Association of the Frequency and Quantity of Alcohol Consumption With Gastrointestinal Cancer

Abstract

Importance: Although total alcohol consumption is a known risk factor for gastrointestinal (GI) cancers, few studies have attempted to assess the pattern of alcohol drinking in association with GI cancers.

Objective: To evaluate the relative association of the frequency of drinking vs the amount of alcohol consumed per occasion with the development of GI cancers.

Design, setting, and participants: A population-based retrospective cohort study used data from the Korean National Health Insurance System database on 11 737 467 participants without cancer who underwent a national health screening program from January 1, 2009, to December 31, 2010. Participants were followed up from the year after their health screening date until they received a diagnosis of GI cancer, death, or December 31, 2017. The median follow-up duration was 6.4 years (interquartile range, 6.4-7.4 years). Statistical analysis was performed from January 1, 2019, to March 31, 2020.

Exposures: Weekly alcohol consumption (nondrinker [0 g/week], mild drinker [0-104 g/week], moderate drinker [105-209 g/week], and heavy drinker [≥210 g/week]), drinking frequency, and amount per occasion.

Main outcomes and measures: Incident GI cancers at 6 specific sites (esophagus, stomach, colorectal, liver, biliary, and pancreas).

Results: Among 11 737 467 participants (6 124 776 women [52.2%]; mean [SD] age, 54.6 [10.4] years), 319 202 (2.7%) developed GI cancer. Compared with nondrinkers, the risk of GI cancer was higher for mild drinkers (adjusted hazard ratio [aHR], 1.04; 95% CI, 1.03-1.05), moderate drinkers (aHR, 1.14; 95% CI, 1.12-1.15), and heavy drinkers (aHR, 1.28; 95% CI, 1.26-1.29). The risk of GI cancer increased linearly with the frequency of drinking in a dose-dependent manner (aHR, 1.39; 95% CI, 1.36-1.41 for individuals who drink every day). In contrast, the risk of GI cancer appeared to increase with consumption up to 5 to 7 units per occasion (aHR, 1.15; 95% CI, 1.14-1.16), and then the HRs were no higher for those with a higher intake per session than 5 to 7 units (8-14 units per occasion: aHR, 1.11; 95% CI, 1.09-1.12; >14 units per occasion: aHR, 1.11; 95% CI, 1.08-1.14). Given similar weekly alcohol consumption levels, the risk of GI cancer increased with a higher frequency of drinking and decreased with a higher amount per occasion. Risk patterns for 6 specific cancers were generally similar to that of all GI cancers.

Conclusions and relevance: In this cohort study, frequent drinking was a more important risk factor for incident GI cancers than the amount of alcohol consumed per occasion. Individuals should be cautioned about regular consumption of small amounts of alcohol in addition to the total amount of alcohol consumption or amount per occasion.

Figure 1.. Risk of Gastrointestinal Cancer According to Alcohol Intake Pattern

A, Weekly alcohol consumption status. B, Frequency of drinking per week. C, Amount (in units) of alcohol consumed per occasion. Hazard ratios (HRs) are adjusted for age, sex, income, smoking status with intensity, regular exercise, body mass index, diabetes, hypertension, and dyslipidemia. See the Methods section and eMethods in the Supplement for exact methods to calculate the amount of alcohol consumed per each standard drink. The horizontal dashed line in each panel indicates a reference line (HR, 1.0). Error bars indicate 95% CIs.

Figure 2.. Association of Frequent Drinking vs Episodic Binge Drinking With Gastrointestinal Cancer Risk

A, Cancer risk by frequency of drinking per week. B, Cancer risk by amount (in units) of alcohol consumed per occasion. Hazard ratios (HRs) are adjusted for age, sex, income, smoking status with intensity, regular exercise, body mass index, and diabetes. See the Methods section and eMethods in the Supplement for exact methods to calculate the amount of alcohol consumed per each standard drink. The horizontal dashed line in each panel indicates a reference line (HR, 1.0). Error bars indicate 95% CIs.

Figure 3.. Association of Frequent Drinking vs Episodic Binge Drinking With Esophageal, Stomach, and Colorectal Cancer Risk

A, Esophageal cancer risk by frequency of drinking per week. B, Esophageal cancer risk by amount (in units) of alcohol consumed per occasion. C, Stomach cancer risk by frequency of drinking per week. D, Stomach cancer risk by amount (in units) of alcohol consumed per occasion. E, Colorectal cancer risk by frequency of drinking per week. F, Colorectal cancer risk by amount (in units) of alcohol consumed per occasion. Hazard ratios (HRs) are adjusted for age, sex, income, smoking status with intensity, regular exercise, body mass index, and diabetes. See the Methods section and eMethods in the Supplement for exact methods to calculate the amount of alcohol consumed per each standard drink. The horizontal dashed line in each panel indicates a reference line (HR, 1.0). Error bars indicate 95% CIs.

Figure 4.. Association of Frequent Drinking vs Episodic Binge Drinking With Liver, Biliary, and Pancreatic Cancer Risk

A, Liver cancer risk by frequency of drinking per week. B, Liver cancer risk by amount (in units) of alcohol consumed per occasion. C, Biliary cancer risk by frequency of drinking per week. D, Biliary cancer risk by amount (in units) of alcohol consumed per occasion. E, Pancreatic cancer risk by frequency of drinking per week. F, Pancreatic cancer risk by amount (in units) of alcohol consumed per occasion. Hazard ratios (HRs) are adjusted for age, sex, income, smoking status with intensity, regular exercise, body mass index, and diabetes. See the Methods section and eMethods in the Supplement for exact methods to calculate the amount of alcohol consumed per each standard drink. The horizontal dashed line in each panel indicates a reference line (HR, 1.0). Error bars indicate 95% CIs.