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Critique 221: The relation of alcohol intake to stomach cancer – 20 November 2018

There have been conflicting results from studies of the association between alcohol intake and the risk of gastric cancer. Some of the differences among studies have related to mixing subjects from Western countries with those from Asia, where dietary patterns, lifestyle factors, drinking patterns, and types of alcohol consumed differ from those among Western populations. Results usually differ between Asian and Western populations.

The present study is based on almost 500,000 subjects from the USA with follow up for a median of 15.5 years. The investigators identified a total of more than 1,300 cases of gastric cardia cancer (GCA) or gastric noncardia cancer (GNCA ). The authors report: “We found no association between higher alcohol consumption and GCA or GNCA, when examined as total alcoholic beverage intake or individual beverage types of beer, wine and liquor. Furthermore, we observed no association by stratum of sex, ethnic group, educational level or smoking status. We did, however, observe lower risk of GNCA among participants who drank up to one drink per day (HR = 0.81, 95% CI: 0.67–0.97) compared to nondrinkers.” They conclude: “Alcohol consumption was not associated with increased risk of GCA or GNCA in this large U.S. cohort.”

Forum members considered this to be a large, very well-done analysis; subjects were aged 50-71 years at baseline, appropriate for evaluating the risk of gastric cancer. Data on a large number of potential confounders were included in the analysis. Diagnosis of cancer was from state cancer registries, shown to be very accurate. The statistical analyses included restricted spine analysis to test for a dose-response curve (not found), and excluded the first two years after alcohol assessment to lower the risk of reverse causality. Further beverage-specific analyses were carried out, and did not show differences according to whether the consumption was of beer, wine, or spirits.

Weaknesses included only one assessment of alcohol intake, at baseline, and no data on binge drinking or other aspects of the pattern of drinking. Subjects were generally well-educated, white, and consumed alcohol moderately (75% reported one drink or less). Thus, these results may not pertain to other ethnic groups or to heavier consumers of alcohol.

Overall, these results provide further support for the lack of an association between light-to-moderate alcohol intake and the risk of gastric cancer. The significant decrease in risk of gastric non-cardia cancer associated with consumption of up to one drink/day should obviously be replicated, but the authors provide some potential mechanisms that could explain such a phenomenon. The study did not support previous data suggesting that wine consumption might have additional benefits to those of other beverages in terms of cancer risk.

Reference: Wang SM, Freedman ND, Loftfield E, Hua X, Abn CC. Alcohol consumption and risk of gastric cardia adenocarcinoma and gastric noncardia adenocarcinoma: A 16-year prospective analysis from the NIH-AARP diet and health cohort. Int J Cancer 2018; pre-publication.

For the full critique of this paper by members of the International Scientific Forum on Alcohol Research, please click here.
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