Meta-analysis of 16 studies of the association of alcohol with colorectal cancer

Sarah McNabb, Tabitha A. Harrison, Demetrius Albanes, Sonja I. Berndt, Hermann Brenner, Bette J. Caan, Peter T. Campbell, Yin Cao, Jenny Chang-Claude, Andrew Chan, Zhengyi Chen, Dallas R. English, Graham G. Giles, Edward L. Giovannucci, Phyllis J. Goodman, Richard B. Hayes, Michael Hoffmeister, Eric J. Jacobs, Amit D. Joshi, Susanna C. LarssonLoïc Le Marchand, Li Li, Yi Lin, Satu Männistö, Roger L. Milne, Hongmei Nan, Christina C. Newton, Shuji Ogino, Patrick S. Parfrey, Paneen S. Petersen, John D. Potter, Robert E. Schoen, Martha L. Slattery, Yu Ru Su, Catherine M. Tangen, Thomas C. Tucker, Stephanie J. Weinstein, Emily White, Alicja Wolk, Michael O. Woods, Amanda I. Phipps, Ulrike Peters

Research output: Contribution to journalArticlepeer-review

91 Scopus citations


Alcohol consumption is an established risk factor for colorectal cancer (CRC). However, while studies have consistently reported elevated risk of CRC among heavy drinkers, associations at moderate levels of alcohol consumption are less clear. We conducted a combined analysis of 16 studies of CRC to examine the shape of the alcohol–CRC association, investigate potential effect modifiers of the association, and examine differential effects of alcohol consumption by cancer anatomic site and stage. We collected information on alcohol consumption for 14,276 CRC cases and 15,802 controls from 5 case-control and 11 nested case-control studies of CRC. We compared adjusted logistic regression models with linear and restricted cubic splines to select a model that best fit the association between alcohol consumption and CRC. Study-specific results were pooled using fixed-effects meta-analysis. Compared to non-/occasional drinking (≤1 g/day), light/moderate drinking (up to 2 drinks/day) was associated with a decreased risk of CRC (odds ratio [OR]: 0.92, 95% confidence interval [CI]: 0.88–0.98, p = 0.005), heavy drinking (2–3 drinks/day) was not significantly associated with CRC risk (OR: 1.11, 95% CI: 0.99–1.24, p = 0.08) and very heavy drinking (more than 3 drinks/day) was associated with a significant increased risk (OR: 1.25, 95% CI: 1.11–1.40, p < 0.001). We observed no evidence of interactions with lifestyle risk factors or of differences by cancer site or stage. These results provide further evidence that there is a J-shaped association between alcohol consumption and CRC risk. This overall pattern was not significantly modified by other CRC risk factors and there was no effect heterogeneity by tumor site or stage.

Original languageEnglish
Pages (from-to)861-873
Number of pages13
JournalInternational Journal of Cancer
Issue number3
StatePublished - Feb 1 2020

Bibliographical note

Publisher Copyright:
Published 2019. This article is a U.S. Government work and is in the public domain in the USA.


  • alcohol
  • colon cancer
  • colorectal cancer
  • rectal cancer

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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