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Int J Cancer. 2017 Nov 15;141(10):1963-1970. doi: 10.1002/ijc.30894. Epub 2017 Jul 31.

Alcohol consumption and risk of urothelial cell bladder cancer in the European prospective investigation into cancer and nutrition cohort.

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Department of Bowel Cancer Screening, Cancer Registry of Norway, Oslo University Hospital, Oslo, Norway.
National Advisory Unit for Women's Health, Women's Clinic, Oslo University Hospital, Oslo, Norway.
International Agency for Research on Cancer, Lyon, France.
Danish Cancer Society Research Center, Copenhagen, Denmark.
Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.
Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain.
CIBER Epidemiología y Salud Pública (CIBERESP), Spain.
Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany.
Hellenic Health Foundation, Athens, Greece.
Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Athens, Greece.
2nd Pulmonary Medicine Department, School of Medicine, National and Kapodistrian University of Athens, "ATTIKON" University Hospital, Haidari, Greece.
Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milano, Italy.
Epidemiology and Prevention Unit, Department of Preventive & Predictive Medicine. Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
Department of Translational Medicine, Division of Clinical and Experimental Urothelial Carcinoma Research, Lund University, Malmö, Sweden.
Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark.
Escuela Andaluza de Salud Pública. Instituto de Investigación Biosanitaria ibs. Granada. Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain.
Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway.
Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden.
Department for biobank research, Umeå University, Umeå, Sweden.
Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy.
Cancer Registry and Histopathology Unit "Civic - M.P. Arezzo" Hospital ASP, Ragusa, Italy.
Department for Determinants of Chronic Diseases, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, London, United Kingdom.
Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland.


Findings on the association between alcohol consumption and bladder cancer are inconsistent. We investigated that association in the European Prospective Investigation into Cancer and Nutrition cohort. We included 476,160 individuals mostly aged 35-70 years, enrolled in ten countries and followed for 13.9 years on average. Hazard ratios (HR) for developing urothelial cell carcinoma (UCC; 1,802 incident cases) were calculated using Cox proportional hazards models. Alcohol consumption at baseline and over the life course was analyzed, as well as different types of beverages (beer, wine, spirits). Baseline alcohol intake was associated with a statistically nonsignificant increased risk of UCC (HR 1.03; 95% confidence interval (CI) 1.00-1.06 for each additional 12 g/day). HR in smokers was 1.04 (95% CI 1.01-1.07). Men reporting high baseline intakes of alcohol (>96 g/day) had an increased risk of UCC (HR 1.57; 95% CI 1.03-2.40) compared to those reporting moderate intakes (<6 g/day), but no dose-response relationship emerged. In men, an increased risk of aggressive forms of UCC was observed even at lower doses (>6 to 24 g/day). Average lifelong alcohol intake was not associated with the risk of UCC, however intakes of spirits > 24 g/day were associated with an increased risk of UCC in men (1.38; 95% CI 1.01-1.91) and smokers (1.39; 95% CI 1.01-1.92), compared to moderate intakes. We found no association between alcohol and UCC in women and never smokers. In conclusion, we observed some associations between alcohol and UCC in men and in smokers, possibly because of residual confounding by tobacco smoking.


alcohol; alcoholic beverages; bladder cancer; cancer stage; cohort study

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