Academic journal article Bulletin of the World Health Organization

Estimates of Alcohol-Related Oesophageal Cancer Burden in Japan: Systematic Review and Meta-analyses/Estimation De la Charge Du Cancer De L'oesophage Lie a L'alcool Au Japon: Revue Systematique et Meta-analyses/Estimaciones De la Carga del Cancer Esofagico Relacionado Con El Consumo De Alcohol En Japon: Una Revision Sistematica Y Metaanalisis

Academic journal article Bulletin of the World Health Organization

Estimates of Alcohol-Related Oesophageal Cancer Burden in Japan: Systematic Review and Meta-analyses/Estimation De la Charge Du Cancer De L'oesophage Lie a L'alcool Au Japon: Revue Systematique et Meta-analyses/Estimaciones De la Carga del Cancer Esofagico Relacionado Con El Consumo De Alcohol En Japon: Una Revision Sistematica Y Metaanalisis

Article excerpt

Introduction

Alcohol consumption is a major contributor to the global burden of disease (1,2) and is a major risk factor for cancer. (3-6) Of all alcohol-related cancers, oesophageal has the highest alcohol-attributable fraction (6)--i.e. the highest proportion of these cancers would be prevented if no alcohol were consumed. (6-8) The global burden of disease (GBD) study estimates that in 2010 alcohol-attributable oesophageal cancer resulted in 76 700 deaths and 1 825 000 disability adjusted life years (DALYs) lost, globally. (9)

A large portion of oesophageal cancers attributable to alcohol consumption occur in Asian countries--52.2% (40 000) of all alcohol-attributable oesophageal cancer deaths and 51.8% (945 000) of all alcohol-attributable oesophageal cancer DALYs. The alcohol-attributable portions for countries in this region have been calculated based on global meta-analyses. (10,11) However, this assumes that the alcohol-attributable risk for oesophageal cancer is the same in all regions. Preliminary evidence, on the other hand, shows that the risk for this cancer is different for people of Asian origin, because of genetic polymorphisms--most importantly the aldehyde dehydrogenase 2 (ALDH2) and alcohol dehydrogenase IB (ADH1B) polymorphisms. (12-15) Thus, the real risk and burden of alcohol-attributable oesophageal cancer in Asia may have been underestimated.

In Japan in 2010, oesophageal cancer was among the top 20 causes of years of life lost (11 deaths and 181 DALYs per 100000 people per year). (9) We did a systematic review and meta-analyses of studies conducted in the Japanese population to estimate the alcohol-attributable burden of oesophageal cancer. We then compared these estimates to the GBD 2010 estimates. (1) We also estimated risk functions according to ALDH2 subsets and investigated potential interactions between ALDH2 and ADH1B polymorphisms.

Methods

Data search and selection

We followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. (16) We used the latest editions of the International Agency for Research on Cancer (IARC) monographs on alcohol (3,4) to identify potentially eligible studies. Additionally, we searched PubMed for publications published before 2014. We did two searches using the following search terms; Search 1: "cancer or neoplasm or carcinom*" and "ALDH2 or ADH1B or ADH2 or ADH3 or ADH1C or dehydrogenase*" and "alcohol or ethanol"; Search 2: "alcohol or ethanol" and "cohort" and "cancer" and "japan" and "review" and "mortality". Inclusion criteria for analyses investigating the relationship between alcohol consumption, ALDH2, and oesophageal cancer were: (i) prospective or historical cohort or case-control study design; (ii) a measure of risk and its corresponding measure of variability was reported or there were sufficient data for us to calculate these; (iii) oesophageal cancer was reported as a separate outcome; (iv) data on total alcohol intake for at least two exposure categories among current drinkers, or estimates for ALDH2 variants by alcohol intake were reported; (v) risk estimates were at least age-adjusted; and (vi) the study was conducted in Japan after 1980. In addition, we searched reference lists of identified articles for additional articles. No active filters or language restrictions were applied. We excluded measures of pure drinking frequency and qualitative characteristics--such as social or problem drinker. Oesophageal cancer cases (International Classification of Diseases [ICD] version 9: 150, ICD-10: C15) were defined as newly diagnosed at the first visit to a specialized clinic, through cancer registries or cause of death on death certificates.

Most quality scores for primary studies are tailored for meta-analyses of randomized trials of interventions (17-19) and many criteria for such scores do not apply to epidemiological studies examined in this study. Additionally, quality score use in meta-analyses remains controversial. …

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