Inverse Relationship Between Moderate Alcohol Intake and Rectal Cancer: Analysis of the North Carolina Colon Cancer Study

Abstract

Background The relationship between alcohol intake and rectal cancer is uncertain Objective We sought to evaluate whether alcohol consumption is associated with distal colorectal cancer and rectal cancer specifically. Design Data on alcohol intake were examined from the North Carolina Colon Cancer Study, a population-based case control study of distal colorectal cancer. Setting 33 counties in the central and eastern part of North Carolina Patients Cases had adenocarcinoma of the rectum, rectosigmoid, and sigmoid colon. Controls were frequency-matched on age, race, and gender. Interventions Demographic and dietary intake data were collected using a validated questionnaire. Main outcome measures Logistic regression was used to estimate odds ratios for the relationship between alcohol consumption and distal colorectal cancer. Results 1,033 cases and 1,011 controls participated. The odds ratio for rectal cancer comparing any vs. no alcohol intake was 0.73 (95% confidence interval 0.60, 0.90), adjusted for age, gender, race, smoking status, obesity, education, red meat intake, use of non-steroidal anti-inflammatory medications and family history of colorectal cancer. The odds ratio for moderate alcohol (≤14 grams/day) was 0.66 (0.53, 0.82), while the odds ratio for heavy alcohol (>14 grams/day) was 0.93 (0.70, 1.23). Moderate beer and wine intakes were also inversely associated with distal colorectal cancer: odds ratios 0.76 (0.60, 0.96) and 0.69 (0.56, 0.86) respectively. Limitations This was a retrospective, observational study. Residual confounding is possible. Conclusions In this study, moderate alcohol intake (especially wine) was inversely associated with distal colorectal cancer.

Moderate Alcohol Consumption and Colorectal Cancer Risk

“…The reduced CRC risk associated with <30 g/d alcohol was found to be significant in only 2 studies: for nonobese individuals consuming between 13.5 and 27 g/d alcohol (Zhao et al, 2012), and for a Mediterranean population, where wine was a significant contributor to the alcoholic beverage type (Kontou et al, 2012). For all other studies, the risks associated with moderate alcohol consumption were not found to be statistically significant, but they consistently showed a reduced risk trend at moderate intake (Crockett et al, 2011;Nan et al, 2013;Park et al, 2010;Razzak et al, 2011).…”

“…Wine consumption was also found to be independently associated with decreased CRC risk when consumed in moderation (Crockett et al, 2011;Kontou et al, 2012;Park et al, 2009), although 1 report found the benefit was significant only for men (Kontou et al, 2012). It is possible that too few women in the latter study consumed enough alcohol to receive the added benefit that men did, especially for wine consumption, where the polyphenolic content is hypothesized to provide antioxidant and anticarcinogenic effects (Kontou et al, 2012).…”

“…A strength of this review was that the majority of studies reviewed used 30 g/d as the cutoff for the moderate reference intake, which was a more appropriate classification of moderate intake (Bongaerts et al, 2008;Crockett et al, 2011;Nan et al, 2013;Razzak et al, 2011). The studies that did not use the 30 g/d alcohol cutoff had slightly higher or lower reference points, while few included additional intake categories above 30 g/d, which allowed for even greater comparisons between the doses (Grosso et al, 2014;Kontou et al, 2012;Zhao et al, 2012).…”

“…However, in the current decade reports have emerged that suggest there is a nonlinear dose-dependent response for moderate alcohol consumption that is associated with a protective effect against the development of CRC (Crockett et al, 2011;Kontou et al, 2012). Other reports have indicated associations between alcohol intake and genetic variants that may account for increased CRC in certain populations (Ferrari et al, 2012;Gao et al, 2008;Toriola et al, 2008).…”

“…Some beneficial reports have emerged that showed moderate wine consumption was inversely associated with CRC (Crockett et al, 2011;Kontou et al, 2012), although the results involving specific types of alcohol studied have been inconsistent (Bongaerts et al, 2008;Pedersen et al, 2003).…”