Biliary tract cancers, encompassing tumors of the gallbladder, extrahepatic bile ducts and ampulla of Vater, are rare but highly fatal malignancies. Apart from gallstones, etiologic factors for biliary tract cancer are not clearly defined. Several epidemiologic studies have suggested that consumption of tea, especially green tea, is protective against a variety of cancers, including gastrointestinal malignancies. As part of a large population-based casecontrol study of biliary tract disease in Shanghai, China, we evaluated the effects of tea consumption on the risk of biliary tract cancers and biliary stones. The study included 627 incident cases with biliary tract cancer, 1,037 cases with biliary stones and 959 randomly selected controls. Study subjects were interviewed to ascertain data on demographic, medical and dietary factors, including tea consumption. Forty-one percent of the controls were ever tea drinkers, defined as those who consumed at least 1 cup of tea per day for at least 6 months. After adjustment for age, education and body mass index, among women, ever tea drinkers had significantly reduced risks of biliary stones (OR 5 0.73, 95% CI 5 0.54-0.98) and gallbladder cancer (OR 5 0.56, 95% CI 5 0.38-0.83). The inverse relationship between tea consumption and gallbladder cancer risk was independent of gallstone disease. Among men, tea drinkers were more likely to be cigarette smokers, and the risk estimates were generally below 1.0, but were not statistically significant. Further studies are needed to confirm these results in other populations and clarify the hormonal and other mechanisms that may be involved. ' 2006 Wiley-Liss, Inc.Key words: biliary tract cancers; gallstones; tea consumption; polyphenol; epidemiology Biliary tract cancers, consisting of tumors of the gallbladder, extrahepatic bile ducts and ampulla of Vater, are rapidly fatal. 1,2 Although these cancers are uncommon in most parts of the world, incidence rates are elevated among native Americans and Hispanics living in the United States and among populations in Central and South America, Eastern Europe and Japan.1,2 Because of the rarity and high fatality of biliary tract cancers, little is known about their etiology apart from a strong link with gallstones.
2A number of epidemiologic studies have suggested that consumption of tea, especially green tea, is protective against certain cancers, including tumors of the lung, stomach, pancreas and esophagus.3-6 The antitumor effects of green tea have been attributed to polyphenols, which in laboratory studies have demonstrated inhibitory effects on tumor growth.7-10 Results of epidemiologic studies examining the association between tea consumption and biliary tract cancer have been mixed, perhaps due to the small number of cases, different types of tea consumed and lack of data on potential confounding factors, such as gallstone disease, diet and cigarette smoking. [11][12][13][14] In this report, we evaluate the effect of tea consumption on the risk of biliary tract cancers and biliary...