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CME

Alcohol Use Associated With Colorectal Cancer Risk

  • Authors: News Author: Emma Hitt, PhD
    CME Author: Hien T. Nghiem, MD
  • CME Released: 9/19/2011
  • THIS ACTIVITY HAS EXPIRED
  • Valid for credit through: 9/19/2012
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Target Audience and Goal Statement

This article is intended for primary care clinicians, gastroenterologists, oncologists, and other specialists who care for patients who may be at risk for colorectal cancer.

The goal of this activity is to provide medical news to primary care clinicians and other healthcare professionals in order to enhance patient care.

Upon completion of this activity, participants will be able to:

  1. Report the association between alcohol consumption and cancer.
  2. Assess the dose-response relationship between alcohol consumption and the risk for colorectal cancer.


Disclosures

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Medscape, LLC, encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.


Author(s)

  • Emma Hitt, PhD

    Emma Hitt is a freelance editor and writer for Medscape.

    Disclosures

    Disclosure: Emma Hitt, PhD, has disclosed no relevant financial relationships.
    Dr. Hitt does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.
    Dr. Hitt does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Editor(s)

  • Brande Nicole Martin

    CME Clinical Editor, Medscape, LLC

    Disclosures

    Disclosure: Brande Nicole Martin has disclosed no relevant financial relationships.

CME Author(s)

  • Hien T. Nghiem, MD

    Assistant Clinical Professor, Associate Residency Program Director, University of California, Irvine-Orange, Department of Family Medicine

    Disclosures

    Disclosure: Hien T. Nghiem, MD, has disclosed no relevant financial relationships.

CME Reviewer(s)

  • Sarah Fleischman

    CME Program Manager, Medscape, LLC

    Disclosures

    Disclosure: Sarah Fleischman has disclosed no relevant financial relationships.


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CME

Alcohol Use Associated With Colorectal Cancer Risk

Authors: News Author: Emma Hitt, PhD CME Author: Hien T. Nghiem, MDFaculty and Disclosures
THIS ACTIVITY HAS EXPIRED

CME Released: 9/19/2011

Valid for credit through: 9/19/2012

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Clinical Context

Alcohol consumption is one of the most important risk factors for human cancers. Intake of alcohol is causally related to cancers of the oral cavity, pharynx, larynx, esophagus, liver, female breast, and colorectum.

The International Agency for Research on Cancer concluded that alcohol consumption is related to colorectal cancer. However, several issues remain unresolved, including quantification of the association for light and moderate alcohol drinking; investigation of the dose-response relationship; and potential heterogeneity of effects by sex, colorectal site, and geographical region.

The aim of this meta-analysis by Fedirko and colleagues was to evaluate the level of alcohol consumption and dose-risk based on observational studies published before May 2010 on alcohol consumption and colorectal cancer.

Study Synopsis and Perspective

Alcohol consumption appears to be strongly and dose-dependently linked to colorectal cancer risk, according to the findings of a new meta-analysis.

Veronika Fedirko, PhD, with the International Agency for Research on Cancer, in Lyon, France, and colleagues reported their findings in the September issue ofthe Annals of Oncology.

According to the researchers, several studies have suggested a link between alcohol consumption and colorectal cancer risk. However, "precise quantification of the association for light and/or moderate alcohol consumption and the identification of a possible threshold of effect remain to be determined." In addition, further information is needed on the "potential heterogeneity of effects by sex, colorectal site, and geographical region."

The current study included 27 cohort and 34 case-control studies published before May 2010 that reported results for at least 3 categories of alcohol intake.

Moderate alcohol consumption was associated with a 21% increase in colorectal cancer (relative risk [RR], 1.21; 95% confidence interval [CI], 1.13 - 1.28), whereas heavy drinking (≥ 4 drinks/day) was associated with a 52% increased risk (RR, 1.52; 95% CI, 1.27 - 1.81).

Compared with nondrinkers and occasional drinkers, men who drank moderate amounts of alcohol (RR, 1.24; 95% CI, 1.13 - 1.37) were more at risk than women who drank similar amounts (RR, 1.08; 95% CI, 1.03 - 1.13).

In addition, Asians were more at risk if they were heavy drinkers than were other ethnicities. The researchers state that this finding may be due in part to a high prevalence of the slow-metabolizing variant of aldehyde dehydrogenase enzyme, present among Asians.

Overall, the dose-risk analysis found a statistically significant 7% increased risk for colorectal cancer for 10 g per day of alcohol intake, which includes light alcohol consumers. According to the researchers, 1 drink is equivalent to 12 g of ethanol.

"The results from this large meta-analysis have important public health implications, given the large number of women and, especially, men consuming alcohol and the high incidence of colorectal cancer worldwide and in developed countries in particular," Dr. Fedirko and colleagues conclude.

No potential explanation was given by the researchers for a mechanism that could explain the association between alcohol consumption and colorectal cancer. In addition, the study authors note that they did not examine whether the "association of alcohol with colorectal cancer risk varied by folate status, smoking, or other potential modifying factors because very few studies investigated these associations."

This study was supported by the International Agency for Research on Cancer, the Italian Association for Research on Cancer, and the Italian Foundation for Cancer Research. The study authors have disclosed no relevant financial relationships.

Ann Oncol. 2011;22:1958-1972.

Study Highlights

  • 27 cohort and 34 case-control studies presenting results for at least 3 categories of alcohol intake were identified from a PubMed search of articles published before May 2010.
  • Nondrinkers or occasional alcohol drinkers were the reference category.
  • Light alcohol drinking was defined as consumption of 1 or less drink/day (≤ 12.5 g/day of ethanol), moderate as 2 to 3 drinks/day (12.6 - 49.9 g/day of ethanol), and heavy as consumption of 4 or more drinks/day (≥ 50 g/day of ethanol).
  • The summary RRs were estimated by the random-effects model.
  • Second-order fractional polynomials and random-effects meta-regression models were used to model the dose-risk relationship.
  • Results demonstrated that the RRs were 1.21 (95% CI, 1.13 - 1.28) for moderate alcohol drinking and 1.52 (95% CI, 1.27 - 1.81) for heavy alcohol drinking.
  • The RRs were higher for rectal cancer vs colon cancer among any drinkers (P = .03) and light drinkers (P = .05), but were the same among moderate and heavy drinkers.
  • The RR for moderate drinkers vs nondrinkers or occasional drinkers was stronger for men (RR, 1.24; 95% CI, 1.13 - 1.37) vs women (RR, 1.08; 95% CI, 1.03 - 1.13; P heterogeneity = .02).
  • For heavy drinkers, the association was stronger in Asian studies (RR, 1.81; 95% CI, 1.33 - 2.46; P heterogeneity = .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.
  • Limitations to this study included statistically significant heterogeneity among studies for moderate and high alcohol doses; type of alcoholic beverage, lifetime exposure to alcohol, and drinking patterns not included; no exclusion of studies with no adjustment for main risk factors; lack of examination of whether the association of alcohol varied with modifying factors; and possible misclassification of alcohol exposure.

Clinical Implications

  • Alcohol consumption is causally related to cancers of the oral cavity, pharynx, larynx, esophagus, liver, female breast, and colorectum.
  • There is strong evidence to support an association between alcohol drinking of more than 1 drink/day and the risk for colorectal cancer.

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