intake and risk of ovarian cancer (OR=1.09; 95% CI 0.94 to 1.26). There was no significant association between total caffeine intake and ovarian cancer risk (OR=0.89; 95% CI 0.55 to 1.45). In addition, caffeinated coffee intake was not significantly associated with ovarian cancer (OR=1.05; 95% CI 0.87 to 1.28). However, combining effect sizes from five studies, we found an inverse significant association between decaffeinated coffee intake and risk of ovarian cancer (OR=0.72; 95% CI 0.58 to 0.90).

Conclusions

Our findings indicated an inverse association between decaffeinated coffee consumption and risk of ovarian cancer. No significant association was found between coffee, caffeine or caffeinated coffee intake and risk of ovarian cancer.

Assessment of moderate coffee consumption and risk of epithelial ovarian cancer: a Mendelian randomization study

Background

Coffee consumption has been shown to be associated with various health outcomes in observational studies. However, evidence for its association with epithelial ovarian cancer (EOC) is inconsistent and it is unclear whether these associations are causal.

Methods

We used single nucleotide polymorphisms associated with (i) coffee and (ii) caffeine consumption to perform Mendelian randomization (MR) on EOC risk. We conducted a two-sample MR using genetic data on 44 062 individuals of European ancestry from the Ovarian Cancer Association Consortium (OCAC), and combined instrumental variable estimates using a Wald-type ratio estimator.

Results

For all EOC cases, the causal odds ratio (COR) for genetically predicted consumption of one additional cup of coffee per day was 0.92 [95% confidence interval (CI): 0.79, 1.06]. The COR was 0.90 (95% CI: 0.73, 1.10) for high-grade serous EOC. The COR for genetically predicted consumption of an additional 80 mg caffeine was 1.01 (95% CI: 0.92, 1.11) for all EOC cases and 0.90 (95% CI: 0.73, 1.10) for high-grade serous cases.

Conclusions

We found no evidence indicative of a strong association between EOC risk and genetically predicted coffee or caffeine levels. However, our estimates were not statistically inconsistent with earlier observational studies and we were unable to rule out small protective associations.

Coffee and cancer risk: a summary overview

We reviewed available evidence on coffee drinking and the risk of all cancers and selected cancers updated to May 2016. Coffee consumption is not associated with overall cancer risk. A meta-analysis reported a pooled relative risk (RR) for an increment of 1 cup of coffee/day of 1.00 [95% confidence interval (CI): 0.99-1.01] for all cancers. Coffee drinking is associated with a reduced risk of liver cancer. A meta-analysis of cohort studies found an RR for an increment of consumption of 1 cup/day of 0.85 (95% CI: 0.81-0.90) for liver cancer and a favorable effect on liver enzymes and cirrhosis. Another meta-analysis showed an inverse relation for endometrial cancer risk, with an RR of 0.92 (95% CI: 0.88-0.96) for an increment of 1 cup/day. A possible decreased risk was found in some studies for oral/pharyngeal cancer and for advanced prostate cancer. Although data are mixed, overall, there seems to be some favorable effect of coffee drinking on colorectal cancer in case-control studies, in the absence of a consistent relation in cohort studies. For bladder cancer, the results are not consistent; however, any possible direct association is not dose and duration related, and might depend on a residual confounding effect of smoking. A few studies suggest an increased risk of childhood leukemia after maternal coffee drinking during pregnancy, but data are limited and inconsistent. Although the results of studies are mixed, the overall evidence suggests no association of coffee intake with cancers of the stomach, pancreas, lung, breast, ovary, and prostate overall. Data are limited, with RR close to unity for other neoplasms, including those of the esophagus, small intestine, gallbladder and biliary tract, skin, kidney, brain, thyroid, as well as for soft tissue sarcoma and lymphohematopoietic cancer.

Tea consumption and the risk of ovarian cancer: A meta-analysis of epidemiological studies

A large number of epidemiological studies have provided conflicting results about the relationship between tea consumption and ovarian cancer. This study aimed to clarify the association between tea consumption and ovarian cancer. A literature search of the MEDICINE, Scopus, PubMed, and Web of Science databases was performed in April 2016. A total of 18 (11 case-control and 7 cohort) studies, representing data for 701,857 female subjects including 8,683 ovarian cancer cases, were included in the meta-analysis. A random-effects meta-analysis was used to compute the pooled relative risks (RR), meta regression, and publication bias, and heterogeneity analyses were performed for the included trials. We found that tea consumption had a significant protective effect against ovarian cancer (relative risk [RR] = 0.86; 95% confidence interval [CI]: 0.76, 0.96). The relationship was confirmed particularly after adjusting for family history of cancer (RR = 0.85; 95% CI: 0.72, 0.97), menopause status (RR = 0.85; 95% CI: 0.72, 0.98), education (RR = 0.82; 95% CI: 0.68, 0.96), BMI (RR = 0.85; 95% CI: 0.70, 1.00), smoking (RR = 0.83; 95% CI: 0.72, 0.93) and Jadad score of 3 (RR = 0.76; 95% CI: 0.56, 0.95) and 5 (RR = 0.74; 95% CI: 0.59, 0.89). The Begg's and Egger's tests (all P > 0.01) showed no evidence of publication bias. In conclusion, our meta-analysis showed an inverse association between tea consumption and ovarian cancer risk. High quality cohort-clinical trials should be conducted on different tea types and their relationship with ovarian cancer.

Coffee consumption is not associated with ovarian cancer risk: a dose-response meta-analysis of prospective cohort studies

Background

Coffee consumption has been associated with numerous cancers, but evidence on ovarian cancer risk is controversial. Therefore, we performed a meta-analysis on prospective cohort studies in order to review the evidence on coffee consumption and risk of ovarian cancer.

Methods

Studies were identified through searching the PubMed and MEDLINE databases up to March 2017. Risk estimates were retrieved from the studies, and dose-response analysis was modelled by using restricted cubic splines. Additionally, a stratified analysis by menopausal status was performed.

Results

A total of 8 studies were eligible for the dose-response meta-analysis. Studies included in the analysis comprised 787,076 participants and 3,541 ovarian cancer cases. The results showed that coffee intake was not associated with ovarian cancer risk (RR = 1.06, 95% CI: 0.89, 1.26). Stratified and subgroup analysis showed consisted results.

Conclusions

This comprehensive meta-analysis did not find evidence of an association between the consumption of coffee and risk of ovarian cancer.

Mechanisms of Phytonutrient Modulation of Cyclooxygenase-2 (COX-2) and Inflammation Related to Cancer

The link between chronic inflammation and cancer involves cytokines and mediators of inflammatory pathways. Cyclooxygenase-2 (COX-2), a key enzyme in fatty acid metabolism, is upregulated during both inflammation and cancer. COX-2 is induced by pro-inflammatory cytokines at the site of inflammation and enhanced COX-2-induced synthesis of prostaglandins stimulates cancer cell proliferation, promotes angiogenesis, inhibits apoptosis, and increases metastatic potential. As a result, COX-2 inhibitors are a subject of intense research interest toward potential clinical applications. Epidemiological studies highlight the potential benefits of diets rich in phytonutrients for cancer prevention. Plants contain numerous phytonutrient secondary metabolites shown to modulate COX-2. Studies have shown that these metabolites, some of which are used in traditional medicine, can reduce inflammation and carcinogenesis. This review describes the molecular mechanisms by which phytonutrients modulate inflammation, including studies of carotenoids, phenolic compounds, and fatty acids targeting various inflammation-related molecules and pathways associated with cancer. Examples of pathways include those of COX-2, mitogen-activated protein kinase kinase kinase, mitogen-activated protein kinase, pro-inflammatory cytokines, and transcription factors like nuclear factor kappa B. Such phytonutrient modulation of COX-2 and inflammation continue to be explored for applications in the prevention and treatment of cancer.

Coffee, Caffeine, and Health Outcomes: An Umbrella Review

To evaluate the associations between coffee and caffeine consumption and various health outcomes, we performed an umbrella review of the evidence from meta-analyses of observational studies and randomized controlled trials (RCTs). Of the 59 unique outcomes examined in the selected 112 meta-analyses of observational studies, coffee was associated with a probable decreased risk of breast, colorectal, colon, endometrial, and prostate cancers; cardiovascular disease and mortality; Parkinson's disease; and type-2 diabetes. Of the 14 unique outcomes examined in the 20 selected meta-analyses of observational studies, caffeine was associated with a probable decreased risk of Parkinson's disease and type-2 diabetes and an increased risk of pregnancy loss. Of the 12 unique acute outcomes examined in the selected 9 meta-analyses of RCTs, coffee was associated with a rise in serum lipids, but this result was affected by significant heterogeneity, and caffeine was associated with a rise in blood pressure. Given the spectrum of conditions studied and the robustness of many of the results, these findings indicate that coffee can be part of a healthful diet.

Tea, coffee, and caffeinated beverage consumption and risk of epithelial ovarian cancers

BACKGROUND

The risk for epithelial ovarian cancer associated with the consumption of caffeinated beverages (tea, coffee, and soft drinks) and green tea is inconclusive. However, few studies have investigated the type of caffeinated beverage or the type of tea.

OBJECTIVE

We assessed consumption of tea (black/caffeinated tea and green tea separately), coffee, and caffeinated soft drinks, as well as level of consumption, and the risk for epithelial ovarian cancer and its histotypes.

STUDY DESIGN

This study was conducted within a population-based case-control study in Alberta and British Columbia, Canada from 2001 to 2012. After restricting to cases of epithelial invasive cancers and controls aged 40-79 years who completed an interview that included coffee, soft drink, and tea consumption (ascertained starting in 2005 in British Columbia and 2008 in Alberta), there were a total of 524 cases and 1587 controls. Those that did not meet the threshold for beverage consumption (at least once per month for 6 months or more) were classified as non-drinkers. Adult lifetime cumulative consumption (cup-years=cups/day*years) was calculated. Unconditional logistic regression was used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI) to describe the association between the relevant drink consumption and risk.

RESULTS

No excess risk was seen for coffee or caffeinated soft drinks. Similarly, any tea consumption was not associated with risk, but when stratified by the type of tea, there was an increase in risk in black tea only drinkers (aOR=1.56; 95% CI:1.07-2.28 for >40 cup-years), but no excess risk for the exclusive green tea drinkers. Similar findings were observed for post-menopausal women. The association for black tea only consumption was mainly seen in the endometrioid histotype (aOR=3.19; 95% CI: 1.32-7.69).

CONCLUSION

Black tea consumption may be associated with an increased risk epithelial ovarian carcinoma. The excess risk is seen only in the endometrioid histotype but not in serous or clear cell. Further studies are required to confirm these findings and identify the constituents in black tea that may increase the risk.

Coffee and cancer risk: A meta-analysis of prospective observational studies

Meta-analyses on coffee and cancer incidence mainly restricted to limited cancers. We carried out a more comprehensive meta-analysis of cohort studies to explore association between coffee and most cancer types. We conducted comprehensive search and summarized relative risk (RR) and 95% confidence intervals for the highest versus lowest coffee intake and cancer using STATA12. We conducted dose-analysis if result suggested significant association. The publication bias was evaluated with begg's and egger's test. Finally, 105 individual prospective studies were included. Inverse associations were observed on oral, pharyngeal, colon, liver, prostate, endometrial cancer and melanoma, with RR 0.69 (95% CI = 0.48-0.99, I² = 73.4%, P = 0.044), 0.87 (95% CI = 0.78-0.96, I² = 28.4%, P = 0.007), 0.46 (95% CI = 0.37-0.57, I² = 0%, P = 0), 0.89 (95% CI = 0.84-0.93, I² = 30.3%, P = 0.003), 0.73 (95% CI = 0.67-0.80, I²  = 0%, P = 0) and 0.89 (95% CI = 0.80-0.99, I²  = 0%, P = 0.031) respectively. However, the relative risk for lung cancer is 2.18 (95% CI = 1.26-3.75, I²  = 63.3%, P = 0.005). The summary relative risk for increment of 2 cups of coffee were RR = 0.73, 95% CI = 0.67-0.79 for liver cancer, RR = 0.97, 95% CI = 0.96-0.98 for prostate cancer and RR = 0.88, 95% CI = 0.85-0.92 for endometrial cancer. Accordingly, coffee intake was associated with reduced risk of oral, pharynx, liver, colon, prostate, endometrial cancer and melanoma and increased lung cancer risk.

Coffee and the Risk of Lymphoma: A Meta-analysis Article

BACKGROUND

Coffee is implicated in the susceptibility to several cancers. However, the association between coffee and lymphoma remains unclear. This meta-analysis aimed to assess quantitatively the association between coffee and the incidence of lymphoma.

METHODS

A literature search was performed for cohort and case-control studies published using PubMed, Cochrane, and EMBASE databases. Studies were included if they reported relative ratios (RR) and corresponding 95% confidence intervals (CIs) of lymphoma with respect to coffee consumption. Pooled relative risk (RR) and its 95% confidence interval (CI) were calculated. All P values are two tailed.

RESULTS

Seven studies met the inclusion criteria, which included three cohort and four case-control studies. Compared with did not or seldom drink coffee per day, being no significantly association between coffee and risk of lymphoma (pooled RR: 1.05, 95%CI: 0.89-1.23). In the subgroup analysis, no significant association between coffee and lymphoma risk was detected not only in different study types (cohort studies RR: 1.29; 95% CI, 0.92-1.80; case control studies RR: 0.99; 95% CI, 0.82-1.99) but also in different regions (Europe RR: 1.21; 95% CI: 0.99-1.47; USA RR: 0.85; 95% CI, 0.62-1.15; Asia RR: 1.08, 95% CI: 0.84-1.40) and coffee consumption status (≥4cups/d 1.03, 95% CI: 0.69-1.56; < 4cups/d RR: 1.06, 95% CI: 0.89-1.26). The funnel plot revealed no evidence for publication bias.

CONCLUSION

There was no sufficient evidence to support coffee consumption association with the risk of lymphoma. Further well-designed large-scaled cohort studies are needed to provide conclusions that are more definitive.

Coffee, tea, caffeine intake, and the risk of cancer in the PLCO cohort

BACKGROUND

The association between coffee intake, tea intake and cancer has been extensively studied, but associations are not established for many cancers. Previous studies are not consistent on whether caffeine may be the source of possible associations between coffee and cancer risk.

METHODS

In the Prostate, Lung, Colorectal, and Ovarian cancer screening trial, of the 97,334 eligible individuals, 10,399 developed cancer. Cancers included were 145 head and neck, 99 oesophageal, 136 stomach, 1137 lung, 1703 breast, 257 endometrial, 162 ovarian, 3037 prostate, 318 kidney, 398 bladder, 103 gliomas, and 106 thyroid.

RESULTS

Mean coffee intake was higher in lower education groups, among current smokers, among heavier and longer duration smokers, and among heavier alcohol drinkers. Coffee intake was not associated with the risk of all cancers combined (RR=1.00, 95% confidence interval (CI)=0.96-1.05), whereas tea drinking was associated with a decreased risk of cancer overall (RR=0.95, 95% CI=0.94-0.96 for 1+ cups per day vs <1 cup per day). For endometrial cancer, a decreased risk was observed for coffee intake (RR=0.69, 95% CI=0,52-0.91 for ⩾2 cups per day). Caffeine intake was not associated with cancer risk in a dose-response manner.

CONCLUSIONS

We observed a decreased risk of endometrial cancer for coffee intake, and a decreased risk of cancer overall with tea intake.

Coffee, tea, and caffeine consumption and risk of epithelial ovarian cancer and borderline ovarian tumors: Results from a Danish case-control study

BACKGROUND

Epidemiological studies that have investigated the association between coffee, tea and caffeine consumption and ovarian cancer risk have produced conflicting results. Furthermore, only few studies have examined the role of coffee and tea consumption separately for borderline ovarian tumors. By use of data from a large Danish population-based case-control study, we examined the risk of ovarian tumors associated with coffee, tea, and caffeine consumption with a particular focus on characterizing risks by tumor behavior and histology.

MATERIAL AND METHODS

From 1995 through 1999, we included 267 women with ovarian cancer, 115 women with borderline ovarian tumors and 911 randomly selected control women. All women completed a beverage frequency questionnaire with detailed information on coffee and tea consumption. Analyses were performed using multiple logistic regression models.

RESULTS

Both coffee (OR = 0.90; 95% CI 0.84-0.97 per cup/day) and total caffeine consumption from coffee and tea combined (OR = 0.93; 95% CI 0.88-0.98 per 100 mg/day) decreased the risk of ovarian cancer. These associations were significant only for the serous and "other" subtypes of ovarian cancer. No relation between tea consumption and ovarian cancer risk was observed. The risk estimates for borderline ovarian tumors resembled those observed for ovarian cancer, but did not reach statistical significance.

CONCLUSIONS

Our results indicate that coffee consumption and total caffeine consumption from coffee and tea combined is associated with a modest decreased risk of ovarian cancer. However, more biological studies are needed to identify bioactive chemical compounds in coffee that potentially could affect ovarian cancer development.

Intake of dietary flavonoids and risk of epithelial ovarian cancer

BACKGROUND

The impact of different dietary flavonoid subclasses on risk of epithelial ovarian cancer is unclear, with limited previous studies that have focused on only a few compounds.

OBJECTIVE

We prospectively examined associations between habitual flavonoid subclass intake and risk of ovarian cancer.

DESIGN

We followed 171,940 Nurses' Health Study and Nurses' Health Study II participants to examine associations between intakes of total flavonoids and their subclasses (flavanones, flavonols, anthocyanins, flavan-3-ols, flavones, and polymeric flavonoids) and risk of ovarian cancer by using Cox proportional hazards models. Intake was calculated from validated food-frequency questionnaires collected every 4 y.

RESULTS

During 16-22 y of follow-up, 723 cases of ovarian cancer were confirmed through medical records. In pooled multivariate-adjusted analyses, total flavonoids were not statistically significantly associated with ovarian cancer risk (HR for the top compared with the bottom quintile: 0.85; 95% CI: 0.66, 1.09; P-trend = 0.17). However, participants in the highest quintiles of flavonol and flavanone intakes had modestly lower risk of ovarian cancer than did participants in the lowest quintile, although the P-trend was not significant [HRs: 0.76 (95% CI: 0.59, 0.98; P-trend = 0.11) and 0.79 (95% CI: 0.63,1.00; P-trend = 0.26), respectively]. The association for flavanone intake was stronger for serous invasive and poorly differentiated tumors (comparable HR: 0.68; 95% CI: 0.50, 0.92; P-heterogeneity = 0.10, P-trend = 0.07) compared with nonserous and less-aggressive tumors. Intakes of other subclasses were not significantly associated with risk. In food-based analyses used to compare subjects who consumed >1 and ≤ 1 cup black tea/d, the HR was 0.68 (95% CI: 0.51, 0.90; P < 0.01).

CONCLUSIONS

Higher intakes of flavonols and flavanones as well as black tea consumption may be associated with lower risk of ovarian cancer. Additional prospective studies are required to confirm these findings.

Meta-analysis of green tea drinking and the prevalence of gynecological tumors in women

We performed a meta-analysis of the correlation between drinking green tea and the risk of female ovarian tumors. Related literature (2000-2010) was retrieved from PubMed, EMbase, CBMdisc, CNKI, and Wanfang databases. The relationship between the prevalence of ovarian cancer and drinking tea in cohort studies was explored. RevMan5.1.0 software was used for the meta-analysis. A total of 6 case control studies and cohort studies were included. A total of 9113 participants, 3842 cases, and 5271 control cases were included in our analysis. Our analysis indicates that drinking green tea can significantly decrease the risk of ovarian cancer (odds ratio = 0.81; 95% confidence interval = 0.73-0.89; P < .0001). Further research is needed to explore the relationship between drinking green tea and the risk of ovarian tumor in different groups of people and with different tea types and dosages.

Flavonoids and cancer prevention: a review of the evidence

The objective of this work is to review data from epidemiological and preclinical studies addressing the potential benefits of diets based on flavonoids for cancer prevention. Flavonoids are subdivided into subclasses including flavonols, flavones, flavanones, flavan-3-ols, anthocyanidins, and isoflavones. Epidemiological studies suggest dietary intake of flavonoids may reduce the risk of tumors of the breast, colon, lung, prostate, and pancreas. However, some studies have reported inconclusive or even harmful associations. A major challenge in the interpretation of epidemiological studies is that most of the data originate from case-control studies and retrospective acquisition of flavonoid intake. Differences in agricultural, sociodemographics, and lifestyle factors contribute to the heterogeneity in the intake of flavonoids among populations residing in the United States, Europe, and Asia. Dose and timing of exposure may influence the anticancer response to flavonoid-rich diets. A limited number of intervention trials of flavonoids have documented cancer preventative effects. Proposed anticancer mechanisms for flavonoids are inhibition of proliferation, inflammation, invasion, metastasis, and activation of apoptosis. Prospective studies with larger sample sizes are needed to develop biomarkers of flavonoid intake and effect. Mechanistic studies are needed to ascertain how flavonoid-rich diets influence gene regulation for cancer prevention.

Tea consumption reduces ovarian cancer risk

OBJECTIVE

To ascertain the relationship between tea drinking and the risk of ovarian cancer among southern Chinese women, a case-control study was conducted in southern China during 2006-2008.

METHODS

Five hundred incident patients with histologically confirmed epithelial carcinoma of the ovary and 500 controls (mean age 59 years) were recruited from four public hospitals in Guangzhou. Information on frequency, quantity and duration of tea drinking, amount of dried tea leaves brewed, together with habitual diet and lifestyle characteristics, was obtained face-to-face from participants using a validated and reliable questionnaire. Logistic regression analyses were performed to assess the association between tea consumption variables and the ovarian cancer risk.

RESULTS

The control subjects reported higher tea consumption levels and prevalence (78.8%) than the ovarian cancer patients (51.4%). Regular drinking of green tea, black tea and/or oolong tea was associated with a lower risk of ovarian cancer, the adjusted odds ratio being 0.29 (95% confidence interval 0.22-0.39) after accounting for confounding factors. When compared with non-drinkers, apparent inverse dose-response relationships were observed for years of drinking, number of cups and quantity of tea consumed, as well as amount of dried tea leaves brewed (p < 0.01).

CONCLUSION

Regular tea consumption is associated with a reduced risk of ovarian cancer for southern Chinese women.

Green tea for ovarian cancer prevention and treatment: a systematic review of the in vitro, in vivo and epidemiological studies

OBJECTIVE

This systematic review was conducted to examine the effects of green tea or green tea components on the prevention and progression of epithelial ovarian cancer.

METHODS

Using Medline, EMBASE and SciVerse (last researched: July 2011), we retrieved 22 articles including 5 epidemiological studies.

RESULTS

In epithelial ovarian cancer cell lines, green tea and green tea components have been shown to downregulate the expression of proteins involved in inflammation, cell signalization, cell motility and angiogenesis. Green tea and green tea components would induce apoptosis and could potentiate the effects of cisplatin, a chemotherapeutic agent. In human observational studies, significant associations between green tea intake and both decreased ovarian cancer occurrence and better prognosis were reported.

CONCLUSIONS

Available literature suggests potential molecular targets for green tea in ovarian cancer treatment and also provides data supporting the clinical evaluation of the role of green tea or green tea components in ovarian cancer prevention and treatment.

Coffee and tea consumption and the risk of ovarian cancer: a prospective cohort study and updated meta-analysis

BACKGROUND

In 2007 the World Cancer Research Fund Report concluded that there was limited and inconsistent evidence for an effect of coffee and tea consumption on the risk of epithelial ovarian cancer (EOC).

OBJECTIVE

In the European Prospective Investigation into Cancer and Nutrition (EPIC), we aimed to investigate whether coffee intakes, tea intakes, or both are associated with the risk of EOC.

DESIGN

All women participating in the EPIC (n = 330,849) were included in this study. Data on coffee and tea consumption were collected through validated food-frequency questionnaires at baseline. HRs and 95% CIs were estimated by using Cox proportional hazards models. Furthermore, we performed an updated meta-analysis of all previous prospective studies until April 2011 by comparing the highest and lowest coffee- and tea-consumption categories as well as by using dose-response random-effects meta-regression analyses.

RESULTS

During a median follow-up of 11.7 y, 1244 women developed EOC. No association was observed between the risk of EOC and coffee consumption [HR: 1.05 (95% CI: 0.75, 1.46) for the top quintile compared with no intake] or tea consumption [HR: 1.07 (95% CI: 0.78, 1.45) for the top quintile compared with no intake]. This lack of association between coffee and tea intake and EOC risk was confirmed by the results of our meta-analysis.

CONCLUSION

Epidemiologic studies do not provide sufficient evidence to support an association between coffee and tea consumption and risk of ovarian cancer.

American Cancer Society Guidelines on nutrition and physical activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity

The American Cancer Society (ACS) publishes Nutrition and Physical Activity Guidelines to serve as a foundation for its communication, policy, and community strategies and, ultimately, to affect dietary and physical activity patterns among Americans. These Guidelines, published approximately every 5 years, are developed by a national panel of experts in cancer research, prevention, epidemiology, public health, and policy, and they reflect the most current scientific evidence related to dietary and activity patterns and cancer risk. The ACS Guidelines focus on recommendations for individual choices regarding diet and physical activity patterns, but those choices occur within a community context that either facilitates or creates barriers to healthy behaviors. Therefore, this committee presents recommendations for community action to accompany the 4 recommendations for individual choices to reduce cancer risk. These recommendations for community action recognize that a supportive social and physical environment is indispensable if individuals at all levels of society are to have genuine opportunities to choose healthy behaviors. The ACS Guidelines are consistent with guidelines from the American Heart Association and the American Diabetes Association for the prevention of coronary heart disease and diabetes, as well as for general health promotion, as defined by the 2010 Dietary Guidelines for Americans and the 2008 Physical Activity Guidelines for Americans.

Tea consumption and epithelial ovarian cancer risk: a systematic review of observational studies

Ovarian cancer is the seventh most common type of cancer in the United States and is often not diagnosed until late stages. Thus, identifying potential risk factors and prevention strategies is particularly important. This systematic review analyzes existing evidence on the association between tea consumption and epithelial ovarian cancer risk in human observational studies. PubMed was searched through September 30, 2010 for eligible articles; 16 articles met the inclusion criteria for this systematic review. Five studies found overall tea intake to be associated with a decreased epithelial ovarian cancer risk, 1 found a borderline decreased risk, 9 found no association, and 1 found a borderline increased risk. Overall, it does not appear that tea consumption increases risk of ovarian cancer, but there is insufficient evidence at this point to conclude that it is protective against ovarian cancer. Many of the studies included in this review had important limitations, especially related to the lack of detailed data collected on tea consumption. Further research is needed and should focus on more detailed assessment of type of tea consumed, frequency, and duration of tea intake. Future studies should also explore potential differences in the association between tea intake and ovarian cancer risk among subpopulations.

Coffee and its consumption: benefits and risks

Coffee is the leading worldwide beverage after water and its trade exceeds US $10 billion worldwide. Controversies regarding its benefits and risks still exist as reliable evidence is becoming available supporting its health promoting potential; however, some researchers have argued about the association of coffee consumption with cardiovascular complications and cancer insurgence. The health-promoting properties of coffee are often attributed to its rich phytochemistry, including caffeine, chlorogenic acid, caffeic acid, hydroxyhydroquinone (HHQ), etc. Many research investigations, epidemiological studies, and meta-analyses regarding coffee consumption revealed its inverse correlation with that of diabetes mellitus, various cancer lines, Parkinsonism, and Alzheimer's disease. Moreover, it ameliorates oxidative stress because of its ability to induce mRNA and protein expression, and mediates Nrf2-ARE pathway stimulation. Furthermore, caffeine and its metabolites help in proper cognitive functionality. Coffee lipid fraction containing cafestol and kahweol act as a safeguard against some malignant cells by modulating the detoxifying enzymes. On the other hand, their higher levels raise serum cholesterol, posing a possible threat to coronary health, for example, myocardial and cerebral infarction, insomnia, and cardiovascular complications. Caffeine also affects adenosine receptors and its withdrawal is accompanied with muscle fatigue and allied problems in those addicted to coffee. An array of evidence showed that pregnant women or those with postmenopausal problems should avoid excessive consumption of coffee because of its interference with oral contraceptives or postmenopausal hormones. This review article is an attempt to disseminate general information, health claims, and obviously the risk factors associated with coffee consumption to scientists, allied stakeholders, and certainly readers.

Green and black tea in relation to gynecologic cancers

SCOPE

Observational studies have evaluated the relationship between green tea intake and cancers of the ovary and endometrium, but we are not aware of the published studies on green tea intake and risk of human papillomavirus (HPV)-related cancers of the cervix, vagina, or vulva.

METHODS AND RESULTS

A critical review of the published literature on tea intake and risk of ovarian and endometrial cancers was conducted. In meta-analyses, we report inverse associations for green tea intake and risk of ovarian cancer (odds ratio [OR]=0.66; 95% confidence interval [CI]: 0.54, 0.80), and for green tea and risk of endometrial cancer (OR=0.78, 95% CI: 0.62, 0.98). There was no association for black tea and ovarian cancer risk (OR=0.94, 95% CI: 0.87, 1.02) and a positive association with endometrial cancer risk (OR=1.20, 95% CI: 1.05, 1.38). We summarized the experimental evidence supporting the antiviral and immunomodulatory activities of green tea catechins, and results from randomized clinical trials that demonstrated green tea catechin efficacy on treatment of cervical lesions and external genital warts.

CONCLUSION

Observational data support a protective role of green tea on risk of ovarian and endometrial cancers. Observational data are needed to evaluate whether green tea reduces risk of human papillomavirus-related cancers.

Coffee consumption and risk of cancers: a meta-analysis of cohort studies

Background

Coffee consumption has been shown to be associated with cancer of various sites in epidemiological studies. However, there is no comprehensive overview of the substantial body of epidemiologic evidence.

Methods

We searched MEDLINE, EMBASE, Science Citation Index Expanded and bibliographies of retrieved articles. Prospective cohort studies were included if they reported relative risks (RRs) and corresponding 95% confidence intervals (CIs) of various cancers with respect to frequency of coffee intake. We did random-effects meta-analyses and meta-regressions of study-specific incremental estimates to determine the risk of cancer associated with 1 cup/day increment of coffee consumption.

Results

59 studies, consisting of 40 independent cohorts, met the inclusion criteria. Compared with individuals who did not or seldom drink coffee per day, the pooled RR of cancer was 0.87 (95% CI, 0.82-0.92) for regular coffee drinkers, 0.89 (0.84-0.93) for low to moderate coffee drinkers, and 0.82 (0.74-0.89) for high drinkers. Overall, an increase in consumption of 1 cup of coffee per day was associated with a 3% reduced risk of cancers (RR, 0.97; 95% CI, 0.96-0.98). In subgroup analyses, we noted that, coffee drinking was associated with a reduced risk of bladder, breast, buccal and pharyngeal, colorectal, endometrial, esophageal, hepatocellular, leukemic, pancreatic, and prostate cancers.

Conclusions

Findings from this meta-analysis suggest that coffee consumption may reduce the total cancer incidence and it also has an inverse association with some type of cancers.

Coffee consumption and risk of cancers: a meta-analysis of cohort studies

BACKGROUND

Coffee consumption has been shown to be associated with cancer of various sites in epidemiological studies. However, there is no comprehensive overview of the substantial body of epidemiologic evidence.

METHODS

We searched MEDLINE, EMBASE, Science Citation Index Expanded and bibliographies of retrieved articles. Prospective cohort studies were included if they reported relative risks (RRs) and corresponding 95% confidence intervals (CIs) of various cancers with respect to frequency of coffee intake. We did random-effects meta-analyses and meta-regressions of study-specific incremental estimates to determine the risk of cancer associated with 1 cup/day increment of coffee consumption.

RESULTS

59 studies, consisting of 40 independent cohorts, met the inclusion criteria. Compared with individuals who did not or seldom drink coffee per day, the pooled RR of cancer was 0.87 (95% CI, 0.82-0.92) for regular coffee drinkers, 0.89 (0.84-0.93) for low to moderate coffee drinkers, and 0.82 (0.74-0.89) for high drinkers. Overall, an increase in consumption of 1 cup of coffee per day was associated with a 3% reduced risk of cancers (RR, 0.97; 95% CI, 0.96-0.98). In subgroup analyses, we noted that, coffee drinking was associated with a reduced risk of bladder, breast, buccal and pharyngeal, colorectal, endometrial, esophageal, hepatocellular, leukemic, pancreatic, and prostate cancers.

CONCLUSIONS

Findings from this meta-analysis suggest that coffee consumption may reduce the total cancer incidence and it also has an inverse association with some type of cancers.

Epidemiologic evidence on coffee and cancer

Coffee consumption is a major and frequent dietary exposure in diverse cultures around the globe whose safety has been questioned. A substantial body of epidemiologic evidence, consisting of over 500 papers relating the consumption of coffee to cancer of various sites, has accumulated to date. Numerous individual, site-specific meta analyses have been undertaken at various times. However, there is no comprehensive, up-to-date overview of the entirety of the knowledge base. To address this need, this review summarized the findings of the meta analyses and recent papers on site-specific human cancers among coffee consumers. For hepatocellular and endometrial cancers, there appears to be a strong and consistent protective association; for colorectal cancer, the direction of association is borderline protective. There appears to be no association with breast, pancreatic, kidney, ovarian, prostate, or gastric cancer. Risk of bladder cancer appears to be associated with heavy coffee consumption in some populations and among men. The associations with childhood leukemia and mother's consumption of coffee were ambiguous-with some suggestion of risk at high levels of daily consumption.

Relationship between caffeine intake and plasma sex hormone concentrations in premenopausal and postmenopausal women

BACKGROUND

Circulating estrogens and androgens are important factors in the development of various female cancers. Caffeine intake may decrease risk of breast and ovarian cancer, although the data are not entirely consistent. Whether or not caffeine affects cancer risk by altering sex hormone levels is currently unknown.

METHODS

We examined the relationship of caffeine, coffee, decaffeinated coffee, and tea with plasma concentrations of estrogens, androgens, progesterone, prolactin, and sex hormone-binding globulin (SHBG) in 524 premenopausal and 713 postmenopausal women from the Nurses' Health Study (NHS) and NHSII.

RESULTS

In premenopausal women, caffeine intake was inversely associated with luteal total and free estradiol, and positively associated with luteal progesterone levels (P-trend = .02, .01, .03, respectively). Coffee intake was significantly associated with lower luteal total and free estradiol levels, but not luteal progesterone levels (P-trend = .007, .004, .20, respectively). Among the postmenopausal women, there was a positive association between caffeine and coffee intake and SHBG levels (P-trend = .03 and .06, respectively). No significant associations were detected with the other hormones.

CONCLUSIONS

Data from this cross-sectional study suggest that caffeine may alter circulating levels of luteal estrogens and SHBG, representing possible mechanisms by which coffee or caffeine may be associated with pre- and postmenopausal malignancies, respectively. Future studies evaluating how caffeine-mediated alterations in sex hormones and binding protein levels affect the risk of female cancers are warranted.

Tea and health: preventive and therapeutic usefulness in the elderly?

PURPOSE OF REVIEW

To update the growing literature suggesting that tea and its constituent flavonoids are inversely related to the risk of chronic diseases common among the elderly.

RECENT FINDINGS

Results are provided from recent observational studies and clinical trials on the relationship of tea and tea catechins to body weight control and energy metabolism, impaired glucose tolerance and diabetes, cardiovascular disease, bone mineral density, cognitive function and neurodegenerative disease, and cancer. The evidence for the efficacy and potency of tea and tea extracts in benefiting these outcomes ranges from compelling for cardiovascular disease to equivocal at best for some forms of cancer.

SUMMARY

Although randomized clinical trials of tea have generally been of short duration and with small sample sizes, together with experimental and epidemiological studies, the totality of the data suggests a role for tea in health promotion as a beverage absent in calories and rich in phytochemicals. Further research is warranted on the putative benefits of tea and the potential for synergy among its constituent flavonoids, L-theanine, and caffeine.

Coffee intake, variants in genes involved in caffeine metabolism, and the risk of epithelial ovarian cancer

We evaluated whether genetic variability, as well as menopausal status, modify the association between coffee intake and risk of ovarian cancer. Risk factor information and biologic specimens from three large epidemiological studies, the Nurses' Health Study (NHS), NHSII, and the New England based Case-Control Study of ovarian cancer (NECC) were pooled resulting in 1,354 ovarian cancer cases and 1,851 controls for analysis. Odds ratios (ORs) and 95% confidence intervals (CI) were estimated using conditional (NHS/NHSII) and unconditional (NECC) logistic regression. Coffee consumption was not associated with overall risk (OR = 0.99; 95% CI 0.77-1.28); however, there was a suggested increased risk of ovarian cancer among premenopausal women in the NECC only and an inverse association among postmenopausal women. Carrying one or both of the variant CYP19013 A or CYP19027 G alleles was associated with an 18% increased (P for trend = 0.02) and 15% decreased (P for trend = 0.05) risk of ovarian cancer, respectively. Variation in CYP1A1, CYP1A2, or CYP2A6 did not explain the inconsistent reports of coffee intake and risk. Furthermore, we did not observe any clear gene-environment interactions between caffeine metabolizing genes and ovarian cancer. Future studies evaluating mechanisms by which coffee mediates this relationship are warranted.

Coffee and caffeine intake and the risk of ovarian cancer: the Iowa Women's Health Study

Laboratory data suggest that caffeine or some components of coffee may cause DNA mutations and inhibit tumor suppressor mechanisms, leading to neoplastic growth. However, coffee consumption has not been clearly implicated in the etiology of human postmenopausal ovarian cancer. This study evaluated the relationship of coffee and caffeine intake with risk of epithelial ovarian cancer in a prospective cohort study of 29,060 postmenopausal women. The participants completed a mailed questionnaire that assessed diet and health history and were followed for ovarian cancer incidence from 1986 to 2004. Age-adjusted and multivariate-adjusted hazard ratios were calculated for four exposure variables: caffeinated coffee, decaffeinated coffee, total coffee, and total caffeine to assess whether or not coffee or caffeine influences the risk of ovarian cancer. An increased risk was observed in the multivariate model for women who reported drinking five or more cups/day of caffeinated coffee compared to women who reported drinking none (HR = 1.81, 95% CI: 1.10-2.95). Decaffeinated coffee, total coffee, and caffeine were not statistically significantly associated with ovarian cancer incidence. Our results suggest that a component of coffee other than caffeine, or in combination with caffeine, may be associated with increased risk of ovarian cancer in postmenopausal women who drink five or more cups of coffee a day.

A review of the epidemiological evidence on tea, flavonoids, and lung cancer

Tea and its main bioactive ingredients, the flavonoids, have been associated with human cancer for several decades. In this article, an overview is provided of observational epidemiological studies of lung cancer incidence in relation to intake of green tea, black tea, flavonols/flavones, and catechins. A PubMed search was conducted in September 2007. Articles were selected if they provided risk ratios (relative risk or odds ratio) for lung cancer and were of observational design (cohort, case-control, or case-cohort). Three of 12 studies reported a significantly lower risk of lung cancer with a high intake of flavonoids, whereas 1 study reported a significantly increased risk. After stratification by type of flavonoid, catechin intake was no longer associated with lung cancer risk in 3 of 4 studies available. For tea, 4 of 20 studies reported significantly reduced risks with high intake. Two studies found significantly increased risk ratios, but both were older studies. Findings were similar for green and black tea but became more significant when only methodologically sounder cohort studies were considered. When tea intake and lung cancer were studied among never- or former smokers to eliminate the confounding effect of smoking, 4 of 7 reported associations were significantly protective. In general, the studies on tea, flavonoids, and lung cancer risk indicate a small beneficial association, particularly among never-smokers. More well-designed cohort studies, in particular for catechins, are needed to strengthen the evidence on effects of long-term exposure to physiological doses of dietary flavonoids.