Synergistic Association Between Hot Tea Drinking, Smoking, and Alcohol Use on Esophageal Cancer Risk

Alcohol and tobacco use are known risk factors for developing esophageal squamous cell cancer. Tea may have inhibitory effects in cancer development, but chronic thermal injury may also initiate carcinogenesis. This prospective study in China investigated associations between tea consumption and esophageal cancer, and potential interactions with smoking and alcohol use. The study comprised 456,155 people aged 30-79, followed for a median of 9.2 years. Overall, 1731 incident cases of esophageal cancer were identified (1106 in men, 625 in women).

• In those who didn’t smoke and were drinking <15 g of ethanol in a day, there was no association between daily tea drinking and esophageal cancer, regardless of tea temperature.
• Participants drinking daily high-temperature tea in the presence of either smoking or drinking ≥15 g of ethanol in a day had an increased risk of esophageal cancer (hazard ratio [HR], 1.6 and 2.3, respectively).
• The strongest association was seen among those participants with a combination of daily high-temperature tea drinking, smoking, and alcohol use (HR, 5.0).

Comments: In this large prospective cohort, researchers found joint associations between high-temperature tea drinking, smoking, and alcohol use on esophageal cancer risk. No benefit of tea drinking was identified. The synergistic effects of hot tea drinking, smoking, and alcohol use on esophageal cancer risk are biologically plausible. In addition to prevention efforts targeting smoking and alcohol use, this calls for limiting hot tea drinking in people with regular alcohol use and/or smoking.

Nicolas Bertholet, MD, MSc

Reference: Yu C, Tang H, Guo Y, et al. Hot tea consumption and its interactions with alcohol and tobacco use on the risk for esophageal cancer: a population-based cohort study. Ann Intern Med. 2018;168(7):489–497.