Association between Alcohol Consumption and Cancers in the Chinese Population—A Systematic Review and Meta-Analysis

Background Alcohol consumption is increasing worldwide and is associated with numerous cancers. This systematic review examined the role of alcohol in the incidence of cancer in the Chinese population. Methods Medline/PubMed, EMBASE, CNKI and VIP were searched to identify relevant studies. Cohort and case-control studies on the effect of alcohol use on cancers in Chinese were included. Study quality was evaluated using the Newcastle-Ottawa Scale. Data were independently abstracted by two reviewers. Odds ratios (OR) or relative risks (RR) were pooled using RevMan 5.0. Heterogeneity was evaluated using the Q test and I-squared statistic. P<.01 was considered statistically significant. Results Pooled results from cohort studies indicated that alcohol consumption was not associated with gastric cancer, esophageal cancers (EC) or lung cancer. Meta-analysis of case-control studies showed that alcohol consumption was a significant risk factor for five cancers; the pooled ORs were 1.79 (99% CI, 1.47–2.17) EC, 1.40 (99% CI, 1.19–1.64) gastric cancer, 1.56 (99% CI, 1.16–2.09) hepatocellular carcinoma, 1.21 (99% CI, 1.00–1.46) nasopharyngeal cancer and 1.71 (99% CI, 1.20–2.44) oral cancer. Pooled ORs of the case-control studies showed that alcohol consumption was protective for female breast cancer and gallbladder cancer: OR 0.76 (99% CI, 0.60–0.97) and 0.70 (99% CI, 0.49–1.00) respectively. There was no significant correlation between alcohol consumption and lung cancer, colorectal cancer, pancreatic cancer, cancer of the ampulla of Vater, prostate cancer or extrahepatic cholangiocarcinoma. Combined results of case-control and cohort studies showed that alcohol consumption was associated with 1.78- and 1.40-fold higher risks of EC and gastric cancer but was not significantly associated with lung cancer. Conclusions Health programs focused on limiting alcohol intake may be important for cancer control in China. Further studies are needed to examine the interaction between alcohol consumption and other risk factors for cancers in Chinese and other populations.

[1]  C. la Vecchia,et al.  Alcohol drinking and pancreatic cancer risk: a meta‐analysis of the dose‐risk relation , 2010, International journal of cancer.

[2]  Wei Liu,et al.  Risk factors for intrahepatic and extrahepatic cholangiocarcinoma: a case–control study in China , 2010, Liver international (Print).

[3]  Hao Li,et al.  Relationship between the expression of hTERT and EYA4 mRNA in peripheral blood mononuclear cells with the progressive stages of carcinogenesis of the esophagus , 2009, Journal of experimental & clinical cancer research : CR.

[4]  Z. Pan,et al.  Risk factors for sporadic colorectal cancer in southern Chinese. , 2009, World journal of gastroenterology.

[5]  H. Cao,et al.  Polymorphisms of alcohol dehydrogenase-2 and aldehyde dehydrogenase-2 and esophageal cancer risk in Southeast Chinese males. , 2009, World journal of gastroenterology.

[6]  P. van’t Veer,et al.  Green tea drinking, high tea temperature and esophageal cancer in high‐ and low‐risk areas of Jiangsu Province, China: A population‐based case–control study , 2009, International journal of cancer.

[7]  P. Liao,et al.  Interaction of methylenetetrahydrofolate reductase C677T, cytochrome P4502E1 polymorphism and environment factors in esophageal cancer in Kazakh population. , 2008, World journal of gastroenterology.

[8]  L. Hou,et al.  Association of transforming growth factor-beta 1 polymorphisms with genetic susceptibility to TNM stage I or II gastric cancer. , 2008, Japanese journal of clinical oncology.

[9]  K. Matsuo,et al.  Polymorphisms of alcohol dehydrogenase 2 and aldehyde dehydrogenase 2 and colorectal cancer risk in Chinese males. , 2008, World journal of gastroenterology.

[10]  X. Fang,et al.  An expression of squamous cell carcinoma antigen 2 in peripheral blood within the different stages of esophageal carcinogenesis. , 2008, Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus.

[11]  Y. Nishino,et al.  Mass screening-based case-control study of diet and prostate cancer in Changchun, China. , 2008, Asian journal of andrology.

[12]  Tao-Tao Liu,et al.  A case-control study of the relationship between hepatitis B virus DNA level and risk of hepatocellular carcinoma in Qidong, China. , 2008, World journal of gastroenterology.

[13]  W. Tan,et al.  Functional Variants in Cell Death Pathway Genes and Risk of Pancreatic Cancer , 2008, Clinical Cancer Research.

[14]  Jian-Min Yuan,et al.  Alcohol, Tobacco, and Diet in Relation to Esophageal Cancer: The Shanghai Cohort Study , 2008, Nutrition and cancer.

[15]  Qin Wang,et al.  Genetic polymorphisms in cytochrome P4502E1, alcohol and aldehyde dehydrogenases and the risk of esophageal squamous cell carcinoma in Gansu Chinese males. , 2008, World journal of gastroenterology.

[16]  Y. Ke,et al.  p53 Codon 72 polymorphism and the risk of esophageal squamous cell carcinoma , 2008, Molecular carcinogenesis.

[17]  Ju-sheng Lin,et al.  DNA methyltransferase 3B promoter polymorphism and its susceptibility to primary hepatocellular carcinoma in the Chinese Han nationality population: a case-control study. , 2007, World journal of gastroenterology.

[18]  Shu-Juan Yang,et al.  Genetic polymorphisms of ADH2 and ALDH2 association with esophageal cancer risk in southwest China. , 2007, World journal of gastroenterology.

[19]  Jia Cao,et al.  CYP2E1 Rsa I polymorphism impacts on risk of colorectal cancer association with smoking and alcohol drinking. , 2007, World journal of gastroenterology.

[20]  G. Jin,et al.  [Correlations of polymorphisms of TGFB1 and TGFBR2 genes to genetic susceptibility to gastric cancer]. , 2007, Ai zheng = Aizheng = Chinese journal of cancer.

[21]  Jian-ming Wang,et al.  [Study on the association between total plasma homocysteine levels, dietary habits and the risk of gastric cancer]. , 2007, Zhonghua liu xing bing xue za zhi = Zhonghua liuxingbingxue zazhi.

[22]  G. Zhu,et al.  Association of the TP53 codon 72 polymorphism with colorectal cancer in a Chinese population. , 2007, Japanese journal of clinical oncology.

[23]  Wei Zhang,et al.  [Relationship between DNA repair gene XRCC1 Arg399Gln polymorphism and susceptibility to prostate cancer in the Han population in Jiangsu and Anhui]. , 2007, Zhonghua nan ke xue = National journal of andrology.

[24]  Yang Zhang,et al.  [Correlations of single nucleotide polymorphisms of DNA repair gene XRCC1 to risk of colorectal cancer]. , 2007, Ai zheng = Aizheng = Chinese journal of cancer.

[25]  Biao Xu,et al.  Diet habits, alcohol drinking, tobacco smoking, green tea drinking, and the risk of esophageal squamous cell carcinoma in the Chinese population , 2007, European journal of gastroenterology & hepatology.

[26]  S. Cox,et al.  Etiological study of esophageal squamous cell carcinoma in an endemic region: a population-based case control study in Huaian, China , 2006, BMC Cancer.

[27]  汪郁,et al.  固定矫治器在颌骨骨折的应用 , 2006 .

[28]  C. Holman,et al.  Green tea and the prevention of breast cancer: a case-control study in Southeast China. , 2006, Carcinogenesis.

[29]  X. Miao,et al.  [Polymorphisms of the DNA repair genes XRCC1 and XPC: relationship to pancreatic cancer risk]. , 2006, Wei sheng yan jiu = Journal of hygiene research.

[30]  Alan R. Boobis,et al.  Meta-analysis of Studies of Alcohol and Breast Cancer with Consideration of the Methodological Issues , 2006, Cancer Causes & Control.

[31]  Kun Chen,et al.  [Association of single nucleotide polymorphisms and haplotypes in DNA repair gene XRCC1 with susceptibility of breast cancer]. , 2006, Zhejiang da xue xue bao. Yi xue ban = Journal of Zhejiang University. Medical sciences.

[32]  J. Fraumeni,et al.  Tea drinking and the risk of biliary tract cancers and biliary stones: A population‐based case–control study in Shanghai, China , 2006, International journal of cancer.

[33]  Wei Zhang,et al.  Genetic polymorphisms in the cytochrome P450 1A1 and 2E1 genes, smoking, drinking and prostate cancer susceptibility: A case‐control study in a Han nationality population in Southern China , 2006, International journal of urology : official journal of the Japanese Urological Association.

[34]  Zuo-Feng Zhang,et al.  Dietary selenium intake, aldehyde dehydrogenase‐2 and X‐ray repair cross‐complementing 1 genetic polymorphisms, and the risk of esophageal squamous cell carcinoma , 2006, Cancer.

[35]  L. Cai,et al.  [DNA repair gene XRCC3 Thr241Met polymorphism and susceptibility to cardia and non-cardia gastric cancer: a case-control study]. , 2006, Zhonghua liu xing bing xue za zhi = Zhonghua liuxingbingxue zazhi.

[36]  Jian-Min Yuan,et al.  Prediagnostic level of serum retinol in relation to reduced risk of hepatocellular carcinoma. , 2006, Journal of the National Cancer Institute.

[37]  N. Seixas,et al.  Occupational exposures and risks of liver cancer among Shanghai female textile workers--a case-cohort study. , 2006, International journal of epidemiology.

[38]  Zuo-Feng Zhang,et al.  Association of smoking, alcohol drinking and dietary factors with esophageal cancer in high- and low-risk areas of Jiangsu Province, China. , 2006, World journal of gastroenterology.

[39]  F. Stickel,et al.  Alcohol Consumption and Cancer of the Gastrointestinal Tract , 2006, Digestive Diseases.

[40]  Jang-Ming Lee,et al.  Relationship between genetic polymorphisms of alcohol and aldehyde dehydrogenases and esophageal squamous cell carcinoma risk in males. , 2005, World journal of gastroenterology.

[41]  B. Graubard,et al.  Toenail selenium and risk of hepatocellular carcinoma mortality in Haimen City, China , 2005, International journal of cancer.

[42]  C. Abnet,et al.  Prospective study of risk factors for esophageal and gastric cancers in the Linxian general population trial cohort in China , 2005, International journal of cancer.

[43]  A. Trentham-Dietz,et al.  Differences in breast cancer risk factors by tumor marker subtypes among premenopausal Vietnamese and Chinese women. , 2005, Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology.

[44]  Xinru Wang,et al.  A novel genetic polymorphism of inducible nitric oxide synthase is associated with an increased risk of gastric cancer. , 2004, World journal of gastroenterology.

[45]  施健,et al.  Meta analyses of risk factors for pancreatic cancer in China , 2004 .

[46]  X. Miao,et al.  [A case-control study on the polymorphisms of methylenetetrahydrofolate reductases, drinking interaction and susceptibility in colorectal cancer]. , 2004, Zhonghua liu xing bing xue za zhi = Zhonghua liuxingbingxue zazhi.

[47]  De-zhong Xu,et al.  Genetic susceptibility and environmental factors of esophageal cancer in Xi'an. , 2004, World journal of gastroenterology.

[48]  P. Su,et al.  [Interactions between lifestyle, methylanetetrahydrofolate reductase gene and polymorphisms in thymidylate synthase gene with risk of stomach cancer]. , 2003, Zhonghua liu xing bing xue za zhi = Zhonghua liuxingbingxue zazhi.

[49]  Zuo-Feng Zhang,et al.  [A case-control study on drinking green tea and decreasing risk of cancers in the alimentary canal among cigarette smokers and alcohol drinkers]. , 2003, Zhonghua liu xing bing xue za zhi = Zhonghua liuxingbingxue zazhi.

[50]  S. Thompson,et al.  Quantifying heterogeneity in a meta‐analysis , 2002, Statistics in medicine.

[51]  W. Chow,et al.  Cigarette and alcohol consumption and the risk of colorectal cancer in Shanghai, China , 2002, European journal of cancer prevention : the official journal of the European Cancer Prevention Organisation.

[52]  L. Ke,et al.  Congou tea drinking and oesophageal cancer in South China , 2002, British Journal of Cancer.

[53]  L. Cai,et al.  Cytochrome P450 2E1 genetic polymorphism and gastric cancer in Changle, Fujian Province. , 2001, World journal of gastroenterology.

[54]  G. Corrao,et al.  A meta-analysis of alcohol drinking and cancer risk , 2001, British Journal of Cancer.

[55]  M. Blaser,et al.  Gastric dysplasia and gastric cancer: Helicobacter pylori, serum vitamin C, and other risk factors. , 2000, Journal of the National Cancer Institute.

[56]  S. Akiba,et al.  A case-control study of nasopharyngeal carcinoma in the high background radiation areas of Yangjiang, China. , 2000, Journal of radiation research.

[57]  Y. Xiang,et al.  Non‐dietary risk factors for nasopharyngeal carcinoma in Shanghai, China , 2000, International journal of cancer.

[58]  G. Matanoski,et al.  Mutagenic drinking water and risk of male esophageal cancer: a population-based case-control study. , 1999, American journal of epidemiology.

[59]  T. Takezaki,et al.  Protective Effect of Allium Vegetables against Both Esophageal and Stomach Cancer: A Simultaneous Case‐referent Study of a High‐epidemic Area in Jiangsu Province, China , 1999, Japanese journal of cancer research : Gann.

[60]  T. Okubo,et al.  Nested case-control study of esophageal cancer in relation to occupational exposure to silica and other dusts. , 1999, American journal of industrial medicine.

[61]  Xiao Wang,et al.  A case-control study of risk factors for hepatocellular carcinoma in Henan, China. , 1998, The American journal of tropical medicine and hygiene.

[62]  F. Speizer,et al.  Alcohol and breast cancer in women: a pooled analysis of cohort studies. , 1998, JAMA.

[63]  C. J. Chen,et al.  Genetic polymorphisms of CYP2E1, GSTM1, and GSTT1; environmental factors and risk of oral cancer. , 1997, Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology.

[64]  J. Fraumeni,et al.  The influence of cigarette smoking, alcohol, and green tea consumption on the risk of carcinoma of the cardia and distal stomach in Shanghai, China , 1996, Cancer.

[65]  N. Day,et al.  Stopping drinking and risk of oesophageal cancer , 1995, BMJ.

[66]  S. Greenland,et al.  Methods for trend estimation from summarized dose-response data, with applications to meta-analysis. , 1992, American journal of epidemiology.

[67]  T. Chalmers,et al.  A meta-analysis of alcoholic beverage consumption in relation to risk of colorectal cancer , 1990, Cancer Causes & Control.

[68]  J. Chang-Claude,et al.  An epidemiological study of precursor lesions of esophageal cancer among young persons in a high-risk population in Huixian, China. , 1990, Cancer research.

[69]  W. G. Cochran The combination of estimates from different experiments. , 1954 .

[70]  C. Alberti,et al.  Hereditary/familial versus sporadic prostate cancer: few indisputable genetic differences and many similar clinicopathological features. , 2010, European review for medical and pharmacological sciences.

[71]  Scott M Langevin,et al.  Review of studies on metabolic genes and cancer in populations of African descent , 2010, Genetics in Medicine.

[72]  L. Cai,et al.  [Meta-analysis on the relationship between alcohol consumption and lung cancer risk]. , 2009, Wei sheng yan jiu = Journal of hygiene research.

[73]  X. Ju,et al.  [Correlation of prostate cancer susceptibility with genetic polymorphism of cytochrome P450 2E1, smoking and drinking: a case-control study in the population of Nanjing area]. , 2009, Zhonghua nan ke xue = National journal of andrology.

[74]  Xu Yao-chu Relationship Between IL-12B Gene Polymorphism and the Susceptibility of Gastric Cancer , 2009 .

[75]  Hu Xiaoqi,et al.  The prevalence of heavy drinking among adults in China. , 2009 .

[76]  C. Jia Relationship of genetic polymorphisms in thymidylate synthase and alcohol drinking with risk of colorectal cancer , 2009 .

[77]  Tan Zhirou A case-control study on the association between genetic polymorphism of GSTM1 and gastric cancer susceptibility in population from Guangxi province of China , 2009 .

[78]  Xu Zhi-yong META-ANALYSIS ON THE RISK FACTORS OF ESOPHAGEAL CANCER IN CHINA , 2009 .

[79]  Fan Zhi-ning The associations between the Klotho gene G-395A and C1818T polymorphisms and the risk of gastric cancer , 2008 .

[80]  X. Biao Polymorphism of DNA repair gene XPD and XRCC1 and its relationship with esophageal squamous cell carcinoma , 2008 .

[81]  Li Qun-we Interaction of Risk Factors for Esophageal Cancer in Dongping County , 2008 .

[82]  Du Zhong-han A Case-Control Study for Detecting Risk Factors of Primary Hepatocellular Carcinoma in Nanchong City , 2008 .

[83]  Hu Xiao-shu The effect of green tea and its possible interactions with relevant factors on lung cancer in Dafeng county,Jiangsu province,China , 2008 .

[84]  Li Zhi-hong Polymorphism of microsomal epoxide hydrolase and susceptibility to primary hepatocellular carcinoma , 2008 .

[85]  Zhang Li-wei Study on relationship between genetic polymorphisms in methylenetetrahydrofolate reductase and risk of Kazakh's esophageal cancer in Xinjiang , 2008 .

[86]  Cui Ya-ling META-ANALYSIS ON THE ASSOCIATION OF HEPATOCELLULAR CARCINOMA WITH ALCOHOL DRINKING AMONG CHINESE PEOPLE , 2008 .

[87]  Chan-Il Jun Relationship among ADH2 and ALDH2 genotypes, alcohol drinking and risk of primary hepatocellular carcinoma , 2007 .

[88]  Lu Chang-dong Meta-analysis of the relationship between alcohol drinking and gastric cancer in Chinese people , 2007 .

[89]  Wu Jian-zhong Polymorphisms of GSTM1, GSTT1 and GSTP1 and susceptibility of rectal cancer , 2007 .

[90]  Z. Jiao Relationship between the Methylenetetrahydrofolate Reductase A1298C Genetic Polymorphisms and Susceptibility to Gastric Cancer , 2007 .

[91]  Zhou Yongsheng A elementary study on risk factors of breast cancer of women in Shenzhen Baoan area , 2006 .

[92]  Duan Xiu-fang A Prospective Study of the Effect of Smoking and Body Mass Index on the Risk of Lung Cancer in Male Workers of Beijing Steel Industry , 2006 .

[93]  Wang Li-na,et al.  Molecular epidemiological study on the relationship between polymorphism of reduced folate carrier gene RFC1-G80A and susceptibility of gastric cancer , 2006 .

[94]  Zang Tong-hua Conditional logistic analysis of smoking, alcohol consumption and gastric cancer , 2006 .

[95]  S. Jing Relationship between polymorphism of E-cadherin gene and genetic susceptibility of non-cardia gastric cancer , 2006 .

[96]  Z. Jiao,et al.  Influence of GSTM1 and GSTT1 Genotypes and Smoking, Alcohol Exposure on the Occurrence of Gastric Cancer: Case-control Study from Nanjing, China , 2006 .

[97]  J. Fraumeni,et al.  Risk Factors for Oral and Pharyngeal Cancer in Shanghai , with Emphasis on Diet 1 , 2005 .

[98]  Zheng Zongl Study on C667T gene polymorphism and susceptibility to gastric cancer , 2005 .

[99]  Wang Chang-cheng Heavy alcohol consumption can enhance risk of hepatocellular carcinom a associated with hepatitis B virus infection , 2005 .

[100]  Xin Zhi-chun META-ANALYSIS OF THE RELATIONSHIP BETWEEN PSYCHOLOGICAL FACTORS、LIVING HABITS AND GASTRIC CANCER IN CHINESE PEOPLE , 2005 .

[101]  Shu Zheng,et al.  Alcohol drinking and colorectal cancer: A population-based prospective cohort study in China , 2004, European Journal of Epidemiology.

[102]  Gao Changming Relationship between polymorphisms of methylenetetrahydrofolate reductase A1298C and the susceptibility of gastric cancer , 2004 .

[103]  Xiao Shu-dong Non-dietary factors and gastric cancer: a case-control study , 2004 .

[104]  Shi Rui-hua Impact of CYP2E1 Polymorphisms on the Risk of Esophageal Cancer , 2004 .

[105]  Zhang Xue-hong Cigarette Smoking,Alcohol Consumption and Risk of Biliary Tract Cancers:A Population-based Case-control Study in Shanghai,China , 2004 .

[106]  Li Hui-qing Study of a CYP1A1 genotype associated with susceptibility to esophageal cancer , 2004 .

[107]  Xie Wei Meta analyses of risk factors for pancreatic cancer in China. , 2004 .

[108]  Ding Jian-hua,et al.  Impact of Genetic Polymorphisms of Glutathione S-transferaseT1,M1 on the Risk of Primary Hepatocellular Carcinoma in Alcohol Drinkers , 2004 .

[109]  W. Bo Meta-analysis of risk factors of esophageal cancer in Xi’an , 2004 .

[110]  Li Yan To investigate the relationship of alcohol intake and primary hepatocellular carcinoma (The etiologic factor of 1057 PHC in JILIN province) , 2003 .

[111]  Yang You-de Study on Risk Factors of Esophageal Cancer in Feicheng City , 2003 .

[112]  Zhou Jian-nong Interaction between Polymorphisms in CYP2E1 Rsa I Genotypes and Lifestyle with Risk of Stomach Cancer , 2003 .

[113]  T. Feng Meta-analysis of risk factors of esophageal cancer in China , 2003 .

[114]  Chen Si A case-control study of the impact of CYP2E1 RsaI polymorphism on the risk of lung cancer , 2002 .

[115]  G. Chang Effects of GSTT1 and GSTM1 Genotypes,Lifestyle Factors and Their Interactions on Risk of Esophageal and Stomach Cancers , 2002 .

[116]  Ding Jian Polymorphisms of Aldehyde Dehydrogenase-2 Genotypes and Alcohol Consumption for the Susceptibility of the Liver Cancer,Stomach Cancer and Esophageal Cancer , 2002 .

[117]  Ding Jianhua Polymorphisms of methylenetetrahydrofolate reductase C677T and the risk of esophageal cancer , 2002 .

[118]  C. Jian Dietary and Other Living Habits and the Risk of Gastric Cancer in Changle, a High - Risk Area in China , 2002 .

[119]  Wu Jian Polymorphisms of Aldehyde Dehydrogenase-2 Genotypes and the Risk of Esophageal Cancer , 2001 .

[120]  L. Xin ETIOLOGICAL FRACTION AND INTERACTIONS ANALYSIS OF RISK FACTORS IN MALE ESOPHAGEAL CANCER IN TIANJIN. , 2001 .

[121]  Bao Ping A case-control study of smoking, alcohol consumption and stomach cancer , 2001 .

[122]  Yu Sun Epidemiological study of the influence of drinking green tea on gastric cancer and chronic gastritis incidence , 2001 .

[123]  R. Kurtz,et al.  GSTT1 and GSTM1 null genotypes and the risk of gastric cancer: a case-control study in a Chinese population. , 2000, Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology.

[124]  Chen Lici A Case control Study on Risk Factors of Primary Liver Cancer in Changle City, Fujian , 2000 .

[125]  Tim Stockwell,et al.  INTERNATIONAL GUIDE FOR MONITORING ALCOHOL CONSUMPTION AND RELATED HARM , 2000 .

[126]  Shen Yueping A CASE-CONTROL STUDY ON ESOPHAGEAL CANCER IN HUAIAN CITY, JIANGSU PROVINCE. (I): ROLE OF THE CIGARETTE SMOKING AND ALCOHOL DRINKING , 1999 .

[127]  K. Mak,et al.  Alcohol and cancer , 1986, Hepatology.