Smoking, Alcohol, and Biliary Tract Cancer Risk: A Pooling Project of 26 Prospective Studies

Emma E. McGee; Sarah S. Jackson; Jessica L. Petrick; Alison L. Van Dyke; Hans Olov Adami; Demetrius Albanes; Gabriella Andreotti; Laura E. Beane-Freeman; Amy Berrington de Gonzalez; Julie E. Buring; Andrew T. Chan; Yu Chen; Gary E. Fraser; Neal D. Freedman; Yu Tang Gao; Susan M. Gapstur; J. Michael Gaziano; Graham G. Giles; Eric J. Grant; Francine Grodstein; Patricia Hartge; Mazda Jenab; Cari M. Kitahara; Synnove F. Knutsen; Woon Puay Koh; Susanna C. Larsson; I. Min Lee; Linda M. Liao; Juhua Luo; Roger L. Milne; Kristine R. Monroe; Marian L. Neuhouser; Katie M. O’Brien; Ulrike Peters; Jenny N. Poynter; Mark P. Purdue; Kim Robien; Dale P. Sandler; Norie Sawada; Catherine Schairer; Howard D. Sesso; Tracey G. Simon; Rashmi Sinha; Rachael Stolzenberg-Solomon; Shoichiro Tsugane; Renwei Wang; Elisabete Weiderpass; Stephanie J. Weinstein; Emily White; Alicja Wolk; Jian Min Yuan; Anne Zeleniuch-Jacquotte; Xuehong Zhang; Bin Zhu; Katherine A. McGlynn; Peter T. Campbell; Jill Koshiol

doi:10.1093/JNCI/DJZ103

Smoking, Alcohol, and Biliary Tract Cancer Risk: A Pooling Project of 26 Prospective Studies

Emma E. McGee, Sarah S. Jackson, Jessica L. Petrick, Alison L. Van Dyke, Hans Olov Adami, Demetrius Albanes, Gabriella Andreotti, Laura E. Beane-Freeman, Amy Berrington de Gonzalez, Julie E. Buring, Andrew T. Chan, Yu Chen, Gary E. Fraser, Neal D. Freedman, Yu Tang Gao, Susan M. Gapstur, J. Michael Gaziano, Graham G. Giles, Eric J. Grant, Francine GrodsteinPatricia Hartge, Mazda Jenab, Cari M. Kitahara, Synnove F. Knutsen, Woon Puay Koh, Susanna C. Larsson, I. Min Lee, Linda M. Liao, Juhua Luo, Roger L. Milne, Kristine R. Monroe, Marian L. Neuhouser, Katie M. O’Brien, Ulrike Peters, Jenny N. Poynter, Mark P. Purdue, Kim Robien, Dale P. Sandler, Norie Sawada, Catherine Schairer, Howard D. Sesso, Tracey G. Simon, Rashmi Sinha, Rachael Stolzenberg-Solomon, Shoichiro Tsugane, Renwei Wang, Elisabete Weiderpass, Stephanie J. Weinstein, Emily White, Alicja Wolk, Jian Min Yuan, Anne Zeleniuch-Jacquotte, Xuehong Zhang, Bin Zhu, Katherine A. McGlynn, Peter T. Campbell, Jill Koshiol

Research output: Contribution to journal › Review article › peer-review

47 Scopus citations

Abstract

Background: Tobacco and alcohol are well-established risk factors for numerous cancers, yet their relationship to biliary tract cancers remains unclear. Methods: We pooled data from 26 prospective studies to evaluate associations of cigarette smoking and alcohol consumption with biliary tract cancer risk. Study-specific hazard ratios (HRs) and 95% confidence intervals (CIs) for associations with smoking and alcohol consumption were calculated. Random-effects meta-analysis produced summary estimates. All statistical tests were two-sided. Results: Over a period of 38 369 156 person-years of follow-up, 1391 gallbladder, 758 intrahepatic bile duct, 1208 extrahepatic bile duct, and 623 ampulla of Vater cancer cases were identified. Ever, former, and current smoking were associated with increased extrahepatic bile duct and ampulla of Vater cancers risk (eg, current vs never smokers HR ¼ 1.69, 95% CI ¼ 1.34 to 2.13 and 2.22, 95% CI ¼ 1.69 to 2.92, respectively), with dose-response effects for smoking pack-years, duration, and intensity (all P_trend < .01). Current smoking and smoking intensity were also associated with intrahepatic bile duct cancer (eg, >40 cigarettes per day vs never smokers HR ¼ 2.15, 95 % CI ¼ 1.15 to 4.00; P_trend ¼ .001). No convincing association was observed between smoking and gallbladder cancer. Alcohol consumption was only associated with intrahepatic bile duct cancer, with increased risk for individuals consuming five or more vs zero drinks per day (HR ¼ 2.35, 95%CI ¼ 1.46 to 3.78; P_trend ¼ .04). There was evidence of statistical heterogeneity among several cancer sites, particularly between gallbladder cancer and the other biliary tract cancers. Conclusions: Smoking appears to increase the risk of developing all biliary tract cancers except gallbladder cancer. Alcohol may increase the risk of intrahepatic bile duct cancer. Findings highlight etiologic heterogeneity across the biliary tract.

Original language	English
Pages (from-to)	1263-1278
Number of pages	16
Journal	Journal of the National Cancer Institute
Volume	111
Issue number	12
DOIs	https://doi.org/10.1093/JNCI/DJZ103
State	Published - 1 Dec 2019
Externally published	Yes

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10.1093/JNCI/DJZ103

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McGee, E. E., Jackson, S. S., Petrick, J. L., Van Dyke, A. L., Adami, H. O., Albanes, D., Andreotti, G., Beane-Freeman, L. E., de Gonzalez, A. B., Buring, J. E., Chan, A. T., Chen, Y., Fraser, G. E., Freedman, N. D., Gao, Y. T., Gapstur, S. M., Gaziano, J. M., Giles, G. G., Grant, E. J., ... Koshiol, J. (2019). Smoking, Alcohol, and Biliary Tract Cancer Risk: A Pooling Project of 26 Prospective Studies. Journal of the National Cancer Institute, 111(12), 1263-1278. https://doi.org/10.1093/JNCI/DJZ103

@article{2b99b196e7f7410ea9682395cd91cda3,

title = "Smoking, Alcohol, and Biliary Tract Cancer Risk: A Pooling Project of 26 Prospective Studies",

abstract = "Background: Tobacco and alcohol are well-established risk factors for numerous cancers, yet their relationship to biliary tract cancers remains unclear. Methods: We pooled data from 26 prospective studies to evaluate associations of cigarette smoking and alcohol consumption with biliary tract cancer risk. Study-specific hazard ratios (HRs) and 95% confidence intervals (CIs) for associations with smoking and alcohol consumption were calculated. Random-effects meta-analysis produced summary estimates. All statistical tests were two-sided. Results: Over a period of 38 369 156 person-years of follow-up, 1391 gallbladder, 758 intrahepatic bile duct, 1208 extrahepatic bile duct, and 623 ampulla of Vater cancer cases were identified. Ever, former, and current smoking were associated with increased extrahepatic bile duct and ampulla of Vater cancers risk (eg, current vs never smokers HR ¼ 1.69, 95% CI ¼ 1.34 to 2.13 and 2.22, 95% CI ¼ 1.69 to 2.92, respectively), with dose-response effects for smoking pack-years, duration, and intensity (all Ptrend < .01). Current smoking and smoking intensity were also associated with intrahepatic bile duct cancer (eg, >40 cigarettes per day vs never smokers HR ¼ 2.15, 95 % CI ¼ 1.15 to 4.00; Ptrend ¼ .001). No convincing association was observed between smoking and gallbladder cancer. Alcohol consumption was only associated with intrahepatic bile duct cancer, with increased risk for individuals consuming five or more vs zero drinks per day (HR ¼ 2.35, 95%CI ¼ 1.46 to 3.78; Ptrend ¼ .04). There was evidence of statistical heterogeneity among several cancer sites, particularly between gallbladder cancer and the other biliary tract cancers. Conclusions: Smoking appears to increase the risk of developing all biliary tract cancers except gallbladder cancer. Alcohol may increase the risk of intrahepatic bile duct cancer. Findings highlight etiologic heterogeneity across the biliary tract.",

author = "McGee, {Emma E.} and Jackson, {Sarah S.} and Petrick, {Jessica L.} and {Van Dyke}, {Alison L.} and Adami, {Hans Olov} and Demetrius Albanes and Gabriella Andreotti and Beane-Freeman, {Laura E.} and {de Gonzalez}, {Amy Berrington} and Buring, {Julie E.} and Chan, {Andrew T.} and Yu Chen and Fraser, {Gary E.} and Freedman, {Neal D.} and Gao, {Yu Tang} and Gapstur, {Susan M.} and Gaziano, {J. Michael} and Giles, {Graham G.} and Grant, {Eric J.} and Francine Grodstein and Patricia Hartge and Mazda Jenab and Kitahara, {Cari M.} and Knutsen, {Synnove F.} and Koh, {Woon Puay} and Larsson, {Susanna C.} and Lee, {I. Min} and Liao, {Linda M.} and Juhua Luo and Milne, {Roger L.} and Monroe, {Kristine R.} and Neuhouser, {Marian L.} and O{\textquoteright}Brien, {Katie M.} and Ulrike Peters and Poynter, {Jenny N.} and Purdue, {Mark P.} and Kim Robien and Sandler, {Dale P.} and Norie Sawada and Catherine Schairer and Sesso, {Howard D.} and Simon, {Tracey G.} and Rashmi Sinha and Rachael Stolzenberg-Solomon and Shoichiro Tsugane and Renwei Wang and Elisabete Weiderpass and Weinstein, {Stephanie J.} and Emily White and Alicja Wolk and Yuan, {Jian Min} and Anne Zeleniuch-Jacquotte and Xuehong Zhang and Bin Zhu and McGlynn, {Katherine A.} and Campbell, {Peter T.} and Jill Koshiol",

note = "Funding Information: SISTER: The Sister Study is supported by the Intramural Research Program of the National Institutes of Health, National Institute of Environmental Health Sciences (ZO1-ES-044005). Funding Information: Figure 1. Forest plots for associations between cigarette smoking status and biliary tract cancer risk by anatomic site in the Biliary Tract Cancers Pooling Project. Hazard ratios for former vs never smoking (A, C, E, G) and current vs never smoking (B, D, F, H) are adjusted for sex (male, female), race (white, black, Asian and Pacific Islander, other), education (less than high school graduate, high school graduate, some college or post-high school training), body mass index in kg per m2 (<18.5, 18.5– <25, 25–<30, ≥30), diabetes (ever vs never diagnosed), birth cohort (1870–1899, 1900–1909, 1910–1919, 1920–1929, 1930–1939, 1940–1949, 1950–1959, 1960–1982), and alcoholic drinks per day (0, >0–0.5, >0.5–1, 1–<3, ≥3). Small black-filled diamonds represent the point estimates for each study. Horizontal lines represent 95% confidence intervals; if ending in an arrow, the interval transcends the region plotted. % weight describes the weight (inverse variance) each study contributed to the summary hazard ratio. Study weight is also represented by the shaded gray region around each study-specific point estimate. I2 is the percentage of variation due to between-study heterogeneity. Summary hazard ratios (dotted lines) and 95% confidence intervals (hollow diamonds) were estimated via random-effects meta-analysis. All statistical tests were two-sided. P values were calculated using the Wald test. Some additional studies collected information on cigarette smoking status but could not contribute to this meta-analysis because they did not have a sufficient number of biliary tract cancer patients who were former or current smokers. AgHealth = Agricultural Health Study; BCDDP = Breast Cancer Detection Demonstration Project; CI = confidence interval; COSM = Cohort of Swedish Men; CPS–II NC = Cancer Prevention Study II Nutrition Cohort; EPIC = European Prospective Investigation into Cancer and Nutrition; HR = hazard ratio; HPFS = Health Professionals Follow–Up Study; IWHS = Iowa Women{\textquoteright}s Health Study; JPHC = Japan Public Health Center-based prospective Study 1 and 2; MCCS = Melbourne Collaborative Cohort Study; MEC = Multiethnic Cohort Study; NHS = Nurses{\textquoteright} Health Study; NIH-AARP = National Institutes of Health-American Association of Retired Persons Diet and Health Study; NYUWHS = New York University Women{\textquoteright}s Health Study; PHS = Physicians{\textquoteright} Health Study; PLCO = Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial; RERF = Radiation Effects Research Foundation Life Span Study; SCHS = Singapore Chinese Health Study; SCS = Shanghai Cohort Study; SISTER = Sister Study; SMC = Swedish Mammography Cohort; VITAL = VITamins and Lifestyle Study; WHI = Women{\textquoteright}s Health Initiative; WHS = Women{\textquoteright}s Health Study; WLHS = Women{\textquoteright}s Lifestyle and Health Study. Funding Information: SCS: The Shanghai Cohort Study is supported by the National Cancer Institute (R01CA043092, R01CA144034, and UM1CA182876). Funding Information: HPFS: This work was supported by grants from the National Institutes of Health (UM1 CA167552, P01 CA55075), the Entertainment Industry Foundation, and the National Colorectal Cancer Research Alliance. HPFS would like to thank the participants and staff of the HPFS for their valuable contributions as well as the following state cancer registries for their help: AL, AZ, AR, CA, CO, CT, DE, FL, GA, ID, IL, IN, IA, KY, LA, ME, MD, MA, MI, NE, NH, NJ, NY, NC, ND, OH, OK, OR, PA, RI, SC, TN, TX, VA, WA, and WY. The authors assume full responsibility for analyses and interpretation of these data. Funding Information: AHS-2: Project support was obtained from National Cancer Institute grant 1U01CA152939. Funding Information: COSM: This cohort is supported by the Swedish Research Council (Research Infrastructure SIMPLER), the Swedish Cancer Foundation, and by Strategic Funds from Karolinska Institutet, Stockholm, Sweden. Funding Information: WHI: The WHI program is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, US Department of Health and Human Services through contracts, HHSN268201600018C, HHSN268201600001C, HHSN268201600 002C, HHSN268201600003C, and HHSN268201600004C. The authors thank the WHI investigators and staff for their dedication, and the study participants for making the program possible. A listing of WHI investigators can be found at http:// www.whi.org/researchers/Documents%20%20Write%20a %20Paper/WHI%20Investigator%20Short%20List.pdf. Funding Information: NYUWHS: The NYUWHS is supported by grants UM1 CA182934 and P30 CA16087 from the National Cancer Institute and by grant P30 ES000260 from the National Institute of Environmental Health Sciences. Funding Information: SCHS: This study is supported by the National Cancer Institute (R01CA080205, R01CA144034, and UM1CA182876). Funding Information: VITAL: The VITAL study was supported by the National Institutes of Health grant K05-CA154337 (National Cancer Institute and Office of Dietary Supplements). Funding Information: WLHS: The WLHS project was supported by the Swedish Research Council (grant number 521–2011-295) and a Distinguished Professor Award at Karolinska Institutet to Hans-Olov Adami, grant number 2368/10–221. Funding Information: AgHealth: This study was funded by the Intramural Program of the National Institutes of Health, National Cancer Institute (Z01 P010119). and the National Institute of Environmental Health Sciences (Z01 ES 049030–11). Funding Information: ATBC: The ATBC Study is supported by the Intramural Research Program of the US National Cancer Institute, National Institutes of Health, and by US Public Health Service contract HHSN261201500005C from the National Cancer Institute, Department of Health and Human Services. Funding Information: JPHC: This work was supported by the National Cancer Center Research and Development Fund (since 2011) and a grant-in-aid from Cancer Research (1989–2010) from the Ministry of Health, Labor, and Welfare of Japan. Funding Information: IWHS: IWHS was funded by a grant from the National Cancer Institute (R01 CA39742). Funding Information: MEC: This work was supported by the National Institutes of Health (P01 CA33619 and U01 CA164973). Funding Information: MCCS: MCCS receives core funding from Cancer Council Victoria and is additionally supported by grants from the Australian National Health and Medical Research Council (209057, 251533, 396414, and 504715). Funding Information: RERF: The Radiation Effects Research Foundation (RERF), Hiroshima and Nagasaki, Japan, is a public interest foundation funded by the Japanese Ministry of Health, Labour and Welfare and the US Department of Energy (DOE). The research was also funded in part through DOE award DE-HS0000031 to the National Academy of Sciences. This publication was supported by RERF Research Protocol A2-13. The views of the authors do not necessarily reflect those of the two governments. Funding Information: EPIC: The coordination of the EPIC is financially supported by the European Commission (DG-SANCO) and the International Agency for Research on Cancer. The national cohorts are supported by Danish Cancer Society, Denmark; Ligue Contre le Cancer, France; Institut Gustave Roussy, France; Mutuelle G{\'e}n{\'e}rale de l{\textquoteright}Education Nationale, France; Institut National de la Sant{\'e} et de la Recherche M{\'e}dicale, France; Deutsche Krebshilfe, Germany; Deutsches Krebsforschungszentrum and Federal Ministry of Education and Research, Germany; Hellenic Health Foundation, Greece; Italian Association for Research on Cancer; National Research Council, Italy; Dutch Ministry of Public Health, Welfare and Sports, the Netherlands; Netherlands Cancer Registry, the Netherlands; LK Research Funds, the Netherlands; Dutch Prevention Funds, the Netherlands; Dutch ZON (Zorg Onderzoek Nederland), the Netherlands; World Cancer Research Fund, London, UK; Statistics Netherlands, the Netherlands; European Research Council, Norway; Health Research Fund, Regional Governments of Andaluc{\'i}a, Asturias, Basque Country, Murcia (project no. 6236) and Navarra, ISCIII RETIC (RD06/0020/0091), Spain; Swedish Cancer Society, Sweden; Swedish Scientific Council, Sweden; Regional Government of Sk{\aa}ne and Va€sterbotten, Sweden; Cancer Research, UK; Medical Research Council, UK; Stroke Association, UK; British Heart Foundation, UK; Department of Health, Food Standards Agency, UK; and Wellcome Trust, UK. Funding Information: PHS: PHS is supported by grants from the National Cancer Institute (CA-34933, CA-40360, and CA-097193) and from the National Heart, Lung, and Blood Institute (HL-26490 and HL-34595), National Institutes of Health, Bethesda, MD. Publisher Copyright: {\textcopyright} 2019 Oxford University Press. All rights reserved.",

year = "2019",

month = dec,

day = "1",

doi = "10.1093/JNCI/DJZ103",

language = "English",

volume = "111",

pages = "1263--1278",

journal = "Journal of the National Cancer Institute",

issn = "0027-8874",

publisher = "Oxford University Press",

number = "12",

}

McGee, EE, Jackson, SS, Petrick, JL, Van Dyke, AL, Adami, HO, Albanes, D, Andreotti, G, Beane-Freeman, LE, de Gonzalez, AB, Buring, JE, Chan, AT, Chen, Y, Fraser, GE, Freedman, ND, Gao, YT, Gapstur, SM, Gaziano, JM, Giles, GG, Grant, EJ, Grodstein, F, Hartge, P, Jenab, M, Kitahara, CM, Knutsen, SF, Koh, WP, Larsson, SC, Lee, IM, Liao, LM, Luo, J, Milne, RL, Monroe, KR, Neuhouser, ML, O’Brien, KM, Peters, U, Poynter, JN, Purdue, MP, Robien, K, Sandler, DP, Sawada, N, Schairer, C, Sesso, HD, Simon, TG, Sinha, R, Stolzenberg-Solomon, R, Tsugane, S, Wang, R, Weiderpass, E, Weinstein, SJ, White, E, Wolk, A, Yuan, JM, Zeleniuch-Jacquotte, A, Zhang, X, Zhu, B, McGlynn, KA, Campbell, PT & Koshiol, J 2019, 'Smoking, Alcohol, and Biliary Tract Cancer Risk: A Pooling Project of 26 Prospective Studies', Journal of the National Cancer Institute, vol. 111, no. 12, pp. 1263-1278. https://doi.org/10.1093/JNCI/DJZ103

TY - JOUR

T1 - Smoking, Alcohol, and Biliary Tract Cancer Risk

T2 - A Pooling Project of 26 Prospective Studies

AU - McGee, Emma E.

AU - Jackson, Sarah S.

AU - Petrick, Jessica L.

AU - Van Dyke, Alison L.

AU - Adami, Hans Olov

AU - Albanes, Demetrius

AU - Andreotti, Gabriella

AU - Beane-Freeman, Laura E.

AU - de Gonzalez, Amy Berrington

AU - Buring, Julie E.

AU - Chan, Andrew T.

AU - Chen, Yu

AU - Fraser, Gary E.

AU - Freedman, Neal D.

AU - Gao, Yu Tang

AU - Gapstur, Susan M.

AU - Gaziano, J. Michael

AU - Giles, Graham G.

AU - Grant, Eric J.

AU - Grodstein, Francine

AU - Hartge, Patricia

AU - Jenab, Mazda

AU - Kitahara, Cari M.

AU - Knutsen, Synnove F.

AU - Koh, Woon Puay

AU - Larsson, Susanna C.

AU - Lee, I. Min

AU - Liao, Linda M.

AU - Luo, Juhua

AU - Milne, Roger L.

AU - Monroe, Kristine R.

AU - Neuhouser, Marian L.

AU - O’Brien, Katie M.

AU - Peters, Ulrike

AU - Poynter, Jenny N.

AU - Purdue, Mark P.

AU - Robien, Kim

AU - Sandler, Dale P.

AU - Sawada, Norie

AU - Schairer, Catherine

AU - Sesso, Howard D.

AU - Simon, Tracey G.

AU - Sinha, Rashmi

AU - Stolzenberg-Solomon, Rachael

AU - Tsugane, Shoichiro

AU - Wang, Renwei

AU - Weiderpass, Elisabete

AU - Weinstein, Stephanie J.

AU - White, Emily

AU - Wolk, Alicja

AU - Yuan, Jian Min

AU - Zeleniuch-Jacquotte, Anne

AU - Zhang, Xuehong

AU - Zhu, Bin

AU - McGlynn, Katherine A.

AU - Campbell, Peter T.

AU - Koshiol, Jill

N1 - Funding Information: SISTER: The Sister Study is supported by the Intramural Research Program of the National Institutes of Health, National Institute of Environmental Health Sciences (ZO1-ES-044005). Funding Information: Figure 1. Forest plots for associations between cigarette smoking status and biliary tract cancer risk by anatomic site in the Biliary Tract Cancers Pooling Project. Hazard ratios for former vs never smoking (A, C, E, G) and current vs never smoking (B, D, F, H) are adjusted for sex (male, female), race (white, black, Asian and Pacific Islander, other), education (less than high school graduate, high school graduate, some college or post-high school training), body mass index in kg per m2 (<18.5, 18.5– <25, 25–<30, ≥30), diabetes (ever vs never diagnosed), birth cohort (1870–1899, 1900–1909, 1910–1919, 1920–1929, 1930–1939, 1940–1949, 1950–1959, 1960–1982), and alcoholic drinks per day (0, >0–0.5, >0.5–1, 1–<3, ≥3). Small black-filled diamonds represent the point estimates for each study. Horizontal lines represent 95% confidence intervals; if ending in an arrow, the interval transcends the region plotted. % weight describes the weight (inverse variance) each study contributed to the summary hazard ratio. Study weight is also represented by the shaded gray region around each study-specific point estimate. I2 is the percentage of variation due to between-study heterogeneity. Summary hazard ratios (dotted lines) and 95% confidence intervals (hollow diamonds) were estimated via random-effects meta-analysis. All statistical tests were two-sided. P values were calculated using the Wald test. Some additional studies collected information on cigarette smoking status but could not contribute to this meta-analysis because they did not have a sufficient number of biliary tract cancer patients who were former or current smokers. AgHealth = Agricultural Health Study; BCDDP = Breast Cancer Detection Demonstration Project; CI = confidence interval; COSM = Cohort of Swedish Men; CPS–II NC = Cancer Prevention Study II Nutrition Cohort; EPIC = European Prospective Investigation into Cancer and Nutrition; HR = hazard ratio; HPFS = Health Professionals Follow–Up Study; IWHS = Iowa Women’s Health Study; JPHC = Japan Public Health Center-based prospective Study 1 and 2; MCCS = Melbourne Collaborative Cohort Study; MEC = Multiethnic Cohort Study; NHS = Nurses’ Health Study; NIH-AARP = National Institutes of Health-American Association of Retired Persons Diet and Health Study; NYUWHS = New York University Women’s Health Study; PHS = Physicians’ Health Study; PLCO = Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial; RERF = Radiation Effects Research Foundation Life Span Study; SCHS = Singapore Chinese Health Study; SCS = Shanghai Cohort Study; SISTER = Sister Study; SMC = Swedish Mammography Cohort; VITAL = VITamins and Lifestyle Study; WHI = Women’s Health Initiative; WHS = Women’s Health Study; WLHS = Women’s Lifestyle and Health Study. Funding Information: SCS: The Shanghai Cohort Study is supported by the National Cancer Institute (R01CA043092, R01CA144034, and UM1CA182876). Funding Information: HPFS: This work was supported by grants from the National Institutes of Health (UM1 CA167552, P01 CA55075), the Entertainment Industry Foundation, and the National Colorectal Cancer Research Alliance. HPFS would like to thank the participants and staff of the HPFS for their valuable contributions as well as the following state cancer registries for their help: AL, AZ, AR, CA, CO, CT, DE, FL, GA, ID, IL, IN, IA, KY, LA, ME, MD, MA, MI, NE, NH, NJ, NY, NC, ND, OH, OK, OR, PA, RI, SC, TN, TX, VA, WA, and WY. The authors assume full responsibility for analyses and interpretation of these data. Funding Information: AHS-2: Project support was obtained from National Cancer Institute grant 1U01CA152939. Funding Information: COSM: This cohort is supported by the Swedish Research Council (Research Infrastructure SIMPLER), the Swedish Cancer Foundation, and by Strategic Funds from Karolinska Institutet, Stockholm, Sweden. Funding Information: WHI: The WHI program is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, US Department of Health and Human Services through contracts, HHSN268201600018C, HHSN268201600001C, HHSN268201600 002C, HHSN268201600003C, and HHSN268201600004C. The authors thank the WHI investigators and staff for their dedication, and the study participants for making the program possible. A listing of WHI investigators can be found at http:// www.whi.org/researchers/Documents%20%20Write%20a %20Paper/WHI%20Investigator%20Short%20List.pdf. Funding Information: NYUWHS: The NYUWHS is supported by grants UM1 CA182934 and P30 CA16087 from the National Cancer Institute and by grant P30 ES000260 from the National Institute of Environmental Health Sciences. Funding Information: SCHS: This study is supported by the National Cancer Institute (R01CA080205, R01CA144034, and UM1CA182876). Funding Information: VITAL: The VITAL study was supported by the National Institutes of Health grant K05-CA154337 (National Cancer Institute and Office of Dietary Supplements). Funding Information: WLHS: The WLHS project was supported by the Swedish Research Council (grant number 521–2011-295) and a Distinguished Professor Award at Karolinska Institutet to Hans-Olov Adami, grant number 2368/10–221. Funding Information: AgHealth: This study was funded by the Intramural Program of the National Institutes of Health, National Cancer Institute (Z01 P010119). and the National Institute of Environmental Health Sciences (Z01 ES 049030–11). Funding Information: ATBC: The ATBC Study is supported by the Intramural Research Program of the US National Cancer Institute, National Institutes of Health, and by US Public Health Service contract HHSN261201500005C from the National Cancer Institute, Department of Health and Human Services. Funding Information: JPHC: This work was supported by the National Cancer Center Research and Development Fund (since 2011) and a grant-in-aid from Cancer Research (1989–2010) from the Ministry of Health, Labor, and Welfare of Japan. Funding Information: IWHS: IWHS was funded by a grant from the National Cancer Institute (R01 CA39742). Funding Information: MEC: This work was supported by the National Institutes of Health (P01 CA33619 and U01 CA164973). Funding Information: MCCS: MCCS receives core funding from Cancer Council Victoria and is additionally supported by grants from the Australian National Health and Medical Research Council (209057, 251533, 396414, and 504715). Funding Information: RERF: The Radiation Effects Research Foundation (RERF), Hiroshima and Nagasaki, Japan, is a public interest foundation funded by the Japanese Ministry of Health, Labour and Welfare and the US Department of Energy (DOE). The research was also funded in part through DOE award DE-HS0000031 to the National Academy of Sciences. This publication was supported by RERF Research Protocol A2-13. The views of the authors do not necessarily reflect those of the two governments. Funding Information: EPIC: The coordination of the EPIC is financially supported by the European Commission (DG-SANCO) and the International Agency for Research on Cancer. The national cohorts are supported by Danish Cancer Society, Denmark; Ligue Contre le Cancer, France; Institut Gustave Roussy, France; Mutuelle Générale de l’Education Nationale, France; Institut National de la Santé et de la Recherche Médicale, France; Deutsche Krebshilfe, Germany; Deutsches Krebsforschungszentrum and Federal Ministry of Education and Research, Germany; Hellenic Health Foundation, Greece; Italian Association for Research on Cancer; National Research Council, Italy; Dutch Ministry of Public Health, Welfare and Sports, the Netherlands; Netherlands Cancer Registry, the Netherlands; LK Research Funds, the Netherlands; Dutch Prevention Funds, the Netherlands; Dutch ZON (Zorg Onderzoek Nederland), the Netherlands; World Cancer Research Fund, London, UK; Statistics Netherlands, the Netherlands; European Research Council, Norway; Health Research Fund, Regional Governments of Andalucía, Asturias, Basque Country, Murcia (project no. 6236) and Navarra, ISCIII RETIC (RD06/0020/0091), Spain; Swedish Cancer Society, Sweden; Swedish Scientific Council, Sweden; Regional Government of Skåne and Va€sterbotten, Sweden; Cancer Research, UK; Medical Research Council, UK; Stroke Association, UK; British Heart Foundation, UK; Department of Health, Food Standards Agency, UK; and Wellcome Trust, UK. Funding Information: PHS: PHS is supported by grants from the National Cancer Institute (CA-34933, CA-40360, and CA-097193) and from the National Heart, Lung, and Blood Institute (HL-26490 and HL-34595), National Institutes of Health, Bethesda, MD. Publisher Copyright: © 2019 Oxford University Press. All rights reserved.

PY - 2019/12/1

Y1 - 2019/12/1

N2 - Background: Tobacco and alcohol are well-established risk factors for numerous cancers, yet their relationship to biliary tract cancers remains unclear. Methods: We pooled data from 26 prospective studies to evaluate associations of cigarette smoking and alcohol consumption with biliary tract cancer risk. Study-specific hazard ratios (HRs) and 95% confidence intervals (CIs) for associations with smoking and alcohol consumption were calculated. Random-effects meta-analysis produced summary estimates. All statistical tests were two-sided. Results: Over a period of 38 369 156 person-years of follow-up, 1391 gallbladder, 758 intrahepatic bile duct, 1208 extrahepatic bile duct, and 623 ampulla of Vater cancer cases were identified. Ever, former, and current smoking were associated with increased extrahepatic bile duct and ampulla of Vater cancers risk (eg, current vs never smokers HR ¼ 1.69, 95% CI ¼ 1.34 to 2.13 and 2.22, 95% CI ¼ 1.69 to 2.92, respectively), with dose-response effects for smoking pack-years, duration, and intensity (all Ptrend < .01). Current smoking and smoking intensity were also associated with intrahepatic bile duct cancer (eg, >40 cigarettes per day vs never smokers HR ¼ 2.15, 95 % CI ¼ 1.15 to 4.00; Ptrend ¼ .001). No convincing association was observed between smoking and gallbladder cancer. Alcohol consumption was only associated with intrahepatic bile duct cancer, with increased risk for individuals consuming five or more vs zero drinks per day (HR ¼ 2.35, 95%CI ¼ 1.46 to 3.78; Ptrend ¼ .04). There was evidence of statistical heterogeneity among several cancer sites, particularly between gallbladder cancer and the other biliary tract cancers. Conclusions: Smoking appears to increase the risk of developing all biliary tract cancers except gallbladder cancer. Alcohol may increase the risk of intrahepatic bile duct cancer. Findings highlight etiologic heterogeneity across the biliary tract.

AB - Background: Tobacco and alcohol are well-established risk factors for numerous cancers, yet their relationship to biliary tract cancers remains unclear. Methods: We pooled data from 26 prospective studies to evaluate associations of cigarette smoking and alcohol consumption with biliary tract cancer risk. Study-specific hazard ratios (HRs) and 95% confidence intervals (CIs) for associations with smoking and alcohol consumption were calculated. Random-effects meta-analysis produced summary estimates. All statistical tests were two-sided. Results: Over a period of 38 369 156 person-years of follow-up, 1391 gallbladder, 758 intrahepatic bile duct, 1208 extrahepatic bile duct, and 623 ampulla of Vater cancer cases were identified. Ever, former, and current smoking were associated with increased extrahepatic bile duct and ampulla of Vater cancers risk (eg, current vs never smokers HR ¼ 1.69, 95% CI ¼ 1.34 to 2.13 and 2.22, 95% CI ¼ 1.69 to 2.92, respectively), with dose-response effects for smoking pack-years, duration, and intensity (all Ptrend < .01). Current smoking and smoking intensity were also associated with intrahepatic bile duct cancer (eg, >40 cigarettes per day vs never smokers HR ¼ 2.15, 95 % CI ¼ 1.15 to 4.00; Ptrend ¼ .001). No convincing association was observed between smoking and gallbladder cancer. Alcohol consumption was only associated with intrahepatic bile duct cancer, with increased risk for individuals consuming five or more vs zero drinks per day (HR ¼ 2.35, 95%CI ¼ 1.46 to 3.78; Ptrend ¼ .04). There was evidence of statistical heterogeneity among several cancer sites, particularly between gallbladder cancer and the other biliary tract cancers. Conclusions: Smoking appears to increase the risk of developing all biliary tract cancers except gallbladder cancer. Alcohol may increase the risk of intrahepatic bile duct cancer. Findings highlight etiologic heterogeneity across the biliary tract.

UR - http://www.scopus.com/inward/record.url?scp=85072023428&partnerID=8YFLogxK

U2 - 10.1093/JNCI/DJZ103

DO - 10.1093/JNCI/DJZ103

M3 - Review article

C2 - 31127946

AN - SCOPUS:85072023428

SN - 0027-8874

VL - 111

SP - 1263

EP - 1278

JO - Journal of the National Cancer Institute

JF - Journal of the National Cancer Institute

IS - 12

ER -

Smoking, Alcohol, and Biliary Tract Cancer Risk: A Pooling Project of 26 Prospective Studies

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