Format

Send to

Choose Destination
J Natl Cancer Inst. 2019 May 24. pii: djz103. doi: 10.1093/jnci/djz103. [Epub ahead of print]

Smoking, Alcohol, and Biliary Tract Cancer Risk: A Pooling Project of 26 Prospective Studies.

Author information

1
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA.
2
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
3
Department of Health Management and Health Economics, University of Oslo, Oslo, Norway.
4
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
5
Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
6
Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
7
Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
8
Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
9
Department of Population Health and Perlmutter Cancer Center, New York University School of Medicine, New York, NY, USA.
10
School of Public Health, Loma Linda University, Loma Linda, CA, USA.
11
Department of Epidemiology, Shanghai Cancer Institute, Shanghai, China.
12
Behavioral and Epidemiology Research Group, American Cancer Society, Inc., Atlanta, GA, USA.
13
Boston Veteran Affairs Healthcare System, Boston, MA, USA.
14
Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Australia.
15
Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia.
16
Department of Epidemiology, Radiation Effects Research Foundation, Hiroshima, Japan.
17
Section of Nutrition and Metabolism, International Agency for Research on Cancer, Lyon, France.
18
Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.
19
Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
20
Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
21
Department of Epidemiology and Biostatistics, School of Public Health, Indiana University Bloomington, Bloomington, IN, USA.
22
Department of Preventive Medicine, Keck School of Medicine and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
23
Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
24
Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA.
25
Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA.
26
Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.
27
Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC, USA.
28
Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan.
29
UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA USA.
30
Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway.
31
Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway.
32
Genetic Epidemiology Group, Folkhälsan Research Center and Faculty of Medicine, University of Helsinki, Helsinki, Finland.
33
Department of Epidemiology, University of Washington, Seattle, WA, USA.
34
Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
35
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.

Abstract

BACKGROUND:

Tobacco and alcohol are well-established risk factors for numerous cancers, yet their relationship to biliary tract cancers remains unclear.

METHODS:

We pooled data from 26 prospective studies to evaluate associations of cigarette smoking and alcohol consumption with biliary tract cancer risk. Study-specific hazard ratios (HRs) and 95% confidence intervals (CIs) for associations with smoking and alcohol consumption were calculated. Random effects meta-analysis produced summary estimates. All statistical tests were two-sided.

RESULTS:

Over a period of 38,369,156 person-years of follow-up, 1,391 gallbladder, 758 intrahepatic bile duct, 1,208 extrahepatic bile duct, and 623 ampulla of Vater cancer cases were identified. Ever, former, and current smoking were associated with increased extrahepatic bile duct and ampulla of Vater cancers risk (e.g., current versus never smokers hazard ratio [HR] = 1.69, 95% confidence interval [CI] = 1.34 to 2.13 and 2.22, 95%CI = 1.69 to 2.92, respectively), with dose-response effects for smoking pack-years, duration, and intensity (all P-trend<0.01). Current smoking and smoking intensity were also associated with intrahepatic bile duct cancer (e.g., >40 cigarettes/day versus never smokers HR = 2.15, 95%CI: 1.15 to 4.00; P-trend=0.001). No convincing association was observed between smoking and gallbladder cancer. Alcohol consumption was only associated with intrahepatic bile duct cancer, with increased risk for individuals consuming ≥5 versus 0 drinks/day (HR = 2.35, 95%CI = 1.46 to 3.78; P-trend=0.04). There was evidence of statistical heterogeneity between several cancer sites, particularly between gallbladder cancer and the other biliary tract cancers.

CONCLUSIONS:

Smoking appears to increase the risk of developing all biliary tract cancers except gallbladder cancer. Alcohol may increase the risk of intrahepatic bile duct cancer. Findings highlight etiologic heterogeneity across the biliary tract.

KEYWORDS:

Alcohol; Ampulla of Vater cancer; Cigarette; Extrahepatic bile duct cancer; Gallbladder cancer; Intrahepatic bile duct cancer; Meta-analysis; Pooling Project; Smoking

PMID:
31127946
DOI:
10.1093/jnci/djz103

Supplemental Content

Full text links

Icon for Silverchair Information Systems
Loading ...
Support Center