Purpose: Determine whether higher coffee intake may reduce the risk of renal cell cancer (RCC) associated with lead (Pb) and other heavy metals with known renal toxicity. Methods: We conducted a nested case-control study of male smokers (136 RCC cases and 304 controls) within the Alpha-Tocopherol, Beta-Carotene Cancer Prevention (ATBC) Study. Cases diagnosed with RCC at five or more years following cohort enrollment, were matched to controls on age (±7 years) and whole blood draw date (±30 days). Conditional logistic regression (using two-sided tests) was used to test for main effects and additive models of effect modification. Results: After a mean follow-up of 16.3 years, coffee consumption was not significantly associated with renal cell cancer risk, when adjusting for blood concentrations of Cd, Hg and Pb and RCC risk factors (age, smoking, BMI, and systolic blood pressure) (p-trend, 0.134). The association with above median blood Pb and RCC (HR = 1.69, 95% CI: 1.06, 2.85) appeared to be modified by coffee consumption, such that RCC risk among individuals with both increased coffee intake and higher blood lead concentration was nearly 3-fold higher RCC risk (HR=3.40, 95% CI: 1.62, 7.13; p-trend 0.003). Conclusion: Contrary to our initial hypothesis, this study suggests that heavy coffee consumption may increase the previously identified association between higher circulating lead (Pb) concentrations and increased RCC risk. Improved assessment of exposure, including potential trace element contaminants in coffee, are needed.
Keywords Renal cell cancer • Heavy metals • Coffee consumption • Epidemiology
BackgroundWell-established risk factors for renal cell cancer (RCC) include cigarette smoking, elevated blood pressure, and obesity-explaining approximately half of all cases [1]. Other factors which have been associated with RCC include diabetes, low exercise, increased alcohol intake, lead (Pb) exposure, and some occupational exposures [3,40,50].Worldwide, nearly every country has reported increases in the age-adjusted incidence of RCC over the past decade, despite relatively constant population prevalence rates of obesity, smoking and hypertension, and a greater than two-fold increase in the prevalence of controlled hypertension in some countries [50]. Taken together, this suggests the need to identify additional factors for improved RCC prevention. Coffee intake is thought to play a role in chemoprevention of cancer through antioxidant activity of naturally occurring polyphenols in coffee beans (e.g., flavonoids and chlorogenic acids) [33]. Coffee is the major dietary source of polyphenols, accounting for 40 to 45 percent of total daily intake in some populations [10,18]. We and others have identified