Dose-specific meta-analysis and sensitivity analysis of the relation between alcohol consumption and lung cancer risk

Alcohol drinking increases the risk of several types of cancer, but studies of the relation between alcohol and lung cancer risk are complicated by smoking. The authors carried out meta-analyses for four study designs and conducted sensitivity analyses to assess the results. Pooled smoking-unadjusted relative risks (RRs) for brewery workers and alcoholics were 1.17 (95% confidence interval (Cl): 0.99, 1.39) and 1.99 (95% Cl: 1.66, 2.39), respectively, relative to population rates. For cohort and case-control studies, the authors conducted dose-specific meta-analyses for ethanol consumption of 1-499, 500-999, 1,000-1,999, and ≥2,000 g/month, relative to nondrinking. Smoking-adjusted RRs for ascending dose groups in cohort studies were 0.98 (95% Cl: 0.79, 1.21), 0.92 (95% Cl: 0.81, 1.04), 1.04 (95% Cl: 0.88, 1.22), and 1.53 (95% Cl: 1.04, 2.25), respectively. Smoking-adjusted odds ratios for ascending groups in case-control studies were 0.63 (95% Cl: 0.51, 0.78), 1.30 (95% Cl: 0.98, 1.70), 1.13 (95% Cl: 0.46, 2.75), and 1.86 (95% Cl: 1.39, 2.49), respectively. Elevated odds ratios were seen for hospital-based case-control studies but not for population -based case-control studies. Sensitivity analyses indicated that smoking explained the elevated RRs in studies of alcoholics and that strong misclassification of smoking status could produce an elevated smoking-adjusted RR in cohort and case-control studies. Overall, evidence for a smoking-adjusted association between alcohol and lung cancer risk is limited to very high consumption groups in cohort and hospital-based case-control studies. At lower levels, any associations observed appear to be explained by confounding.