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Meta-Analysis
. 2020 Mar 2;3(3):CD005004.
doi: 10.1002/14651858.CD005004.pub3.

Green tea (Camellia sinensis) for the prevention of cancer

Tommaso Filippini  1 , Marcella Malavolti  1 , Francesca Borrelli  2 , Angelo A Izzo  2 , Susan J Fairweather-Tait  3 , Markus Horneber  4 , Marco Vinceti  1   5
Affiliations
Meta-Analysis

Green tea (Camellia sinensis) for the prevention of cancer

Tommaso Filippini et al. Cochrane Database Syst Rev. .

Abstract

Background: This review is an update of a previously published review in the Cochrane Database of Systematic Reviews (2009, Issue 3).Tea is one of the most commonly consumed beverages worldwide. Teas from the plant Camellia sinensis can be grouped into green, black and oolong tea, and drinking habits vary cross-culturally. C sinensis contains polyphenols, one subgroup being catechins. Catechins are powerful antioxidants, and laboratory studies have suggested that these compounds may inhibit cancer cell proliferation. Some experimental and nonexperimental epidemiological studies have suggested that green tea may have cancer-preventative effects.

Objectives: To assess possible associations between green tea consumption and the risk of cancer incidence and mortality as primary outcomes, and safety data and quality of life as secondary outcomes.

Search methods: We searched eligible studies up to January 2019 in CENTRAL, MEDLINE, Embase, ClinicalTrials.gov, and reference lists of previous reviews and included studies.

Selection criteria: We included all epidemiological studies, experimental (i.e. randomised controlled trials (RCTs)) and nonexperimental (non-randomised studies, i.e. observational studies with both cohort and case-control design) that investigated the association of green tea consumption with cancer risk or quality of life, or both.

Data collection and analysis: Two or more review authors independently applied the study criteria, extracted data and assessed methodological quality of studies. We summarised the results according to diagnosis of cancer type.

Main results: In this review update, we included in total 142 completed studies (11 experimental and 131 nonexperimental) and two ongoing studies. This is an additional 10 experimental and 85 nonexperimental studies from those included in the previous version of the review. Eleven experimental studies allocated a total of 1795 participants to either green tea extract or placebo, all demonstrating an overall high methodological quality based on 'Risk of bias' assessment. For incident prostate cancer, the summary risk ratio (RR) in the green tea-supplemented participants was 0.50 (95% confidence interval (CI) 0.18 to 1.36), based on three studies and involving 201 participants (low-certainty evidence). The summary RR for gynaecological cancer was 1.50 (95% CI 0.41 to 5.48; 2 studies, 1157 participants; low-certainty evidence). No evidence of effect of non-melanoma skin cancer emerged (summary RR 1.00, 95% CI 0.06 to 15.92; 1 study, 1075 participants; low-certainty evidence). In addition, adverse effects of green tea extract intake were reported, including gastrointestinal disorders, elevation of liver enzymes, and, more rarely, insomnia, raised blood pressure and skin/subcutaneous reactions. Consumption of green tea extracts induced a slight improvement in quality of life, compared with placebo, based on three experimental studies. In nonexperimental studies, we included over 1,100,000 participants from 46 cohort studies and 85 case-control studies, which were on average of intermediate to high methodological quality based on Newcastle-Ottawa Scale 'Risk of bias' assessment. When comparing the highest intake of green tea with the lowest, we found a lower overall cancer incidence (summary RR 0.83, 95% CI 0.65 to 1.07), based on three studies, involving 52,479 participants (low-certainty evidence). Conversely, we found no association between green tea consumption and cancer-related mortality (summary RR 0.99, 95% CI 0.91 to 1.07), based on eight studies and 504,366 participants (low-certainty evidence). For most of the site-specific cancers we observed a decreased RR in the highest category of green tea consumption compared with the lowest one. After stratifying the analysis according to study design, we found strongly conflicting results for some cancer sites: oesophageal, prostate and urinary tract cancer, and leukaemia showed an increased RR in cohort studies and a decreased RR or no difference in case-control studies.

Authors' conclusions: Overall, findings from experimental and nonexperimental epidemiological studies yielded inconsistent results, thus providing limited evidence for the beneficial effect of green tea consumption on the overall risk of cancer or on specific cancer sites. Some evidence of a beneficial effect of green tea at some cancer sites emerged from the RCTs and from case-control studies, but their methodological limitations, such as the low number and size of the studies, and the inconsistencies with the results of cohort studies, limit the interpretability of the RR estimates. The studies also indicated the occurrence of several side effects associated with high intakes of green tea. In addition, the majority of included studies were carried out in Asian populations characterised by a high intake of green tea, thus limiting the generalisability of the findings to other populations. Well conducted and adequately powered RCTs would be needed to draw conclusions on the possible beneficial effects of green tea consumption on cancer risk.

PubMed Disclaimer

Conflict of interest statement

TF: none known MM: none known FB: none known AAI: none known SF: none known MH: none known MV: none known

Figures

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1
PRISMA flow‐chart
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Newcastle‐Ottawa scale for nonexperimental studies
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3
Funnel plot of comparison 2. Nonexperimental studies: highest versus lowest green tea exposure, outcome 2.2, any cancer mortality
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4
Funnel plot of comparison 2. Nonexperimental studies: highest versus lowest green tea exposure, outcome 2.3, oral cancer
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5
Funnel plot of comparison 2. Nonexperimental studies: highest versus lowest green tea exposure, outcome 2.6, any gut cancer
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Funnel plot of comparison 2. Nonexperimental studies: highest versus lowest green tea exposure, outcome 2.7, oesophageal cancer
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Funnel plot of comparison 2. Nonexperimental studies: highest versus lowest green tea exposure, outcome 2.21, prostate cancer
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Funnel plot of comparison 2. Nonexperimental studies: highest versus lowest green tea exposure, outcome 2.23, urinary tract cancer
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Funnel plot of comparison 2. Nonexperimental studies: highest versus lowest green tea exposure, outcome 2.8, stomach cancer
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Funnel plot of comparison 2. Nonexperimental studies: highest versus lowest green tea exposure, outcome 2.9, liver cancer
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Funnel plot of comparison 2. Nonexperimental studies: highest versus lowest green tea exposure, outcome 2.10, pancreatic cancer
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12
Funnel plot of comparison 2. Nonexperimental studies: highest versus lowest green tea exposure, outcome 2.12, colorectal cancer
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13
Funnel plot of comparison 2. Nonexperimental studies: highest versus lowest green tea exposure, outcome 2.13, colon cancer
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Funnel plot of comparison 2. Nonexperimental studies: highest versus lowest green tea exposure, outcome 2.14, rectal cancer
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Funnel plot of comparison 2. Nonexperimental studies: highest versus lowest green tea exposure, outcome 2.16, lung cancer
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Funnel plot of comparison 2. Nonexperimental studies: highest versus lowest green tea exposure, outcome 2.17, breast cancer
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Funnel plot of comparison 2. Nonexperimental studies: highest versus lowest green tea exposure, outcome 2.18, gynaecological cancer
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Funnel plot of comparison 2. Nonexperimental studies: highest versus lowest green tea exposure, outcome 2.19, endometrial cancer
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Funnel plot of comparison 2. Nonexperimental studies: highest versus lowest green tea exposure, outcome 2.20, ovarian cancer
1.1
1.1. Analysis
Comparison 1: Experimental studies: highest versus lowest green tea exposure, Outcome 1: Prostate cancer incidence
1.2
1.2. Analysis
Comparison 1: Experimental studies: highest versus lowest green tea exposure, Outcome 2: Gynaecological cancer incidence
1.3
1.3. Analysis
Comparison 1: Experimental studies: highest versus lowest green tea exposure, Outcome 3: Non‐melanoma skin cancer incidence
2.1
2.1. Analysis
Comparison 2: Nonexperimental studies: highest versus lowest green tea exposure, Outcome 1: Any cancer incidence
2.2
2.2. Analysis
Comparison 2: Nonexperimental studies: highest versus lowest green tea exposure, Outcome 2: Any cancer mortality
2.3
2.3. Analysis
Comparison 2: Nonexperimental studies: highest versus lowest green tea exposure, Outcome 3: Oral cancer
2.4
2.4. Analysis
Comparison 2: Nonexperimental studies: highest versus lowest green tea exposure, Outcome 4: Oral, pharyngeal and laryngeal cancer
2.5
2.5. Analysis
Comparison 2: Nonexperimental studies: highest versus lowest green tea exposure, Outcome 5: Pharyngeal cancer
2.6
2.6. Analysis
Comparison 2: Nonexperimental studies: highest versus lowest green tea exposure, Outcome 6: Any gut cancer
2.7
2.7. Analysis
Comparison 2: Nonexperimental studies: highest versus lowest green tea exposure, Outcome 7: Oesophageal cancer
2.8
2.8. Analysis
Comparison 2: Nonexperimental studies: highest versus lowest green tea exposure, Outcome 8: Stomach cancer
2.9
2.9. Analysis
Comparison 2: Nonexperimental studies: highest versus lowest green tea exposure, Outcome 9: Liver cancer
2.10
2.10. Analysis
Comparison 2: Nonexperimental studies: highest versus lowest green tea exposure, Outcome 10: Pancreatic cancer
2.11
2.11. Analysis
Comparison 2: Nonexperimental studies: highest versus lowest green tea exposure, Outcome 11: Biliary tract cancer
2.12
2.12. Analysis
Comparison 2: Nonexperimental studies: highest versus lowest green tea exposure, Outcome 12: Colorectal cancer
2.13
2.13. Analysis
Comparison 2: Nonexperimental studies: highest versus lowest green tea exposure, Outcome 13: Colon cancer
2.14
2.14. Analysis
Comparison 2: Nonexperimental studies: highest versus lowest green tea exposure, Outcome 14: Rectal cancer
2.15
2.15. Analysis
Comparison 2: Nonexperimental studies: highest versus lowest green tea exposure, Outcome 15: Nasopharyngeal carcinoma
2.16
2.16. Analysis
Comparison 2: Nonexperimental studies: highest versus lowest green tea exposure, Outcome 16: Lung cancer
2.17
2.17. Analysis
Comparison 2: Nonexperimental studies: highest versus lowest green tea exposure, Outcome 17: Breast cancer
2.18
2.18. Analysis
Comparison 2: Nonexperimental studies: highest versus lowest green tea exposure, Outcome 18: Gynaecological cancer
2.19
2.19. Analysis
Comparison 2: Nonexperimental studies: highest versus lowest green tea exposure, Outcome 19: Endometrial cancer
2.20
2.20. Analysis
Comparison 2: Nonexperimental studies: highest versus lowest green tea exposure, Outcome 20: Ovarian cancer
2.21
2.21. Analysis
Comparison 2: Nonexperimental studies: highest versus lowest green tea exposure, Outcome 21: Prostate cancer
2.22
2.22. Analysis
Comparison 2: Nonexperimental studies: highest versus lowest green tea exposure, Outcome 22: Renal cancer
2.23
2.23. Analysis
Comparison 2: Nonexperimental studies: highest versus lowest green tea exposure, Outcome 23: Urinary tract cancer
2.24
2.24. Analysis
Comparison 2: Nonexperimental studies: highest versus lowest green tea exposure, Outcome 24: Hematopoietic cancer
2.25
2.25. Analysis
Comparison 2: Nonexperimental studies: highest versus lowest green tea exposure, Outcome 25: Leukaemia
2.26
2.26. Analysis
Comparison 2: Nonexperimental studies: highest versus lowest green tea exposure, Outcome 26: Lymphoma
2.27
2.27. Analysis
Comparison 2: Nonexperimental studies: highest versus lowest green tea exposure, Outcome 27: Multiple myeloma
2.28
2.28. Analysis
Comparison 2: Nonexperimental studies: highest versus lowest green tea exposure, Outcome 28: Non‐melanoma skin cancer
2.29
2.29. Analysis
Comparison 2: Nonexperimental studies: highest versus lowest green tea exposure, Outcome 29: Thyroid cancer
2.30
2.30. Analysis
Comparison 2: Nonexperimental studies: highest versus lowest green tea exposure, Outcome 30: Brain cancer
See this image and copyright information in PMC

Update of

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    1. Yang G, Zheng W, Xiang YB, Gao J, Li HL, Zhang X, et al. Green tea consumption and colorectal cancer risk: a report from the Shanghai Men's Health Study. Carcinogenesis 2011;32(11):1684-8. - PMC - PubMed
Ye 1998 {published data only}
    1. Ye WM, Yi YN, Luo RX, Zhou TS, Lin RT, Chen GD. Diet and gastric cancer: a case-control study in Fujian Province, China. World Journal of Gastroenterology 1998;4(6):516-8. - PMC - PubMed
Yu 1995 {published data only}
    1. Yu GP, Hsieh CC, Wang LY, Yu SZ, Li XL, Jin TH. Green-tea consumption and risk of stomach cancer: a population-based case-control study in Shanghai, China. Cancer Causes & Control 1995;6(6):532-8. - PubMed
Zhang 2002 {published data only}
    1. Zhang M, Binns CW, Lee AH. Tea consumption and ovarian cancer risk: a case-control study in China. Cancer Epidemiology, Biomarkers & Prevention 2002;11(8):713-8. - PubMed
Zhang 2007 {published data only}
    1. Zhang M, Holman CD, Huang JP, Xie X. Green tea and the prevention of breast cancer: a case-control study in Southeast China. Carcinogenesis 2007;28(5):1074-8. - PubMed
    1. Zhang M, Huang J, Xie X, Holman CD. Dietary intakes of mushrooms and green tea combine to reduce the risk of breast cancer in Chinese women. International Journal of Cancer 2009;124(6):1404-8. [PMID: ] - PubMed
Zhang 2008 {published data only}
    1. Zhang M, Zhao X, Zhang X, Holman CD. Possible protective effect of green tea intake on risk of adult leukaemia. British Journal of Cancer 2008;98(1):168-70. - PMC - PubMed
    1. Zhang XD, Zhao XY, Zhang M, Liang Y, Xu XH, D'Arcy C, et al. A case-control study on green tea consumption and the risk of adult leukemia. Zhonghua Liu Xing Bing Xue za Zhi 2008;29(3):290-3. - PubMed
Zhao 2017 {published data only}
    1. Zhao LG, Li HL, Sun JW, Yang Y, Ma X, Shu XO, et al. Green tea consumption and cause-specific mortality: results from two prospective cohort studies in China. Journal of Epidemiology 2017;27(1):36-41. - PMC - PubMed
Zheng 1993 {published data only}
    1. Zheng T, Boyle P, Willett WC, Hu H, Dan J, Evstifeeva TV, et al. A case-control study of oral cancer in Beijing, People's Republic of China. Associations with nutrient intakes, foods and food groups. European Journal of Cancer. Part B, Oral Oncology 1993;29(1):45-55. - PubMed
Zhong 2001 {published data only}
    1. Zhong L, Goldberg MS, Gao YT, Hanley JA, Parent ME, Jin F. A population-based case-control study of lung cancer and green tea consumption among women living in Shanghai, China. Epidemiology 2001;12(6):695-700. - PubMed

References to studies excluded from this review

Ahmad 2012 {published data only}
    1. Ahmad MR, Pervaiz MK, Pervaiz G. Non-occupational risk factors of urinary bladder cancer in Faisalabad and Lahore, Pakistan. Journal of the Pakistan Medical Association 2012;62(3):236-9. - PubMed
Allen 2011 {published data only}
    1. Allen NE, Balkwill A, Beral V, Green J, Reeves G, Million Women Study Collaborators. Fluid intake and incidence of renal cell carcinoma in UK women. British Journal of Cancer 2011;104(9):1487-92. - PMC - PubMed
Alsanad 2016 {published data only}
    1. Alsanad SM, Howard RL, Williamson EM. An assessment of the impact of herb-drug combinations used by cancer patients. BMC Complementary and Alternative Medicine 2016;16(1):393. - PMC - PubMed
Amarasinghe 2013 {published data only}
    1. Amarasinghe HK, Usgodaarachchi U, Kumaraarachchi M, Johnson NW, Warnakulasuriya S. Diet and risk of oral potentially malignant disorders in rural Sri Lanka. Journal of Oral Pathology & Medicine 2013;42(9):656-62. - PubMed
Arts 2001 {published data only}
    1. Arts IC, Hollman PC, Bueno De Mesquita HB, Feskens EJ, Kromhout D. Dietary catechins and epithelial cancer incidence: the Zutphen elderly study. International Journal of Cancer 2001;92(2):298-302. - PubMed
Asgari 2011 {published data only}
    1. Asgari MM, White E, Warton EM, Hararah MK, Friedman GD, Chren MM. Association of tea consumption and cutaneous squamous cell carcinoma. Nutrition and Cancer 2011;63(2):314-18. - PMC - PubMed
Askari 2014 {published data only}
    1. Askari F, Parizi MK, Jessri M, Rashidkhani B. Dietary patterns in relation to prostate cancer in Iranian men: a case-control study. Asian Pacific Journal of Cancer Prevention 2014;15(5):2159-63. - PubMed
Azeem 2013 {published data only}
    1. Azeem K, Sevcikova J, Tomaskova H, Horakova D, Prochazka V, Martinek A, et al. Pancreatic cancer and lifestyle factors. Klinicka Onkologie 2013;26(4):257-62. - PubMed
Bailey 2017 {published data only}
    1. Bailey HD, Lacour B, Guerrini-Rousseau L, Bertozzi A-I, Leblond P, Faure-Conter C, et al. Parental smoking, maternal alcohol, coffee and tea consumption and the risk of childhood brain tumours: the ESTELLE and ESCALE studies (SFCE, France). Cancer Causes & Control 2017;28(7):719-32. - PubMed
Bamia 2015 {published data only}
    1. Bamia C, Lagiou P, Jenab M, Trichopoulou A, Fedirko V, Aleksandrova K, et al. Coffee, tea and decaffeinated coffee in relation to hepatocellular carcinoma in a European population: multicentre, prospective cohort study. International Journal of Cancer 2015;136(8):1899-908. [DOI: ] - PMC - PubMed
Bao 2015 {published data only}
    1. Bao PP, Zhao GM, Shu XO, Peng P, Cai H, Lu W, et al. Modifiable lifestyle factors and triple-negative breast cancer survival: a population-based prospective study. Epidemiology (Cambridge, Mass.) 2015;26(6):909-16. - PMC - PubMed
Baroudi 2014 {published data only}
    1. Baroudi O, Chaaben AB, Mezlini A, Moussa A, Omrane I, Jilson I, et al. Impact of lifestyle factors and nutrients intake on occurrence of gastrointestinal cancer in Tunisian population. Tumour Biology 2014;35(6):5815-22. - PubMed
Bates 2007 {published data only}
    1. Bates MN, Hopenhayn C, Rey OA, Moore LE. Bladder cancer and mate consumption in Argentina: a case-control study. Cancer Letters 2007;246(1-2):268-73. - PubMed
Bianchi 2000 {published data only}
    1. Bianchi GD, Cerhan JR, Parker AS, Putnam SD, See WA, Lynch CF, et al. Tea consumption and risk of bladder and kidney cancers in a population-based case-control study. American Journal of Epidemiology 2000;151(4):377-83. - PubMed
Bonaventure 2013 {published data only}
    1. Bonaventure A, Rudant J, Goujon-Bellec S, Orsi L, Leverger G, Baruchel A, et al. Childhood acute leukemia, maternal beverage intake during pregnancy, and metabolic polymorphisms [Erratum appears in Cancer Causes Control. 2014 Aug;25(8):1081]. Cancer Causes & Control 2013;24(4):783-93. - PubMed
Butler 2015 {published data only}
    1. Butler LM, Huang JY, Wang R, Lee MJ, Yang CS, Gao YT, et al. Urinary biomarkers of catechins and risk of hepatocellular carcinoma in the Shanghai Cohort Study. American Journal of Epidemiology 2015;181(6):397-405. - PMC - PubMed
Chen 2009 {published data only}
    1. Chen YK, Lee CH, Wu IC, Liu JS, Wu DC, Lee JM, et al. Food intake and the occurrence of squamous cell carcinoma in different sections of the esophagus in Taiwanese men. Nutrition (Burbank, Los Angeles County, Calif.) 2009;25(7-8):753-61. - PubMed
Chyou 1995 {published data only}
    1. Chyou PH, Nomura AM, Stemmermann GN. Diet, alcohol, smoking and cancer of the upper aerodigestive tract: a prospective study among Hawaii Japanese men. International Journal of Cancer 1995;60(5):616-21. - PubMed
DArena 2013 {published data only}
    1. D'Arena G, Simeon V, De Martino L, Statuto T, D'Auria F, Volpe S, et al. Regulatory T-cell modulation by green tea in chronic lymphocytic leukemia. International Journal of Immunopathology and Pharmacology 2013;26(1):117-25. [DOI: 10.1177/039463201302600111] - DOI - PubMed
Deandrea 2010 {published data only}
    1. Deandrea S, Foschi R, Galeone C, La Vecchia C, Negri E, Hu J. Is temperature an effect modifier of the association between green tea intake and gastric cancer risk? European Journal of Cancer Prevention 2010;19(1):18-22. - PubMed
Emami 2014 {published data only}
    1. Emami H, Nikoobin F, Roayaei M, Ziya HR. Double-blinded, randomized, placebo-controlled study to evaluate the effectiveness of green tea in preventing acute gastrointestinal complications due to radiotherapy. Journal of Research in Medical Sciences 2014;19(5):445-50. - PMC - PubMed
Ettrich 2012 {published data only}
    1. Ettrich T, Stingl J, Muche R, Berger A, Seufferlein T. The MIRACLE trial: a randomized, controlled trial comparing green tea extract versus placebo for the prevention of metachronous colon adenomas in a screening population. Journal of Clinical Oncology 2015;33(3 Suppl):TPS786.
Ferrucci 2014 {published data only}
    1. Ferrucci LM, Cartmel B, Molinaro AM, Leffell DJ, Bale AE, Mayne ST. Tea, coffee, and caffeine and early-onset basal cell carcinoma in a case-control study. European Journal of Cancer Prevention 2014;23(4):296-302. - PMC - PubMed
Gao 2002 {published data only}
    1. Gao C-M, Takezaki T, Wu J-Z, Li Z-Y, Liu Y-T, Li S-P, et al. Glutathione-S-transferases M1 (GSTM1) and GSTT1 genotype, smoking, consumption of alcohol and tea and risk of esophageal and stomach cancers: a case-control study of a high-incidence area in Jiangsu Province, China. Cancer Letters 2002;188(1-2):95-102. - PubMed
Gao 2009 {published data only}
    1. Gao Y, Hu N, Han X, Giffen C, Ding T, Goldstein AM, et al. Jasmine tea consumption and upper gastrointestinal cancer in China. Cancer Causes & Control 2009;20(10):1997-2007. - PMC - PubMed
Hara 1984 {published data only}
    1. Hara N, Sakata K, Nagai M, Fujita Y, Hashimoto T, Yanagawa H. Statistical analyses on the pattern of food consumption and digestive-tract cancers in Japan. Nutrition and Cancer 1984;6(4):220-8. - PubMed
He 2017 {published data only}
    1. He F, Xie JX, Liu CL, Xiong WM, Xu QP, Liu ZQ, et al. The relationship of lung cancer with menstrual and reproductive factors may be influenced by passive smoking, cooking oil fumes, and tea intake: a case-control study in Chinese women. Medicine 2017;96(46):e8816. - PMC - PubMed
Henning 2012 {published data only}
    1. Henning SM, Wang P, Aronson WJ, Carpenter CL, Heber D. Inhibition of NFkappaB and proapoptotic effect of green tea in prostate tumor tissue: a phase II clinical trial in men with prostate cancer. Cancer Prevention Research (Philadelphia, Pa.) 2012;5(11 Suppl 1):B67. [DOI: ]
Ide 2008 {published data only}
    1. Ide R, Mizoue T, Fujino Y, Hoshiyama Y, Sakata K, Tamakoshi A, et al. Cigarette smoking, alcohol drinking, and oral and pharyngeal cancer mortality in Japan. Oral diseases 2008;14(4):314-19. - PubMed
Il'yasova 2003 {published data only}
    1. Il'yasova D, Martin C, Sandler RS. Tea intake and risk of colon cancer in African-Americans and whites: North Carolina colon cancer study. Cancer Causes & Control 2003;14(8):767-72. - PubMed
Inoue 1997 {published data only}
    1. Inoue M, Tajima K, Hirose K, Hamajima N, Takezaki T, Kuroishi T, et al. Epidemiological features of first-visit outpatients in Japan: comparison with general population and variation by sex, age, and season. Journal of Clinical Epidemiology 1997;50(1):69-77. - PubMed
Inoue 2001 {published data only}
    1. Inoue M, Tajima K, Mizutani M, Iwata H, Iwase T, Miura S, et al. Regular consumption of green tea and the risk of breast cancer recurrence: follow-up study from the Hospital-based Epidemiologic Research Program at Aichi Cancer Center (HERPACC), Japan. Cancer Letters 2001;167(2):175-82. - PubMed
Ishizuka 2003 {published data only}
    1. Ishizuka H, Eguchi H, Oda T, Ogawa S, Nakagawa K, Honjo S, et al. Relation of coffee, green tea, and caffeine intake to gallstone disease in middle-aged Japanese men. European Journal of Epidemiology 2003;18(5):401-5. - PubMed
Jatoi 2003 {published data only}
    1. Jatoi A, Ellison N, Burch PA, Sloan JA, Dakhil SR, Novotny P, et al. A phase II trial of green tea in the treatment of patients with androgen independent metastatic prostate carcinoma. Cancer 2003;97(6):1442-6. - PubMed
Jia 2012 {published data only}
    1. Jia Y, Hu T, Hang CY, Yang R, Li X, Chen ZL, et al. Case-control study of diet in patients with cervical cancer or precancerosis in Wufeng, a high incidence region in China. Asian Pacific Journal of Cancer Prevention 2012;13(10):5299-302. - PubMed
Johnson 2011 {published data only}
    1. Johnson S, Koh WP, Wang R, Govindarajan S, Yu MC, Yuan JM. Coffee consumption and reduced risk of hepatocellular carcinoma: findings from the Singapore Chinese Health Study. Cancer Causes & Control 2011;22(3):503-10. - PMC - PubMed
Kono 1991 {published data only}
    1. Kono S, Shinchi K, Ikeda N, Yanai F, Imanishi K. Physical activity, dietary habits and adenomatous polyps of the sigmoid colon: a study of self-defense officials in Japan. Journal of Clinical Epidemiology 1991;44(11):1255-61. - PubMed
Kuwahara 2000 {published data only}
    1. Kuwahara Y, Kono S, Eguchi H, Hamada H, Shinchi K, Imanishi K. Relationship between serologically diagnosed chronic atrophic gastritis, Helicobacter pylori, and environmental factors in Japanese men. Scandinavian Journal of Gastroenterology 2000;35(5):476-81. - PubMed
Lee 1990 {published data only}
    1. Lee HH, Wu HY, Chuang YC, Chang AS, Chao HH, Chen KY, et al. Epidemiologic characteristics and multiple risk factors of stomach cancer in Taiwan. Anticancer Research 1990;10(4):875-81. - PubMed
Lee 2013 {published data only}
    1. Lee AH, Su D, Pasalich M, Binns CW. Tea consumption reduces ovarian cancer risk. Cancer Epidemiology 2013;37(1):54-9. - PubMed
Liu 2013a {published data only}
    1. Liu H, Jiang X, Zhang MW, Pan YF, Yu YX, Zhang SC, et al. Association of CASP9, CASP10 gene polymorphisms and tea drinking with colorectal cancer risk in the Han Chinese population. Journal of Zhejiang University. Science 2013;14(1):47-57. - PMC - PubMed
Liu 2014 {published data only}
    1. Liu SZ, Chen WQ, Wang N, Yin MM, Sun XB, He YT. Dietary factors and risk of pancreatic cancer: a multi-centre case-control study in China. Asian Pacific Journal of Cancer Prevention 2014;15(18):7947-50. - PubMed
Liu 2015 {published data only}
    1. Liu P, Zhang M, Jin J, Holman CD. Tea consumption reduces the risk of de novo myelodysplastic syndromes. Leukemia Research 2015;39(2):164-9. - PubMed
Luo 2010 {published data only}
    1. Luo J, Gao YT, Chow WH, Shu XO, Li H, Yang G, et al. Urinary polyphenols and breast cancer risk: results from the Shanghai Women's Health Study [Erratum appears in Breast Cancer Res Treat. 2010 Apr;120(3):703]. Breast Cancer Research and Treatment 2010;120(3):693-702. - PMC - PubMed
Menzler 2015 {published data only}
    1. Menzler S, Weinel R, Seufferlein TT. Does green tea prevent colorectal adenomas. Presentation of the design of a prospective, multicenter double-blind study. European Surgical Research. Europaische Chirurgische Forschung. Recherches Chirurgicales Europeennes 2015;55(1-2):107-8. [DOI: 10.1159/000381514] - DOI
Mineharu 2011 {published data only}
    1. Mineharu Y, Koizumi A, Wada Y, Iso H, Watanabe Y, Date C, et al, JACC study Group. Coffee, green tea, black tea and oolong tea consumption and risk of mortality from cardiovascular disease in Japanese men and women. Journal of Epidemiology and Community Health 2011;65(3):230-40. - PubMed
Montella 2007 {published data only}
    1. Montella M, Polesel J, La Vecchia C, Dal Maso L, Crispo A, Crovatto M, et al. Coffee and tea consumption and risk of hepatocellular carcinoma in Italy. International Journal of Cancer 2007;120:1555-9. - PubMed
Montella 2009 {published data only}
    1. Montella M, Tramacere I, Tavani A, Gallus S, Crispo A, Talamini R, et al. Coffee, decaffeinated coffee, tea intake and risk of renal cell cancer. Nutrition and Cancer 2009;61(1):76-80. - PubMed
Nagano 2000 {published data only}
    1. Nagano J, Kono S, Preston DL, Moriwaki H, Sharp GB, Koyama K, et al. Bladder-cancer incidence in relation to vegetable and fruit consumption: a prospective study of atomic-bomb survivors. International Journal of Cancer 2000;86(1):132-8. - PubMed
Nakachi 1998 {published data only}
    1. Nakachi K, Suemasu K, Suga K, Takeo T, Imai K, Higashi Y. Influence of drinking green tea on breast cancer malignancy among Japanese patients. Japanese Journal of Cancer Research 1998;89(3):254-61. - PMC - PubMed
Nakachi 2003 {published data only}
    1. Nakachi K, Eguchi H, Imai K. Can teatime increase one's lifetime? Ageing Research Reviews 2003;2(1):1-10. - PubMed
Oguni 1992 {published data only}
    1. Oguni I, Chen SJ, Lin PZ. Protection against cancer risk by Japanese green tea. Preventive Medicine 1992;21:332.
Ohno 1985 {published data only}
    1. Ohno Y, Aoki K, Obata K, Morrison AS. Case-control study of urinary bladder cancer in metropolitan Nagoya. National Cancer Institute Monographs 1985;69:229-34. - PubMed
Ohno 1995 {published data only}
    1. Ohno Y, Wakai K, Genka K, Ohmine K, Kawamura T, Tamakoshi A et al. Tea consumption and lung cancer risk: a case-control study in Okinawa, Japan. Japanese Journal of Cancer Research 1995;86(11):1027-34. - PMC - PubMed
Parodi 2017 {published data only}
    1. Parodi S, Merlo DF, Stagnaro E. Coffee and tea consumption and risk of leukaemia in an adult population: a reanalysis of the Italian multicentre case-control study. Cancer Epidemiology 2017;47:81-7. [DOI: 10.1016/j.canep.2017.01.005] - DOI - PubMed
Pisters 2001 {published data only}
    1. Pisters KM, Newman RA, Coldman B, Shin DM, Khuri FR, Hong WK, et al. Phase I trial of oral green tea extract in adult patients with solid tumors. Journal of Clinical Oncology 2001;19(6):1830-8. - PubMed
Ren 1991 {published data only}
    1. Ren A, Han X. Dietary factors and esophageal cancer: a case-control study. Zhonghua Liu Xing Bing Xue za Zhi 1991;12(4):200-4. - PubMed
Sasazuki 2008 {published data only}
    1. Sasazuki S, Inoue M, Miura T, Iwasaki M, Tsugane S. Plasma tea polyphenols and gastric cancer risk: a case-control study nested in a large population-based prospective study in Japan. Cancer Epidemiology, Biomarkers & Prevention 2008;17(2):343-51. - PubMed
Sasazuki 2012 {published data only}
    1. Sasazuki S, Tamakoshi A, Matsuo K, Ito H, Wakai K, Nagata C, et al, Research Group for the Development and Evaluation of Cancer Prevention Strategies in Japan. Green tea consumption and gastric cancer risk: an evaluation based on a systematic review of epidemiologic evidence among the Japanese population. Japanese Journal of Clinical Oncology 2012;42(4):335-46. - PubMed
Sawada 2017 {published data only}
    1. Sawada N. Risk and preventive factors for prostate cancer in Japan: the Japan Public Health Center-based prospective (JPHC) study. Journal of Epidemiology 2017;27(1):2-7. - PMC - PubMed
Seo 2013 {published data only}
    1. Seo AY, Lee DH, Shin CM, Kim SB, Son W-C, Kim N, et al. Green tea extracts for the prevention of colorectal adenomas and cancer: a preliminary report. Journal of Gastroenterology and Hepatology 2013;28:121. [DOI: ]
Shibata 2000 {published data only}
    1. Shibata K, Moriyama M, Fukushima T, Kaetsu A, Miyazaki M, Une H. Green tea consumption and chronic atrophic gastritis: a cross-sectional study in a green tea production village. Journal of Epidemiology 2000;10(5):310-6. - PubMed
Shim 1995 {published data only}
    1. Shim JS, Kang MH, Kim YH, Roh JK, Roberts C, Lee IP. Chemopreventive effect of green tea (Camellia sinensis) among cigarette smokers. Cancer Epidemiology, Biomarkers & Prevention 1995;4(4):387-91. - PubMed
Shimizu 2008 {published data only}
    1. Shimizu M, Fukutomi Y, Ninomiya M, Nagura K, Kato T, Araki H, et al. Green tea extracts for the prevention of metachronous colorectal adenomas: a pilot study. Cancer Epidemiology, Biomarkers & Prevention 2008;17(11):3020-5. [DOI: 10.1158/1055-9965.EPI-08-0528] - DOI - PubMed
Shin 2018 {published data only}
    1. Shin CM, Lee DH, Seo AY, Lee HJ, Kim SB, Son W-C, et al. Green tea extracts for the prevention of metachronous colorectal polyps among patients who underwent endoscopic removal of colorectal adenomas: a randomized clinical trial. Clinical Nutrition 2018;37(2):452-8. [DOI: 10.1016/j.clnu.2017.01.014] - DOI - PubMed
Stingl 2011 {published data only}
    1. Stingl JC, Ettrich T, Muche R, Wiedom M, Brockmoller J, Seeringer A, et al. Protocol for minimizing the risk of metachronous adenomas of the colorectum with green tea extract (MIRACLE): a randomised controlled trial of green tea extract versus placebo for nutriprevention of metachronous colon adenomas in the elderly population. BMC Cancer 2011;11:360. [DOI: 10.1186/1471-2407-11-360] - DOI - PMC - PubMed
Suganuma 1999 {published data only}
    1. Suganuma M, Okabe S, Sueoka N, Sueoka E, Matsuyama S, Imai K, et al. Green tea and cancer chemoprevention. Mutation Research 1999;428(1-2):339-44. - PubMed
Sun 2002 {published data only}
    1. Sun CL, Yuan JM, Lee MJ, Yang CS, Gao YT, Ross RK, et al. Urinary tea polyphenols in relation to gastric and esophageal cancers: a prospective study of men in Shanghai, China. Carcinogenesis 2002;23(9):1497-1503. - PubMed
Tong 2014 {published data only}
    1. Tong GX, Liang H, Chai J, Cheng J, Feng R, Chen PL, et al. Association of risk of gastric cancer and consumption of tobacco, alcohol and tea in the Chinese population. Asian Pacific Journal of Cancer Prevention 2014;15(20):8765-74. - PubMed
Tsubono 1997 {published data only}
    1. Tsubono Y, Takahashi T, Iwase Y, Iitoi Y, Akabane M, Tsugane S. Dietary differences with green tea intake among middle-aged Japanese men and women. Preventive Medicine 1997;26(5 Pt 1):704-10. - PubMed
Tsugane 2014 {published data only}
    1. Tsugane S, Sawada N. The JPHC study: design and some findings on the typical Japanese diet. Japanese Journal of Clinical Oncology 2014;44(9):777-82. - PubMed
Wakai 1993 {published data only}
    1. Wakai K, Ohno Y, Obata K, Aoki K. Prognostic significance of selected lifestyle factors in urinary bladder cancer. Japanese Journal of Cancer Research 1993;84(12):1223-9. - PMC - PubMed
Wang 2002 {published data only}
    1. Wang LD, Zhou Q, Feng CW, Liu B, Qi YJ, Zhang YR, et al. Intervention and follow-up on human esophageal precancerous lesions in Henan, northern China, a high-incidence area for esophageal cancer. Gan to Kagaku Ryoho. Cancer & Chemotherapy 2002;29 Suppl 1:159-72. - PubMed
Wang 2008 {published data only}
    1. Wang N, Zheng Y, Jiang Q, Yu X, Chen Y. Tea and reduced liver cancer mortality. Epidemiology (Cambridge, Mass.) 2008;19(5):761. - PubMed
Wang 2010 {published data only}
    1. Wang P, Aronson WJ, Huang M, Zhang Y, Lee RP, Heber D, et al. Green tea polyphenols and metabolites in prostatectomy tissue: implications for cancer prevention. Cancer Prevention Research (Philadelphia, Pa.) 2010;3(8):985-93. [DOI: 10.1158/1940-6207.CAPR-09-0210] - DOI - PMC - PubMed
Wang 2012d {published data only}
    1. Wang P, Aronson W, Abgaryan N, Carpenter CL, Vadgama JV, Heber D, et al. Antioxidant activity of green tea: a phase II clinical trial in men with prostate cancer. Cancer Prevention Research (Philadelphia, Pa.) 2012;5 Suppl 1(11):B68. [DOI: ]
Wang 2012e {published data only}
    1. Wang ZH, Gao QY, Fang JY. Green tea and incidence of colorectal cancer: evidence from prospective cohort studies. Nutrition and Cancer 2012;64(8):1143-52. - PubMed
Wang 2014a {published data only}
    1. Wang L, Zhang X, Liu J, Shen L, Li Z. Tea consumption and lung cancer risk: a meta-analysis of case-control and cohort studies. Nutrition (Burbank, Los Angeles County, Calif.) 2014;30(10):1122-7. - PubMed
Wu 2003a {published data only}
    1. Wu AH, Tseng CC, Van den Berg D, Yu MC. Tea intake, COMT genotype, and breast cancer in Asian-American women. Cancer Research 2003;63(21):7526-9. - PubMed
Wu 2013a {published data only}
    1. Wu S, Li F, Huang X, Hua Q, Huang T, Liu Z, et al. The association of tea consumption with bladder cancer risk: a meta-analysis. Asia Pacific Journal of Clinical Nutrition 2013;22(1):128-37. - PubMed
Yu 1991 {published data only}
    1. Yu GP, Hsieh CC. Risk factors for stomach cancer: a population-based case-control study in Shanghai. Cancer Causes & Control 1991;2(3):169-74. - PubMed
YuanJ M 2007 {published data only}
    1. Yuan J-M, Gao Y-T, Yang CS, Yu MC. Urinary biomarkers of tea polyphenols and risk of colorectal cancer in the Shanghai Cohort Study. International Journal of Cancer 2007;120(6):1344-50. - PubMed
Zeegers 2001a {published data only}
    1. Zeegers MP, Dorant E, Goldbohm RA, Van den Brandt PA. Are coffee, tea, and total fluid consumption associated with bladder cancer risk? Results from the Netherlands cohort study. Cancer Causes & Control 2001;12(3):231-8. - PubMed
Zeegers 2001b {published data only}
    1. Zeegers MP, Tan FE, Goldbohm RA, Van den Brandt PA. Are coffee and tea consumption associated with urinary tract cancer risk? A systematic review and meta-analysis. International Journal of Epidemiology 2001;30(2):353-62. - PubMed
Zhang 2004 {published data only}
    1. Zhang M, Lee AH, Binns CW, Xie X. Green tea consumption enhances survival of epithelial ovarian cancer. International Journal of Cancer 2004;112(3):465-9. - PubMed
Zhang 2006 {published data only}
    1. Zhang XH, Andreotti G, Gao YT, Deng J, Liu E, Rashid A, et al. Tea drinking and the risk of biliary tract cancers and biliary stones: a population-based case-control study in Shanghai, China. International Journal of Cancer 2006;118(12):3089-94. - PMC - PubMed
Zhang 2009 {published data only}
    1. Zhang M, Huang J, Xie X, Holman CD. Dietary intakes of mushrooms and green tea combine to reduce the risk of breast cancer in Chinese women. International Journal of Cancer 2009;124(6):1404-8. - PubMed
Zhang 2013 {published data only}
    1. Zhang SC, Jin W, Liu H, Jin MJ, Chen ZX, Ding ZY, et al. RPSA gene mutants associated with risk of colorectal cancer among the Chinese population. Asian Pacific Journal of Cancer Prevention 2013;14(12):7127-31. - PubMed
Zhang 2016 {published data only}
    1. Zhang Z, Garzotto M, Beer TM, Thuillier P, Lieberman S, Mori M, et al. Effects of omega-3 fatty acids and catechins on fatty acid synthase in the prostate: a randomized controlled trial. Nutrition and Cancer 2016;68(8):1309-19. [DOI: 10.1080/01635581.2016.1224365] - DOI - PMC - PubMed
Zhu 2016 {published data only}
    1. Zhu H, Li X, Zhang X, Chen D, Li D, Ren J, et al. Polymorphisms in mismatch repair genes are associated with risk and microsatellite instability of gastric cancer, and interact with life exposures. Gene 2016;579(1):52-7. [DOI: ] - PubMed

References to ongoing studies

NCT01496521 {published data only}
    1. NCT01496521. Chemoprevention of esophageal squamous cell carcinoma (ESCC) with aspirin and tea polyphenols. clinicaltrials.gov/ct2/show/NCT01496521.
Shannon 2010 {published data only}
    1. Shannon J, Lieberman S, Maxcy C, Thuillier P, Peters L, Garzotto M. Fish oil, green tea, and prostate cancer prevention. Journal of Clinical Oncology 2010;28 Suppl 15:17.

Additional references

Ahmad 1999
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