Alcohol intake and colorectal cancer: A comparison of approaches for including repeated measures of alcohol consumption

Department of Nutrition, Harvard School of Public Health, Boston, MA, USA.
Epidemiology (Impact Factor: 6.2). 04/2008; 19(2):258-64. DOI: 10.1097/EDE.0b013e31816339e0
Source: PubMed


In numerous studies, alcohol intake has been found to be positively associated with colorectal cancer risk. However, the majority of studies included only one exposure measurement, which may bias the results if long-term intake is relevant.
We compared different approaches for including repeated measures of alcohol intake among 47,432 US men enrolled in the Health Professionals Follow-up Study. Questionnaires including questions on alcohol intake had been completed in 1986, 1990, 1994, and 1998. The outcome was incident colorectal cancer during follow-up from 1986 to 2002.
During follow-up, 868 members of the cohort experienced colorectal cancer. Baseline, updated, and cumulative average alcohol intakes were positively associated with colorectal cancer, with only minor differences among the approaches. These results support moderately increased risk for intake >30 g/d and weaker increased risk for lower intake. The hazard ratio for baseline alcohol intake was 1.07 (95% confidence interval = 1.02-1.11) per 10 g/d increase, which was similar for updated and cumulative average alcohol intake. Consistent moderate and high alcohol intake showed increased risk, and the relative risk decreased slightly with longer latency time. Alcohol frequency was positively associated with cancer risk among men with alcohol intake above 15 g/d.
Alcohol intake was positively associated with colorectal cancer, with minor differences among analytic approaches (which may be attributable to low intraindividual variation during follow-up).

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    • "A recent meta analysis from the IARC of 34 case control and 7 cohort studies provides strong evidence for an association between alcohol consumption of more than 1 drink per day and the risk for colorectal cancer (Fedirko et al., 2011). Similar results were reported from the Netherlands (Bongaerts et al., 2008, 2010) and the US (Thygesen et al., 2008) but not from Great Britain (Park et al., 2009, 2010). "
    Colorectal Cancer - From Prevention to Patient Care, 02/2012; , ISBN: 978-953-51-0028-7
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    • "All studies (I-squared = 76.4%, p = 0.000) Tavani, 1998 Barra, 1992 Choi, 1991 Murata, 1996 All cohort studies (I-squared = 0.0%, p = 0.468) Peters, 1989 Thygesen, 2008 Peters, 1992 Otani, 2003 Cohort studies Lim & Park, 2008 Akhter, 2007 Sharpe, 2002 Pedersen, 2003 Longnecker, 1990 Ferrari, 2007 Riboli, 1991 Wakai, 2005 Author, year Murata, 1999 Boutron, 1995 Ji, 2002 All case-control studies (I-squared = 83.4%, p = 0.0001) "
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    ABSTRACT: The International Agency for Research on Cancer (IARC) concluded that alcohol consumption is related to colorectal cancer (CRC). However, several issues remain unresolved, including quantification of the association for light (≤1 drink/day) and moderate (2-3 drinks/day) alcohol drinking, investigation of the dose-response relationship, and potential heterogeneity of effects by sex, colorectal site, and geographical region. Twenty-seven cohort and 34 case-control studies presenting results for at least three categories of alcohol intake were identified from a PubMed search of articles published before May 2010. The summary relative risks (RRs) were estimated by the random effects model. Second-order fractional polynomials and random effects meta-regression models were used for modeling the dose-risk relation. The RRs were 1.21 [95% confidence interval (CI) 1.13-1.28] for moderate and 1.52 (95% CI 1.27-1.81) for heavy (≥4 drinks/day) alcohol drinking. The RR for moderate drinkers, compared with non-/occasional drinkers, was stronger for men (RR = 1.24, 95% CI 1.13-1.37) than for women (RR = 1.08, 95% CI 1.03-1.13; P(heterogeneity) = 0.02). For heavy drinkers, the association was stronger in Asian studies (RR = 1.81, 95% CI 1.33-2.46; P(heterogeneity) = 0.04). The dose-risk analysis estimated RRs of 1.07 (95% CI 1.04-1.10), 1.38 (95% CI 1.28-1.50), and 1.82 (95% CI 1.41-2.35) for 10, 50, and 100 g/day of alcohol, respectively. This meta-analysis provides strong evidence for an association between alcohol drinking of >1 drink/day and colorectal cancer risk.
    Annals of Oncology 02/2011; 22(9):1958-72. DOI:10.1093/annonc/mdq653 · 7.04 Impact Factor
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    ABSTRACT: Screening for colorectal cancer (CRC) involves consideration of only a patient’s age and their family history of CRC [1, 2], but there are other risk factors which can potentially affect screening. This section will examine known risk factors and how some of these can affect one’s risk and subsequent screening for CRC. Other factors such as personal and family history of colorectal neoplasia as well as aspirin and other chemo-preventative agents will be discussed elsewhere. This section will serve as an overview of the various factors and the respective studies that examine their association with CRC as well as advanced adenomas. Age has been shown to be one of the strongest predictors of CRC [3] and will not be discussed as there is little debate as to the importance of this factor. In addition, this chapter will examine the modifiable risk factors since this is where clinicians can help patients to reduce their risk of CRC. A study by Platz et al. demonstrated that over two thirds of CRC may be preventable in men [4]. KeywordsRisk factors-Tobacco use-Body mass index
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