Alcohol consumption as a cause of cancer
Alcohol consumption as a cause of cancer
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DOI：
10.1111/add.13477
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发表时间：
2017-02-01
期刊：
影响因子：
6
通讯作者：
Connor, Jennie
中科院分区：
文献类型：
--
作者：
Connor, Jennie
背景与目的有越来越多的研究证据表明酒精在癌症中的因果作用，同时媒体上也有不清楚和相互矛盾的信息。这篇论文的目的是澄清酒精是致癌原因的证据的说服力，以及在这一背景下原因的含义。方法根据Medline数据库和国际癌症研究机构档案中已发表的荟萃分析，对近期有关酒精与癌症的流行病学和生物学研究进行综述和总结。也对这些出版物中没有收录的更新的流行病学研究进行了审查。对流行病学中因果推断的性质的简要描述被用来框架对酒精致癌证据的力度的讨论，并将其与酒精与心血管疾病保护性关联的情况进行对比。结果对病因的一般流行病学认识是增加人群发病率的一个因素。在大量流行病学证据表明饮酒与一种疾病之间存在关联的情况下，推断这是一种因果关联需要对观察到的发现作出其他解释，才能判断为不太可能。即使不完全了解生物机制，流行病学证据也可以支持酒精导致口咽癌、喉癌、食道癌、肝癌、结肠癌、直肠癌和乳腺癌的判断。所测量的相关性显示出生物学上可信的效应梯度，并且有一些证据表明，当消费停止时，喉癌、咽癌和肝癌的风险是可逆的。队列研究的局限性意味着，真正的影响可能比目前估计的要弱一些或更强一些，但不太可能在性质上有所不同。同样或类似的流行病学研究通常也报告了饮酒对心血管疾病的保护作用，但现在人们对这些发现持高度怀疑的态度。结论有强有力的证据表明，酒精会在人体的七个部位致癌，可能还会在其他部位致癌。目前的估计表明，这些地区由酒精引起的癌症占全球所有癌症死亡人数的5.8%。酒精增加每种癌症发病率的特定生物学机制的确认并不需要推断酒精是原因之一。
Background and aims There is increasing research evidence about the causal role of alcohol in cancer, accompanied by unclear and conflicting messages in the media. This paper aimed to clarify the strength of the evidence for alcohol as a cause of cancer, and the meaning of cause in this context. Methods Recent epidemiological and biological research on alcohol and cancer was reviewed and summarized, drawing upon published meta-analyses identified from the Medline database and the archives of the International Agency for Research on Cancer. More recent epidemiological studies not included in these publications were also reviewed. A brief description of the nature of causal inference in epidemiology was used to frame discussion of the strength of the evidence that alcohol causes cancer, and contrast this with the case for a protective association of alcohol with cardiovascular disease. Results The usual epidemiological understanding of a cause is a factor that increases the incidence of a condition in the population. In the context of a body of epidemiological evidence of an association of alcohol consumption with a disease, the inference that it is a causal association requires alternative explanations of the observed finding to be judged unlikely. Even without complete knowledge of biological mechanisms, the epidemiological evidence can support the judgement that alcohol causes cancer of the oropharynx, larynx, oesophagus, liver, colon, rectum and breast. The measured associations exhibit gradients of effect that are biologically plausible, and there is some evidence of reversibility of risk in laryngeal, pharyngeal and liver cancers when consumption ceases. The limitations of cohort studies mean that the true effects may be somewhat weaker or stronger than estimated currently, but are unlikely to be qualitatively different. The same, or similar, epidemiological studies also commonly report protection from cardiovascular disease associated with drinking but a high level of scepticism regarding these findings is now warranted. Conclusions There is strong evidence that alcohol causes cancer at seven sites in the body and probably others. Current estimates suggest that alcohol-attributable cancers at these sites make up 5.8% of all cancer deaths worldwide. Confirmation of specific biological mechanisms by which alcohol increases the incidence of each type of cancer is not required to infer that alcohol is a cause.