Abstract
Objectives: We evaluated the association between alcohol intake and lung cancer in a trial-based cohort in Finland, the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study (ATBC Study).
Methods: During an average of 7.7 years of follow-up, 1059 lung cancer cases were diagnosed among the 27,111 male smokers with complete alcohol and dietary information. The relationship between alcohol and lung cancer was assessed in multivariate Cox regression models that adjusted for age, smoking, body mass index and intervention group.
Results: Nondrinkers, 11% of the study population, were at increased lung cancer risk compared to drinkers (RR = 1.2, 95% CI: 1.0–1.4), possibly due to the inclusion of ex-drinkers who had stopped drinking for health reasons. Among drinkers only, we observed no association between lung cancer and total ethanol or specific beverage (beer, wine, spirits) intake. We found no significant effect modification by level of smoking, dietary micronutrients or trial intervention group; however, for men in the highest quartile of alcohol intake, we observed a slight increase in risk for lighter smokers (>1 pack/day) and reduced risk among the heaviest smokers (<30 cigarettes/day).
Conclusions: We concluded that alcohol consumption was not a risk factor for lung cancer among male cigarette smokers, and its effect was not significantly modified by other factors, notably smoking history.
Similar content being viewed by others
References
Leo MA, Lieber CS (1985) New pathway for retinol metabolism in liver microsomes. J Biol Chem 260: 5228-5231.
Adami H-O, McLaughlin JK, Hsing AW, et al. (1992) Alcoholism and cancer risk: a population-based cohort study. Cancer Causes Control 3: 419-425.
Potter JD, Sellers TA, Folsom AR (1992) Alcohol, beer and lung cancer in postmenopausal women. The Iowa Women's Health Study. Ann Epidemiol 2: 587-595.
Bandera EV, Freudenheim JL, Graham S, et al. (1992) Alcohol consumption and lung cancer in white males. Cancer Causes Control 3: 361-369.
Murata M, Takayama K, Choi BC, Pak AW (1996) A nested case-control study on alcohol drinking, tobacco smoking, and cancer. Cancer Detect Prev 20: 557-565.
Pollack ES, Nomura AMY, Heilbrun LK, Stemmermann GN, Green SB (1984) Prospective study of alcohol consumption and cancer. N Eng J Med 310: 617-621.
Kono S, Ikeda M, Tokudome S, Nishizumi M, Kuratsune M (1986) Alcohol and mortality: a cohort study of male Japanese physicians. Int J Epidemiol 15: 527-532.
Dosemeci M, Gokmen I, Unsal M, Hayes R, Blair A (1997) Tobacco, alcohol use, and risks of laryngeal and lung cancer by subsite and histologic type in Turkey. Cancer Causes Control 8: 729-737.
Hillers V, Massey L (1985) Interrelationships of moderate and high alcohol consumption with diet and health status. Am J Clin Nutr 41: 356-362.
Lieber CS, Garro A, Leo M, Mak K, Worner T (1986) Alcohol and cancer. Hepatology 6: 1005-1019.
Morgan MY (1982) Alcohol and nutrition. Br Med Bull 38: 21-29.
Forman M, Beecher G, Lanza E, et al. (1995) Effect of alcohol consumption on plasma carotenoid concentrations in premenopausal women: a controlled dietary study. Am J Clin Nutr 62: 131-135.
Rimm E, Colditz G (1993) Smoking, alcohol, and plasma level of carotenes and vitamin E. Ann N Y Acad Sci 686: 323-334.
Lieber CS (1997) Cytochrome P-4502E1: its physiological and pathological role. Physiol Rev 77: 517-544.
Brooks PJ (1977) DNA damage, DNA repair, and alcohol toxicity — a review. Alcohol Clin Exp Res 21: 1073-1082.
Topinka J, Binkova B, Sram R, Fojtikova I (1991) DNA-repair capacity and lipid peroxidation in chronic alcoholics. Mutat Res 263: 133-136.
Mufti SI, Prabhala R, Moriguchi S, et al. (1988) Functional and numerical alterations induced by ethanol in the cellular immune system. Immunopharmacology 15: 85-94.
Waston R, Borgs P, Witte M, et al. (1994) Alcohol, immunomodulation, and disease. Alcohol Alcohol 29: 131-139.
Kato I, Nomura AMY, Stemmermann GN, Chyou P-H (1992) Prospective study of the association of alcohol with cancer of the upper aerodigestive tract and other sites. Cancer Causes Control 3: 145-151.
Blot W, McLaughlin J, Winn D, et al. (1998) Smoking and drinking in relation to oral and pharyngeal cancer. Cancer Res 48: 3282-3287.
Albanes D, Heinonen OP, Taylor PR, et al. (1996) α-Tocopherol and β-carotene supplements and lung cancer incidence in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study: effects of base-line characteristics and study compliance. J Natl Cancer Inst 88: 1560-1570.
ATBC Cancer Prevention Study Group (1994) The alpha-tocopherol, beta-carotene lung cancer prevention study: design, methods, participant characteristics, and compliance. Ann Epidemiol 4: 1-10.
American Joint Committee on Cancer (AJCC) (1992) Lung. In: Beahrs OH, Hensen DE, Hutter RV, Myers MH, eds. Manual for Staging of Cancer, 4th ed. Philadelphia: Lippincott, pp. 115-122.
Pietinen P, Hartman AM, Haapa E, et al. (1988) Reproducibility and validity of dietary assessment instruments. Am J Epidemiol 128: 655-666.
SAS Institute, Inc. (1996) SAS/STAT Software Changes and Enhancements through Release 6.11: The PHREG Procedure. Cary, NC: SAS Institute.
SAS Institute, Inc. (1994) SAS/STAT User's Guide, Version 6, 4th ed. Cary, NC: SAS Institute Inc.
Cox D (1972) Regression models and life-tables. J R Soc B 34: 187-220.
Willett W (1990) Implications of total energy intake for epidemiologic analyses. In: Willett W, ed. Nutr Epidemiol. Oxford University Press.
Klatsky A, Friedman G, Siegelaub A (1981) Alcohol and mortality. Ann Intern Med 95: 139-145.
Bandera E, Freudenheim J, Marshall J, et al. (1997) Diet and alcohol consumption and lung cancer risk in the New York State Cohort. Cancer Causes Control 8: 828-840.
Gordon T, Kannel W (1984) Drinking and mortality: The Framingham Study. Am J Epidemiol 120: 97-107.
Stefani ED, Correa P, Fierro L, Fontham ET-H, Chen V, Zavala D (1993) The effect of alcohol on the risk of lung cancer in Uruguay. Cancer Epidemiol Biomarkers Prev 2: 21-26.
Giovannucci E, Colditz G, Stampfer M, et al. (1991) The assessment of alcohol consumption by a simple self-administered questionnaire. Am J Epidemiol 133: 810-817.
Poikolainen K (1985) Underestimation of recalled alcohol intake in relation to actual consumption. Br J Addiction 80: 215-216.
Shaper A, Wannamethee G, Walker M (1988) Alcohol and mortality in British men: explaining the U-shaped curve. Lancet 1267-1273.
Glynn S, Albanes D, Pietinen P, et al. (1996) Alcohol consumption and risk of colorectal cancer in a cohort of Finnish men. Cancer Causes Control 7: 214-223.
Anderson L, Koseniauskas R, Burak E, et al. (1994) Suppression of in vivo clearance of N-nitrosodimethylamine in mice by cotreatment with ethanol. Drug Metab Dispos 22: 43-49.
Anderson L, Souliotis V, Chhabra S, Moskal T, Harbaugh S, Krytopoulos S (1996) N-nitrosodimethylamine-derived O6-methylguanine in DNA of monkey gastrointestinal and urogenital organs and enhancement by ethanol. Int J Cancer 66: 130-134.
Stocks P (1975) Cancer incidence in north Wales and Liverpool region in relation to habits and environment. British Empire Cancer Campaign 35th Annual Report, Part II (Suppl). London: Her Majesty's Stationery Office.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Woodson, K., Albanes, D., Tangrea, J.A. et al. Association between alcohol and lung cancer in the alpha-tocopherol, beta-carotene cancer prevention study in Finland. Cancer Causes Control 10, 219–226 (1999). https://doi.org/10.1023/A:1008911624785
Issue Date:
DOI: https://doi.org/10.1023/A:1008911624785