Alcohol consumption and the risk of nasopharyngeal carcinoma: a systematic review

Abstract

The evidence concerning the influence of alcohol drinking on the risk of nasopharyngeal carcinoma (NPC) has yielded intriguing findings but has lacked a clear-cut interpretation due to inconsistencies. To unify this body of evidence, we performed a systematic review. With funding and using a protocol developed by the World Cancer Research Fund (WCRF), 15 bibliographic databases were searched for epidemiological studies that reported a measure of association between alcoholic beverage consumption and NPC. Pooled odds ratios (ORs) for highest-vs.-lowest categories of total alcohol intake was obtained by using an inverse-variance weighted random-effects model. A dose-response trend was examined in models using generalized least square estimation. The search identified 14 case-control studies from 5 countries. For total alcohol intake, the pooled ORs in a comparison of the highest to the lowest category was 1.33 (95% CI: = 1.09-1.62) in 11 studies. Data from 6 studies indicated a J-shape dose-response trend, with NPC risk decreasing with up to 15 drinks/wk and increasing with higher intake. Fewer data were available to assess the associations between NPC and intake of beer, wine, and spirits. The potential J-shaped dose-response trend suggests a reduced risk of NPC related to the light alcohol drinking, an observation that warrants further study. Considered in total, the quantitative summaries of the case-control evidence suggest that heavy alcohol consumption is associated with an increased risk of NPC.

FIG. 1

Flow diagram of study selection process.

FIG. 2

Forest plot of OR and 95% confidence intervals for highest versus lowest category of total alcohol intake and NPC. Results are from a random-effects model. Matching/adjustment variable abbreviations: S, smoking; F, salted fish; G, gender; A, age; E, education; ET, ethnicity; RE, residence; O, occupational exposure; FHN, Family history of NPC; HCE, history of chronic ear and nose disease; OF, other food.

FIG. 3

Dose-response meta-analysis of case-control study results of NPC risk in relation to total alcohol intake (shown by first author and year of publications). The pooled dose-response curve (thick solid line) was obtained by a quadratic model using generalized least squares for trend estimation.