A Prospective Investigation of Coffee Drinking and Bladder Cancer Incidence in the United States
A Prospective Investigation of Coffee Drinking and Bladder Cancer Incidence in the United States
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DOI：
10.1097/ede.0000000000000676
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发表时间：
2017-09-01
期刊：
影响因子：
5.4
通讯作者：
Sinha, Rashmi
中科院分区：
文献类型：
--
作者：
Loftfield, Erikka;Freedman, Neal D.;Sinha, Rashmi
背景：1991年，基于有限的流行病学证据，咖啡与膀胱癌正相关，咖啡被列为2B类致癌物，可能对人类致癌。2016年，由于缺乏前瞻性研究的证据，特别是对于从不吸烟的人，国际癌症研究机构降低了这一分类。方法：在美国国立卫生研究院-美国退休人员协会前瞻性队列研究中，用食物频率问卷评估基线咖啡饮用量。在469,047名基线时无癌症的美国成年人中，6,012例膀胱癌病例（5,088名男性和924名女性）在bb6,300,000人年的随访中被确定。采用多变量调整Cox比例风险模型来估计风险比（HR）和95%置信区间（CI），以不喝咖啡的人为参照组。结果：在调整了年龄和性别的模型中，喝咖啡与膀胱癌呈正相关（相对于不喝咖啡的人，4杯/天的风险比= 1.91,95% CI = 1.70, 2.14； P趋势< 0.0001）。然而，在对吸烟和其他潜在混杂因素进行调整后，这种关联大大减弱（相对于不喝咖啡的人，4杯/天的HR = 1.18, 95% CI = 1.05, 1.33； P趋势= 0.0007）。根据现有数据，在大多数队列中对终生吸烟模式进行额外调整后，相关性进一步减弱（P趋势= 0.16）。没有证据表明不吸烟者之间存在关联（P趋势= 0.84）。结论：饮用咖啡与膀胱癌之间存在正相关关系，这表明吸烟测量不完善或未测量的危险因素可能是我们积极发现的解释。
Background: In 1991, coffee was classified as a group 2B carcinogen, possibly carcinogenic to humans, based on limited epidemiologic evidence of a positive association with bladder cancer. In 2016, the International Agency for Research on Cancer downgraded this classification due to lack of evidence from prospective studies particularly for never smokers.Methods: Baseline coffee drinking was assessed with a food frequency questionnaire in the NIH-AARP prospective cohort study. Among 469,047 US adults, who were cancer free at baseline, 6,012 bladder cancer cases (5,088 men and 924 women) were identified during >6.3 million person-years of follow-up. Multivariable-adjusted Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI), with non-coffee drinkers as the reference group.Results: Coffee drinking was positively associated with bladder cancer in models adjusted for age and sex (HR for = 4 cups/d relative to coffee nondrinkers = 1.91, 95% CI = 1.70, 2.14; P trend < 0.0001). However, the association was substantially attenuated after adjustment for cigarette smoking and other potential confounders (HR for = 4 cups/d relative to coffee nondrinkers = 1.18, 95% CI = 1.05, 1.33; P trend = 0.0007). Associations were further attenuated after additional adjustment for lifetime smoking patterns among the majority of the cohort with this available data (P trend = 0.16). There was no evidence of an association among never smokers (P trend = 0.84).Conclusions: Positive associations between coffee drinking and bladder cancer among ever smokers but not never smokers suggest that residual confounding from imperfect measurement of smoking or unmeasured risk factors may be an explanation for our positive findings.