| Summary: | <h4>Background</h4> <p>While the high-temperature tea consumption has been suggested as a risk factor for esophageal cancer (EC), this has not been consistently observed and whether it is independent of alcohol and tobacco exposure has not been evaluated.</p> <h4>Objective</h4> <p>To examine the joint association of high-temperature tea consumption and established risk factors of alcohol consumption and smoking on EC risk.</p> <h4>Design</h4> <p>China Kadoorie Biobank, prospective cohort study established during 2004-08.</p> <h4>Setting</h4> <p>Ten areas across China</p> <h4>Participants</h4> <p>456,155 participants aged 30-79 years after excluding participants with cancer at baseline and those who had cut down consumption of tea, alcohol, or tobacco before baseline.</p> <h4>Measurements</h4> <p>The usual temperature at which tea was consumed, other tea consumption metrics, and lifestyle behaviors were self-reported once at baseline. Outcome was EC incidence until 2015.</p> <h4>Results</h4> <p> During a median of 9.2 years of follow-up, we documented 1,731 incident EC cases. We found that high-temperature tea consumption in combination with either alcohol consumption or smoking had a greater risk of developing EC than high-temperature tea consumption alone. Compared with participants who consumed tea less than weekly and consumed alcohol <15g per day, those daily consumers who preferred burning hot tea and consumed alcohol ≥15g had the greatest risk of developing EC (hazard ratio=5.00; 95% CI: 3.64, 6.88). Similarly, the hazard ratio (95% CI) for those who were both current smoker and daily tea consumer preferring burning hot tea was 2.03 (1.55, 2.67).</p> <h4>Limitations</h4> <p> Tea consumption was self-reported once at baseline, leading to the possibility of nondifferential misclassification and attenuation of the association.</p> <h4>Conclusion</h4> <p>Our findings highlight the importance of abstaining from high-temperature tea in excessive alcohol consumers and smokers on EC prevention.</p>
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