Very hot tea drinking increases esophageal squamous cell carcinoma risk in a high-risk area of China: a population-based case–control study

Xiaorong Yang,1,2 Yingchun Ni,2 Ziyu Yuan,3,4 Hui Chen,1 Amelie Plymoth,5 Li Jin,3,4 Xingdong Chen,3,4 Ming Lu,1,2,4 Weimin Ye4,5 1Clinical Epidemiology Unit, Qilu Hospital of Shandong University, Jinan, China; 2Department of Epidemiology, School of Public Health, Shandong University, Jinan, China; 3State Key Laboratory of Genetic Engineering, Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Fudan University, Shanghai, China; 4Fudan University Taizhou Institute of Health Sciences, Taizhou, China; 5Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden Background: Previous studies on the association between green tea drinking and esophageal squamous cell carcinoma (ESCC) risk show inconsistent results.Materials and methods: We conducted a large population-based case–control study from 2010 to 2013 in a high-risk area of China, in which 1,355 ESCC cases and 1,962 controls were recruited. Information on lifelong tea drinking was collected via face-to-face interviews using an electronic structured questionnaire. ORs with 95% CIs were estimated using unconditional logistic regression models.Results: Most tea drinkers were males and consumed exclusively green tea. After adjustment for potential confounders, among men the OR of ever green tea drinking for ESCC risk was 1.52 (95% CI: 1.24–1.85), compared with never tea drinking. The excess risk increased monotonically with earlier age at starting, longer duration, more intensity, and accumulation of tea drinking. The OR of drinking very hot green tea for ESCC risk was 2.15 (95% CI: 1.52–3.05), compared with never drinking tea. For accumulation of tea drinking and the risk of ESCC, a non-linear relationship was observed. Before the accumulation of tea drinking reached 5 L/day*years, drinking tea showed a mild protective effect; then the ORs sharply increased to around 2.0 from 5 L/day*years to 25 L/day*years, and leveled off thereafter. The non-linear relationship was further modified by tea temperature. The joint effect of tea drinking and alcohol consumption on ESCC risk was also significant (P=0.019).Conclusion: Very hot tea drinking significantly increases the risk of ESCC among Chinese men, which is particularly evident among alcohol drinkers. Keywords: green tea, high temperature, esophageal squamous cell carcinoma, risk factor, case–control stud