Alcohol intake and cancer of the upper digestive tract

Editor—A Danish study of 156 subjects with upper digestive tract cancers showed that wine drinkers may be at a lower risk than drinkers with a similar intake of beer or spirits.1 Wine is the most common alcoholic beverage in Italy, accounting for over 80% of alcohol intake.2 We investigated the separate and combined effect of wine drinking in a large dataset.3 Data were collected between 1984 and 1993 in Greater Milan and the province of Pordenone, Northern Italy, on 547 histologically confirmed incident cases of cancer of the oral cavity and pharynx (466 men, 81 women; age 22-74 (median 57)) and 412 cases of cancer of the oesophagus (345 men, 67 women; age 26-74 (median 60)). Controls were 2375 subjects (1797 men, 578 women; age 25-74 (median 56)) admitted to the same network of hospitals with acute non-neoplastic conditions unrelated to alcohol or tobacco consumption. Of these, 570 were admitted for trauma, 593 for non-traumatic orthopaedic conditions, 475 for acute surgical diseases, 428 for eye diseases, and 309 for miscellaneous other illnesses. Trained interviewers questioned cases and controls, using a structured questionnaire; questions on the days per week that each type of alcoholic beverage (wine, beer, and spirits) was consumed and the average number of drinks per day were included. The table gives the distribution of cases of oral and pharyngeal and oesophageal cancer and of the comparison group according to consumption of various alcoholic beverages. When non-drinkers and moderate drinkers (<3 drinks a day) were used as the comparison group, the odds ratios of oral and pharyngeal cancer were 4.95 for very heavy (⩾10 drinks per day) wine drinkers and 4.13 for very heavy wine, beer, and spirit drinkers. Corresponding findings for oesophageal cancer were 7.53 and 5.52. The odds ratios for beer or spirit drinkers only were 0.9 (95% confidence interval 0.3 to 2.4) for cancers of the oral cavity (7 cases, 47 controls) and 1.5 (0.6 to 3.9) for oesophageal cancer (7 cases, 47 controls). These results were consistent across separate diagnostic conditions in controls. This pattern of risk according to type of alcoholic beverage is different from that reported in the Danish study.1 Taken together, these data lead us to conclude that ethanol is the main component of alcoholic beverages that determines the risk of cancer and that the most frequently consumed beverage in each area tends to be the one with the highest risk.4,5 Wine consumption is clearly strongly related to cancers of the upper digestive tract in individuals and populations with heavy consumption.