PURPOSE: Previous reports are conflicting about increased risk of lung cancer associated with total alcohol intake or choice of specific beverage type. A major problem is confounding by the powerful smoking-lung cancer relation. We studied risk of incident lung cancer in a multi-ethnic cohort.
METHODS: We studied risk of incident lung cancer in a multi-ethnic cohort of 126,293 persons that supplied baseline data from 1978-1985 and were followed through 2008. We used Cox proportional hazards models with 8 covariates; cigarette smoking and alcohol drinking were studied with lifelong abstainers as referent, yielding relative risks (RR) and 95% confidence intervals (CI).
RESULTS: The number of persons with incident lung cancer was 1852. The RR (CI) of lung cancer for exdrinkers = 1.1 (0.9-1.5), for < 1 drink per day = 1.0 (0.9-1.1), for 1-2 drinks per day = 1.0 (0.9-1.2), and for ≥ 3 drinks per day = 1.3 (1.1-1.5, p = 0.002). The RR’s at ≥ 3 drinks per day were 1.3 in both men and women, 1.4 in never and ex-smokers and 1.2 in smokers of < 1 or ≥ 1 pack per day. Among 1,234 alcohol drinkers, the RR’s for drinkers of preponderantly wine, liquor and beer were 1.2 (0.8-1.8), 1.4(1.0-1.9, p=0.07), and 1.7 (1.2-2.6, p = 0.008) respectively. The increased risk of heavy beer drinkers was concentrated in men, especially African American men, the heaviest smokers, and persons of lower education while that of heavy liquor drinkers was concentrated in white men. Type of wine (red, white, etc.) had no consistent independent relation to risk.
CONCLUSIONS: We conclude that, with respect to lung cancer, 1) Heavier, but not light-moderate alcohol drinking is associated with increased risk, 2) Variations in increased risk by beverage choice are likely due to confounding by other lifestyle traits.
CLINICAL IMPLICATIONS: Avoidance of any type of heavy alcohol (beer, wine, liquor)intake may reduce the risk of lung cancer.
DISCLOSURE: The following authors have nothing to disclose: Stanton Siu, Yan Li, David Baer, Natalia Udaltsova, Arthur Klatsky
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