6. Alcohol And Colorectal Cancer
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6. Alcohol And Colorectal Cancer

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6. Alcohol And Colorectal Cancer 6. Alcohol And Colorectal Cancer Presentation Transcript

  • ALCOHOL AND COLORECTAL CANCER Adrian Cakra MBBS 4 Colorectal Unit TQEH
  • FOCUS BEER, WINE, SPIRITS AND HOW THEY INFLUENCE THE RELATIVE RISK OF DEVELOPING COLORECTAL CANCER “HOW MUCH IS TOO MUCH?”
  • STUDIES 1. A Pedersen, C Johansen, M Grønbæk (Copenhagen, 2002)  Randomly selected sample of 15491 men & 13641 women.  Assessment of weekly intake of beer, wine, and spirits.  Development of colorectal cancer during follow-up o JC Anderson, et.al (New York, 2005)  Hand-picked samples of 2291 patients presenting for colonoscopy (screening).  Known risk factors for colorectal neoplasia & alcohol drinking pattern.  Colonoscopy findings.
  • STUDIES 2. CR Sharpe, J Seimiatycki, B Rachet (Montréal, 2002)  Hand-picked samples of 585 patients with diagnosed colorectal cancer.  Information obtained as soon as possible after diagnosis.  Assessing alcohol drinking pattern. l A Moskal, et.al. (Lyon, 2006)  Meta-analysis.  Journal articles published between 1990 and 2005.  Analysing association between relative risk and various alcohol intake levels.
  • BRIEF OVERVIEW  1 in 8 Australian adults drank at a high risk level (ABS, 2005) LOW MODERATE HIGH <3 daily 4 - 6 daily >7 daily  A standard drink : +/- 10g of pure alcohol  Most men prefer : beer  Most women prefer : wine  Annual consumption in average: – Beer : 4.6L per person – Wine : 3.1L per person – Spirits : 2.1L per person
  • STUDY 1  RESULTS: QUANTITY RR (COLON) RR (RECTUM) Low 1.1 1.2 Beer Moderate 1.1 1.4 High 1.2 1.8 Low 0.9 0.9 Wine Moderate 0.9 0.9 High 0.5 0.9 Low 1.1 1.0 Spirit Moderate 1.3 1.3 High 1.5 1.4
  • STUDY 1 1.6 Non-wine 1.4 1.2 Wine RR 1.0 0.8 0.6 0.4 0 1-7 8-21 22-35 >35 Alcohol Consumption (drinks/week)
  • STUDY 1 – In heavy alcohol consumption, the association between alcohol and rectal cancer is more prominent in comparison with colon cancer. – Risk of developing colon cancer is not much different among different types of alcohol. – Heavier beer and spirits intake is associated with an increase in the relative risk of developing rectal cancer. – Slight decrease in relative risk of developing rectal cancer associated with wine consumption. – Those who include wine in their alcohol intake have significantly reduced relative risk of developing rectal cancer.
  • STUDY 2  RESULTS: QUANTITY RR (COLON + RECTUM) Low 1.0 Beer Moderate 0.9 High 2.4 Low 1.0 Wine Moderate 0.6 High 0.5 Low 1.0 Spirit Moderate 0.9 High 2.5
  • STUDY 2 PATHOLOGICAL DISTRIBUTION PATHOLOGY ABSTAINER BEER WINE SPIRITS High-grade dysplasia 0.7% 0.3% 0.5% 0.4% Tubular adenomas 13.1% 11.5% 9.7% 11.1% Villous adenomas 2.9% 2.0% 1.2% 3.1% Malignant polyp 0.2% 0.7% 0.2% 0.9% Adenocarcinoma 0.7% 0.7% 0.3% 0.9% Significant neoplasia 10.7% 10.8% 5.9% 14.7%
  • STUDY 2 – Wine in moderate quantity may decrease the likelihood of developing colorectal cancer up to half compared to higher quantity. – Beer and spirits in high quantity may increase the likelihood of developing colorectal cancer by more than twofold compared to lower quantity.
  • STUDY 3  RESULTS: QUANTITY RR (COLON) RR (RECTUM) Low 1.0 1.1 Beer Moderate 1.4 1.7 High 2.4 1.5 Low 0.9 1.1 Wine Moderate 0.8 1.5 High 0.9 0.2 Low 1.1 1.4 Spirit Moderate 1.6 1.5 High 1.6 1.9 Distal colon is more likely to get affected than proximal colon with any alcohol type.
  • STUDY 3 – In relation to alcohol, the distal colon is more likely to develop neoplasia in comparison with the proximal colon. – Heavy beer consumption has the strongest relationship with cancer of the distal colon and rectum. – Risk of developing colorectal cancer increases with longer period of alcohol consumption (ie. start drinking at earlier age) regardless the alcohol type. – Wine consumption relates to a decrease in relative risk of developing rectal cancer.
  • STUDY 4  Comparison between high and low alcohol intake.  16 studies with more than 6,300 patients included.  FINDINGS: – Positive association to colon cancer in men (RR 1.64) and women (RR 1.23) – Positive association to rectal cancer in men (RR 1.79) and women (RR 1.39) – Ethanol in alcoholic beverages is the significant factor, not the type of the beverages itself.
  • WHICH ONE IS BETTER? BEER WINE SPIRITS
  • HOW MUCH? BEER & SPIRITS 30g of alcohol daily is the maximum safety limit in relation to the relative risk of developing colorectal cancer. Consumption above that level may increase the relative risk of developing colorectal cancer significantly (up to twofold). WINE (especially RED) 10g - 30g of alcohol daily is believed to be the optimum quantity to get the benefit of wine in reducing the relative risk of developing colorectal cancer (up to half). Consumption above that level is not proven to be beneficial.
  • HOW MANY? BEER (LOW STRENGTH) BEER (FULL STRENGTH) 425mL 425mL 425mL 375mL 375mL SPIRITS PORT/SHERRY 30mL 30mL 30mL 60mL 60mL 60mL WINE SPARKLING WINE 100mL 100mL 100mL 180mL 180mL
  • IN SUMMARY  Low to moderate consumption of alcohol in general does not increase the relative risk of developing colorectal cancer.  Low to moderate consumption of wine (especially red) in general may lower the relative risk of developing colorectal cancer.  High consumption of alcohol in general may increase the relative risk of developing colorectal cancer (especially rectal cancer).  Beer is associated with significantly higher relative risk of developing colorectal cancer in high quantity drinkers, men in particular.  It is generally safe to drink up to 30g of alcohol daily, although the lesser the better.  Drink red wine!
  • POLYPHENOLS  Administration of 50mg/kg red wine polyphenols to rats  Induction of colon carcinogenesis  Polyphenol-treated rats had lower tumour yield in comparison with control rats  Chemopreventive against colon cancer ?
  • POLYPHENOLS
  • POLYPHENOLS DOWN-REGULATED GENES AFTER POLYPHENOL TREATMENT CELL SURFACE ANTIGENS GENE EXPRESSION CONTROL RECEPTORS & SIGNAL TRANSDUCTION GROWTH FACTORS ENERGY METABOLISM TRANSPORT & BINDING PROTEINS DAMAGE & STRESS RESPONSE CHOLESTEROL & LIPID METABOLISM XENOBIOTIC METABOLISM INFLAMMATORY & IMMUNE RESPONSES UNASSIGNED CELL STRUCTURE CELL CYCLE METABOLIC ENZYMES Courtesy of Dolara, P, et al. (2004)
  • REFERENCES  Anderson, JC, et al. (2005) Prevalence and Risk of Colorectal Neoplasia in Consumers of Alcohol in a Screening Population. American Journal of Gastroenterology. Vol.100. pp.2049-2055.  Australian Bureau of Statistics (2006) Alcohol Consumption in Australia: A Snapshot, 2004-05. Commonwealth of Australia. Available from <http:// www.abs.gov.au/ausstats/abs@.nsf/mf/4832.0.55.001/> Accessed on 12 August 2007.  Bongaerts, BWC, et al. (2007) Alcohol consumption and distinct molecular pathways to colorectal cancer. British Journal of Nutrition. Vol.97. pp.430-434.  Dolara, P, et al. (2005) Red wine polyphenols influence carcinogenesis, intestinal microflora, oxidative damage and gene expression profiles of colonic mucosa in F344 rats. Journal of Mutation Research. Vol.591. pp.237-246.  Moskal, A, et al. (2006) Alcohol intake and colorectal cancer risk: A dose- response meta-analysis of published cohort studies. International Journal of Cancer. Vol.120. pp.664-671.  Pedersen, A, et al. (2003) Relations between amount and type of alcohol and colon and rectal cancer in a Danish population based cohort study. Gut: International Journal of Gastroenterology and Hepatology. Vol.52. pp.861-867.