Esophageal cancer is the eighth most common cancer worldwide, with an estimated 456,000 new cases in 2012, and the sixth most common cause of death from cancer with an estimated 400,000 deaths, according to data from GLOBOCAN, which provides statistics on the incidence and mortality of cancer worldwide. In the United States, nearly 17,000 adults, mostly men (13,360), will be diagnosed with esophageal cancer in 2018, and about 16,000 will die from their disease, according to the American Cancer Society.
Although consumption of tea at high temperatures has been suggested as a risk factor for the cancer due to chronic thermal injury to the esophageal mucosa—the International Agency for Research on Cancer classified the intake of scalding beverages (> 65° C) as “probably carcinogenic to the human esophagus”—a direct association has not been observed consistently, and whether any relationship is independent of alcohol and tobacco exposure has not been evaluated.
Now, an observational study examining the effect of hot tea and its interactions with excessive alcohol and tobacco use on the risk of esophageal cancer has found that the combination is associated with a 5-fold increased risk for the disease. Abstaining from hot tea may be beneficial for preventing esophageal cancer in people who drink alcohol excessively or smoke, according to the study authors. The study by Yu et al is published in Annals of Internal Medicine.
The researchers surveyed 456,155 participants aged 30 to 79 years enrolled in the China Kadoorie Biobank (CBK) study. Participants in CBK who had cancer at baseline or who reduced consumption of tea, alcohol, or tobacco before baseline were excluded.
The researchers prospectively examined the joint association of tea-drinking metrics, especially beverage temperature, and the established risk factors of smoking and alcohol consumption with esophageal cancer risk. Outcome was esophageal cancer incidence up to 2015.
During a median follow-up of 9.2 years, 1,731 incident esophageal cancer cases were documented. High-temperature tea drinking combined with either alcohol consumption or smoking was associated with a greater risk for esophageal cancer than hot tea drinking alone.
Compared with participants who drank tea less than weekly and consumed fewer than 15 g of alcohol daily, those who drank burning-hot tea and 15 g or more of alcohol daily had the greatest risk for esophageal cancer (hazard ratio [HR] = 5.00; 95% confidence interval [CI] = 3.64–6.88). Likewise, the HR for current smokers who drank burning-hot tea daily was 2.03 (95% CI = 1.55–2.67).
“Our findings show a noticeable increase in esophageal cancer risk associated with a combination of high-temperature tea drinking, excessive alcohol consumption, and tobacco smoking. They suggest that abstaining from hot tea might be beneficial for preventing esophageal cancer in persons who drink alcohol excessively or smoke. More prospective studies are warranted to confirm the interactions observed in this study. Studies that directly measure tea temperature are particularly encouraged,” concluded the study authors.
Funding for this study was provided by the National Natural Science Foundation of China and National Key Research and Development Program.
Jun Lv, PhD, a researcher at the Peking University Health Science Center in Beijing, China, is the corresponding author of this study.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.