Moderate alcohol intake and cancer: the role of underreporting

Klatsky, Arthur L.; Udaltsova, Natalia; Li, Yan; Baer, David; Tran, H. Nicole; Friedman, Gary D.

doi:10.1007/s10552-014-0372-8

Cited by 33 publications

(24 citation statements)

References 13 publications

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“…These characteristic errors would be expected to bias HRs for obesity upwards relative to measured BMI because of underreporting at the highest BMI levels [29][30][31], as documented in a number of studies [32][33][34]. Similar predictions have been noted in the context of other types of data, where underreporting of exposure at high levels would be expected to increase HRs [35][36][37]. Sociodemographic factors such as age, gender, race and socio-economic status are also related to error in reporting [38][39][40] and may introduce residual confounding that is exacerbated by the restrictions.…”

Section: Discussionmentioning

confidence: 76%

Comparative effects of the restriction method in two large observational studies of body mass index and mortality among adults

Flegal

Graubard

2017

Eur J Clin Investigation

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Background A method applied in some large studies of weight and mortality is to begin with a well-defined analytic cohort and use successive restrictions in order to control for methodologic bias and arrive at final analytic results. Materials and methods Two observational studies of body mass index and mortality allow a comparative assessment of these restrictions in very large data sets. One was a meta-analysis of individual participant data with a sample size of 8 million. The second was a study of a South Korean cohort with a sample size of 12 million. Both presented results for participants without pre-existing disease before and after restricting the sample to never smokers and deleting the first 5 years of follow-up. Results Initial results from both studies were generally similar, with hazard ratios (HRs) below 1 for overweight and above 1 for underweight and obesity. The meta-analysis showed higher HRs for overweight and obesity after the restrictions, including a change in the direction of the HR for overweight from 0.99 (95% CI 0.98–1.01) to 1.11 (95% CI 1.10, 1.11). The South Korean data showed little effect of the restrictions and the HR for overweight changed from 0.85 (95% CI 0.84–0.86) to 0.91 (95% CI 0.90, 0.91). The summary effect size for overweight was 0.90 (95% CI 0.89–0.91) before restrictions and 1.02 (95% CI 1.02, 1.03) after restrictions. Conclusions The effect of the restrictions is not consistent across studies, weakening the argument that analyses without such restrictions lack validity.

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Section: Discussionmentioning

confidence: 76%

Comparative effects of the restriction method in two large observational studies of body mass index and mortality among adults

Flegal

Graubard

2017

Eur J Clin Investigation

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“…There are several limitations of this study. First, because self‐reported alcohol and tobacco consumption can be unreliable due to the changeable nature of drinking and smoking habits or underreporting: i.e., we did not consider behavioral changes after the initial diagnosis of cancer, the analyses may produce a conservative result. Furthermore, there were differences in drinking and smoking patterns between joint categories: e.g., the proportion of heavy drinkers was higher among ever‐drinker/ever‐smoker (13.7%) than among ever‐drinker/never‐smoker (4.2%).…”

Section: Discussionmentioning

confidence: 99%

Joint and independent effect of alcohol and tobacco use on the risk of subsequent cancer incidence among cancer survivors: A cohort study using cancer registries

Tabuchi

Ozaki

Ioka

et al. 2015

Intl Journal of Cancer

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Drinking alcohol and smoking tobacco are major modifiable risk factors for cancer. However, little is known about whether these modifiable factors of cancer survivors are associated with subsequent primary cancer (SPC) incidence, regardless of the first cancer sites. 27,762 eligible cancer survivors diagnosed between 1985 and 2007 were investigated for SPC until the end of 2008, using hospital-based and population-based cancer registries. The association between drinking, smoking and combined drinking and smoking (interaction) at the time of the first cancer diagnosis and incidence of SPCs (i.e., all SPCs, alcohol-related, smoking-related and specific SPCs) was estimated by Poisson regression. Compared with never-drinker/neversmoker, the categories ever-drinker/ever-smoker, current-drinker/current-smoker and heavy-drinker/heavy-smoker had 43-108%, 51-126% and 167-299% higher risk for all, alcohol-related and tobacco-related SPCs, respectively. The interaction of drinking and smoking had significantly high incidence rate ratios (IRRs) for SPCs among ever-drinker/ever-smoker and currentdrinker/current-smoker, although ever drinking did not show a significant risk. Ever-drinker/ever-smoker had also significantly higher IRRs for esophageal and lung SPCs than never-drinker/never-smoker. Among comprehensive cancer survivors, ever and current drinkers only had a SPC risk when combined with smoking, while ever and current smokers had a SPC risk regardless of drinking status. Heavy drinking and heavy smoking were considered to be independent additive SPC risk factors. To reduce SPC incidence, it may be necessary (i) to reduce or stop alcohol use, (ii) to stop tobacco smoking and (iii) dual users, especially heavy users, should be treated as a high-risk population for behavioral-change intervention.Drinking alcohol and smoking tobacco are widespread, representative, modifiable lifestyle factors. Of 834,000 deaths from non-communicable diseases in 2007 in Japan, drinking alcohol and smoking tobacco accounted for 31,000 and 129,000 deaths, respectively.1 There is a large potential health gain if these risk factors are jointly controlled. 2 This may be true not only for the general population but also cancer survivors.In recent years, the number of second or further subsequent primary cancers (SPCs) has been growing, partly due to prolonged survival times for cancer patients: 5-15% of cancer survivors develop a SPC.3,4 Curtis et al. reported that approximately 35% of all excess risk for SPCs may be attributable to behavioral factors, such as drinking and smoking, which underscores the importance of these modifiable risk factors, especially in patients with tobacco-related and alcohol-related cancers. 5,6 For example, in a meta-analysis of early stage non-small-cell lung cancer, Parsons et al. reported a relative risk of 4.3 (95% confidence interval [CI] 1.1-17.0) of SPCs in patients who continued to smoke. 7 Patients with head and neck cancers with heavy alcohol intake at diagnosis showed a relative risk of 2.1 (1.4-3.3) for...

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“…14,17 However, recent evidence has challenged these findings and suggest that there is no safe limit of consumption, especially for cancer. [18][19][20][21] Despite the controversy, identifying a safe threshold based on sound methodology which accounts for beverage type, the frequency and volume of consumption and patterns of use for alcohol remains an important research question. 21 Recent reviews on the topic suggest that even light-to-moderate alcohol use may not be protective for chronic disease.…”

Section: Introductionmentioning

confidence: 99%

Alcohol consumption and low-risk drinking guidelines among adults: a cross-sectional analysis from Alberta’s Tomorrow Project

Brenner

Haig

Poirier

et al. 2017

Health Promot Chronic Dis Prev Can

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Introduction Moderate to heavy alcohol consumption is a risk factor for all-cause mortality and cancer incidence. Although cross-sectional data are available through national surveys, data on alcohol consumption in Alberta from a large prospective cohort were not previously available. The goal of these analyses was to characterize the levels of alcohol consumption among adults from the Alberta’s Tomorrow Project in the context of cancer prevention guidelines. Furthermore, we conducted analyses to examine the relationships between alcohol consumption and other high-risk or risk-related behaviours. Methods Between 2001 and 2009, 31 072 men and women aged 35 to 69 years were enrolled into Alberta’s Tomorrow Project, a large provincial cohort study. Data concerning alcohol consumption in the past 12 months were obtained from 26 842 participants who completed self-administered health and lifestyle questionnaires. We conducted cross-sectional analyses on daily alcohol consumption and cancer prevention guidelines for alcohol use in relation to sociodemographic factors. We also examined the combined prevalence of alcohol consumption and tobacco use, obesity and comorbidities. Results Approximately 14% of men and 12% of women reported alcohol consumption exceeding recommendations for cancer prevention. Higher alcohol consumption was reported in younger age groups, urban dwellers, those with higher incomes and those who consumed more red meat. Moreover, volume of daily alcohol consumption was positively associated with current tobacco use in both men and women. Overall, men were more likely to fall in the moderate and high-risk behavioural profiles and show higher daily alcohol consumption patterns compared to women. Conclusion Despite public health messages concerning the adverse impact of alcohol consumption, a sizeable proportion of Alberta’s Tomorrow Project participants consumed alcohol in excess of cancer prevention recommendations. Continued strategies to promote low-risk drinking among those who choose to drink could impact future chronic disease risk in this population.

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Moderate alcohol intake and cancer: the role of underreporting

Abstract: We conclude that the apparent increased risk of cancer among light-moderate drinkers may be substantially due to underreporting of intake.

Cited by 33 publications

References 13 publications

Comparative effects of the restriction method in two large observational studies of body mass index and mortality among adults

Comparative effects of the restriction method in two large observational studies of body mass index and mortality among adults

Joint and independent effect of alcohol and tobacco use on the risk of subsequent cancer incidence among cancer survivors: A cohort study using cancer registries

Alcohol consumption and low-risk drinking guidelines among adults: a cross-sectional analysis from Alberta’s Tomorrow Project

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