Coffee consumption and the risk of cancer: An overview
Research Center for Military Health, P.O. Box 906, Yaounde, Cameroon
Yaounde Military Hospital, P.O. Box 12794, Yaounde, Cameroon
a r t i c l e i n f o
Received 29 May 2008
Received in revised form 29 July 2008
Accepted 19 August 2008
a b s t r a c t
Habitual coffee drinking has been associated with a reduced risk of mortality and chronic
diseases, including cancer. The favourable influence of coffee is supported by several plau-
sible mechanisms due to the presence of a variety of biological compounds such as caffeine,
diterpenes, caffeic acid, polyphenols as well as volatile aroma and heterocyclic substances.
Current evidence suggests that coffee consumption is associated with a reduced risk of
liver, kidney, and to a lesser extent, premenopausal breast and colorectal cancers, while
it is unrelated to prostate, pancreas and ovary cancers. Coffee drinking may still help
reduce death due to liver cancer.
? 2008 Elsevier Ireland Ltd. All rights reserved.
Coffee is among the most widely consumed beverages
in the world and is top dietary antioxidant source in the
Nordic countries . Although some possible negative ef-
fects, such as spontaneous abortion and stillbirth have
been suggested during pregnancy , habitual coffee con-
sumption has been associated with a substantially lower
risk of mortality  as well as degenerative, progressive
and chronic diseases, including Alzheimer’s disease ,
Parkinson’s disease , type 2 diabetes , and coronary
heart disease .
The relationship between coffee and cancer holds great
interest, given a large array of compounds found in that
beverage that could potentially alter cancer risk through
several biological mechanisms. Coffee is the major source
of caffeine and some animal studies have reported caffeine
to both stimulate and suppress tumors, depending upon
the species and the phase of administration . Coffee con-
tains two specific diterpenes, cafestol and kahweal, which
produce biological effects compatible with anticarcino-
genic properties, including the induction of phase II en-
zymes involvedin carcinogen
specific inhibition of the activity of phase I enzyme respon-
sible for carcinogen activation and stimulation of intracel-
lular antioxidant defence mechanisms . Coffee is an
important source of polyphenols, such as lignan phytoes-
trogens and flavonoids  and polyphenols are found to
exhibit anticarcinogenic properties in several laboratory
and epidemiological studies [13,14].
Coffee is also a major source of the chlorogenic acid
that contributes to its antioxidant effect . Intake of
chlorogenic acid has been shown to reduce glucose con-
centrations in rats  and intake of quinides, degrada-
tion products of chlorogenic acid,
sensitivity . Chronic hyperinsulinemia and insulin
resistance are confirmed markers of high risk for some
cancer sites .
Hypermethylation of DNA is a common characteristic in
tumor cells and is a key epigenetic mechanism for silenc-
ing various genes, including those encoding the tumor
suppressor proteins, DNA repair enzymes, and receptors.
Gene-specific hypermethylation is known to be associated
with inactivation of various pathways involved in the
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Cancer Letters 277 (2009) 121–125
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inflammatory and stress response and apoptosis. It has
been demonstrated that caffeic acid, the main ingredient
of coffee, inhibits DNA methylation in cultured MCF-7
and MAD-MB-231 human cancer cells . The aim of this
paper is to provide an overview of associations between
caffeinated coffee consumption and risk of major cancer
2. Breast cancer
Breast cancer is the second leading cause of cancer-
associated deaths in women in most industrialized coun-
tries. The incidence of this disease in women in Western
countries is about 5 times that in women in developing
countries and Japan . There is no consistent associa-
tion among the case-control studies that have evaluated
the relationship between coffee consumption and the inci-
dence of breast cancer although some studies have re-
ported statistically significant
particularly among premenauposal women [8,14,20]. Pre-
liminary results from the Nurses; Health Study suggested
a weak inverse association between caffeine intake (rela-
tive risk of 0.81; 95% CI 0.71–1.00 for the fifth vs. the first
quintile) and the risk of breast cancer . A Norwegian
cohort of 14,593 women who drank P5 cups of coffee
per day experienced a statistically significant 50% de-
crease in breast cancer risk compared to those who drank
62 cups . In addition, one international investigation
assessing coffee consumption and the risk of hereditary
breast cancer reported an inverse dose-response relation-
ship. Premenopausal women with a BRCA1 or BRCA2
mutation who habitually drank 6 or more cups of coffee
per day experienced a 70% statistically significant reduc-
tion in breast cancer risk . However, a meta-analysis
of three cohort studies that addressed that association
found a nonsignificant negative association for one cup
per day of coffee consumption increase . Similarly, a
nonsignificant negative association was reported in lean
women  and in those drinking coffee at age 18–35
. Although the data are not compelling due to varia-
tion in methods of brewing, degree of roasting coffee
beans and size of cups and strength at consumption, bio-
logical mechanisms are established and some evidence
suggests that regular coffee drinking at least four cups
per day is related to modestly reduced premenauposal
breast cancer risk.
3. Colorectal cancer
Colorectal cancer is one of the most common cancers
worldwide. It is predominantly a disease of Westernized
countries with incidence rates approximately 10-fold high-
er in developed than in developing countries . It has
been suggested that coffee is a protective factor against
colorectal cancer through its carcinogenic constituents,
cafestol and kahweal  and its ability to induce excre-
tion of bile acids and neutral sterols into the colon .
Moreover, coffee might decrease colorectal cancer risk by
increasing large bowel mobility in the rectosigmoid region
, while caffeine has been shown to inhibit colon cancer
cell growth .
To date, at least a total of 20 case-control and 10 cohort
studies having examined the association between high cof-
fee consumption and colorectal cancer risk produced
mixed results. A reduced risk is supported by some case-
control studies [29–31] and the combined results of 12
case-control studies revealed a statistically significant
12% reduction in colorectal cancer risk for high coffee con-
sumption versus low consumption . Cohort studies
[33–35] showed inverse or no association and a pooled
analysis performed from 4 cohort studies showed a statis-
tically non-significant 4% reduction in risk of colorectal
cancer for the highest compared to the lowest exposure
consumption category . Indeed, such studies have in-
cluded a limited number of cases and those carried out in
the USA, Europe and Asia reporting inverse associations
between coffee and colorectal cancer were restricted to
subgroups of subjects, but not all the subjects, which were
inconsistent across studies. As well, information on coffee
consumption was collected only once and did not consider
change in consumption over time. Overall, accumulated
evidence suggests that coffee consumption has no or mod-
estly favorable influence on the risk of colorectal cancer.
4. Prostate cancer
Prostate cancer is the second most common cancer in
the world and the sixth most common cause of cancer
death. A pooled analysis of data from six cohort studies
examining the relationship between coffee consumption
and the risk of prostate cancer found a cumulative effect
estimate of 1.00 (95% CI 0.94-1.07) per cup per day in-
crease . Another meta-analysis of five case-control
studies yielded a summary odds ratio (OR) of 1.02 (95%
CI 0.99–1.04) per cup per day increase . As well, one
investigation assessed the association between prostate
cancer risk and cumulative lifetime daily coffee consump-
tion, duration of daily drinking, and age at started daily
drinking and found no important effect . Overall, cur-
rent evidence excludes any substantial association be-
tween coffee consumption and the risk of prostate cancer.
5. Ovary cancer
Ovarian cancer is both the seven most common cancer
and cause of cancer death in women worldwide. Relatively
few studies have been carried out on the efficacy of coffee
to influence the risk of ovarian cancer. An early meta-anal-
ysis of the crude data of seven case-control studies of cof-
fee consumption and ovarian cancer published before 1990
reported a combined OR of 1.3 (95% CI 1.1–1.5) for coffee
users versus nonusers . Recent case-control studies
found reduced risk [38,39] and a meta-analysis of eight
case-control studies reported a small borderline significant
negative association with a pooled OR of 0.98 (95% CI 0.96–
1.01) for additional daily consumption of coffee , while
no significant association was apparent in three prospec-
tive cohort studies [40–42]. Still, no significant association
was detected between ovarian cancer risk and combined
A. Nkondjock/Cancer Letters 277 (2009) 121–125
regular coffee consumption, alcohol drinking and smoking
. Evidence from these studies does not show that coffee
consumption has a considerable impact on ovarian cancer
6. Pancreatic cancer
Pancreatic cancer is among the leading cause of cancer-
related deaths worldwide, with a 5-year survival rate less
than 5%, and a case fatality proportion of 99% within 12
months of diagnosis . Over the past two decades, many
studies have been carried out on coffee and pancreatic can-
cer after the early warning in the early 1980s that coffee
consumption was related to pancreatic cancer risk .
Some ecological [46,47], case-control [48,49], and cohort
[50–52] studies carried out in the USA, Canada, Europe
and Asia investigated the relationship between coffee con-
sumption and the risk of pancreatic cancer. In general,
these investigations yield inconsistent results with a
meta-analysis on 25 case-control studies giving a summary
effect estimate of 1.04 (95% CI 1.0–1.07) and a summary ef-
fect estimate of 1.00 (95% CI 0.94–1.07) per 1 cup/day for
10 cohort studies . To date, evidence from previous re-
search does not point toward any association between cof-
fee and pancreatic cancer.
7. Liver cancer
Primary Liver cancer, which includes hepatocellular
carcinoma (HCC) as well as angiosarcoma, cholangiocarci-
noma, and hepatoblastoma  is the fifth most common
cancer throughout the world. The incidence is highest in
developing countries, where about 80% of all patients are
found . Several studies have considered the relation-
ship between coffee consumption and the risk of HCC. A
meta-analysis, including six case-control studies from
southern Europe and Japan (1551 cases) and four cohort
studies from Japan (709 cases) reported a statistically sig-
nificant 41% reduction in the risk among coffee drinkers
compared with never drinkers, with similar results from
case-control and prospective studies . Another meta-
analysis of four cohort and five case-control studies involv-
ing a total of 2260 cases and 239,146 noncases found that
an increased coffee consumption is associated with a re-
duced risk of liver cancer, both among individuals with
and without a history of liver disease, with a statistically
significant 43% reduction in risk for an increment of two
cups of coffee per day . Still, a meta-analysis of five
case-control and four cohort studies for the highest versus
lowest coffee consumption category showed a statistically
significant pooled association with liver cancer. Summary
estimate was 0.72 (95% CI 0.52–0.99) for case-control stud-
ies and 0.53 (95% CI 0.39–0.73) for cohort studies . A
number of putative mechanisms suggest that coffee may
protect against oxidative stress-induced liver cell damage
Iron is a cocarcinogen or a promoter of HCC, even in pa-
tients without hemochromatosis or cirrhosis . There is
suggestion that the increased intake of polyphenol com-
pounds present in coffee may maintain a relatively lower
iron status and therefore reduce the risk of liver injury
. Cirrhosis is a major risk factor for the development
of HCC . Coffee inhibits elevation of liver transaminases
 and this possible hepato-protective effect might trans-
late into reduced risk and mortality from liver cirrhosis
[61,62]. In general, meta-analyses for the highest versus
lowest coffee consumption category showed statistically
significant inverse pooled association with liver cancer
for case-control and cohort studies. Therefore, coffee con-
sumption appears to reduce the risk of liver cancer.
8. Kidney cancer
Over the past three decades, kidney cancer incidence
rates have been increasing steadily . There is specula-
tion that the risk of kidney cancer may be affected by the
quantity and type of beverages consumed since the major
functions of the kidneys are to regulate water and inor-
ganic-ion balance and to excrete waste products and for-
eign chemicals . Coffee consumption may reduce
kidney cancer risk because caffeine has a diuretic effect
by blocking anti-diuretic hormone and antioxidants in cof-
fee alleviate oxidative damage to DNA, proteins and other
molecules . Moreover, coffee consumption may reduce
the risk of kidney cancer by improving insulin sensitivity
. A possible link between insulin sensitivity and renal
cell cancer risk is suggested by the strong positive associa-
tion between obesity and renal cell cancer risk . Among
investigations that have addressed the association be-
tween coffee consumption and the risk of kidney cancer,
one ecological study  reported correlation of incidence
of 0.62 for men and 0.4 for women. A total of nineteen
case-control studies reported inconsistent results, giving
a summary estimates of 0.99 (95% CI 0.96–1.01) , while
a pooled analysis of 13 cohort studies found that, coffee
consumption was associated, but not significantly, with a
lower risk of kidney cancer overall, with a summary
estimate of 0.95 (95% CI 0.90–1.01) among women .
Overall, there is sufficient evidence showing that coffee
consumption is associated with a modestly lower risk of
9. Cancer survival
Few studies have explored the possible effect of coffee
consumption on people who are living with a diagnostic
of cancer. A particular emphasis has been placed on the
condition of liver cancer survivors. A study of 46,399
men and 64,289 women aged 40–79 years who took part
in the Japan collaborative Cohort study for Evaluation of
cancer Risk observed that increasing coffee consumption
was associated with a statistically significant 50% reduc-
tion in HCC mortality . Tverdal and Skurtveit 
examined mortality due to liver cirrhosis, a risk factor for
liver cancer at follow-up of 51,306 men and women. After
17 years, coffee consumption was related to a statistically
significant 40% decrease in death from liver cirrhosis.
Among elderly home-dwelling participants, an increment
of one more cup per day was associated with a 3% reduc-
tion in the risk of death from cancer . However, there
A. Nkondjock/Cancer Letters 277 (2009) 121–125
are findings of no significant association between coffee
drinking and death caused by cancer [71,72].
Coffee is a widely consumed beverage worldwide and
there is substantial evidence from both laboratory and ani-
mal studies for its favorable influence on the risk of cancer.
Although caution is still needed because the method of cof-
fee preparation, such as whether it is filtered or boiled, and
the type of coffee beans can change considerably with time
and vary geographically and because a variety of food
items are incorporated to coffee in various amounts, a
growing body of evidence from epidemiological investiga-
tions suggest that coffee drinking does not have harmful
effect. Instead, coffee consumption is inversely associated
with the risk of liver, kidney, and to a lesser extent, breast
and colorectal cancers. Additional well designed studies, in
particular randomized clinical studies among high risk
populations, are needed to provide valuable insights into
coffee consumption and the risk of cancer, and to deter-
mine patterns of consumption with respect to health
Dr. Nkondjock acknowledges support from the Came-
roonian Minister Delegate at the Presidency, in Charge of
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