Dr. A K Nanda       

MD, Radiation Oncology

         Once I went to a photocopy shop situated in front of my hospital. Suddenly the shopkeeper recognized me and asked, “Sir, I have noticed that the number of cancer patients are growing day by day, what is the cause of it ?”. At that time he was chewing tobacco in his mouth. With a smile I replied, “tobacco is the major cause of cancer but despite knowing this, a lot of people are smoking and chewing tobacco with out any reason”. Then he realized that he was doing the same. So he again asked me, “sir, I am seeing a number of persons who do not use tobacco are also getting cancer”. Then I replied, “majority of cancers are related to tobacco, but there are other factors also exist”. Many cancer patients, who do not drink alcohol or smoke, often ask that even if they do not use tobacco why they suffer from cancer. Tobacco contributes about 60% of all cancers and rest 40% of cancers are caused by a number of other factors which need to be analysed to discover answers to the above queries. Here the problem is that there are many factors which cause cancer (Apart from tobacco and alcohol) and each factor contributes less to cancer. Hence we may not get a positive result in a prospective study when we study one among those factors. For this reason significant number of prospective studies have to be conducted to establish an association between cancer and non-tobacco factors. Hence if a factor is shown to be carcinogenic in some studies, we have to consider it and act accordingly to keep ourselves away from cancer. One of those factors will be discussed below.

        Tea is a most frequently consumed beverages all over world  after water especially in India. A lot of people love to drink it very hot. Many also love to have it with smoking. But many people do not know that these habits may be equally responsible for causing cancer. 

Have a look on some studies:

• The study by Farhad Ishlami(2019) found that those who drank more than 700 ml of tea a day at a temperature of 60 degrees Celsius or more had a 90 percent higher risk for esophageal cancer compared with 'cooler' drinkers.
• The researchers divided tea temperature into "very hot" - meaning a temperature of over 60°C, and "cold or lukewarm," that is, a temperature that is or falls below 60°C.

• In 2018 a study in China published in Annals of Internal Medicine that found that drinking hot tea combined with heavy alcohol and tobacco, significantly increases the risk of esophageal cancer.
• The World Health Organization, in 2016, said drinking coffee, tea and other beverages at temperatures hotter than 149 degrees Fahrenheit "probably causes cancer.“
• In Hong Kong, preference for consuming drinks or soups at high temperatures was associated with esophageal cancer risk (Cheng et al., 1992).
• In northeast China, scalding temperature of meals and drinks was identified as the strongest dietary risk factor for esophageal cancer (Hu et al., 1994).
• A study in France showed that hot Calvados was the type of alcoholic beverage carrying the highest risk for esophageal cancer (Launoy et al., 1997).
• Ingestion of drinks at high temperatures has also been shown to increase the risk of esophageal cancer in earlier studies such as Puerto Rico (Martinez, 1969), Singapore (De Jong et al., 1974) and Iran (Cook-Mozaffari et al., 1979).

       From the above study we can see that hot drinking is associated with Esophageal cancer. Here the cancer is Esophageal squamous cell carcinoma. We have seen in previous article that Obesity is associated with Esophageal adenocarcinoma which is another type of Esophageal cancer. Please keep in mind that smoking and alcohol are two major cause of Esophageal cancer (discussed in previous articles) and factors like hot drinks and obesity are the minor causes. But these factors must be taken into consideration as these are the answer to the question raised in introduction.

Esophageal cancer Prognosis:

      Esophageal cancer is the 6th most common cause of cancer mortality worldwide. Esophageal cancer can be treated, but it is rarely curable. According to the American Cancer Society approximately 20% of people with Esophageal cancer survive more than 5 years after the diagnosis. Now you can understand why title of this article is like that.

Mechanism:

• Hot drinks may cause Chronic thermal injury which leads to inflammation that could lead to cancer.
• Also Chronic thermal injury make it easier for carcinogens (ingested through food, drink or smoking) to penetrate the esophageal lining.

Conclusion:

• In some studies it is concluded that drinking very hot beverages like tea, green tea, soup etc. may be associated with esophageal cancer which is a fatal disease.
• Cancer associated with hot drinking is Esophageal squamous cell carcinoma.
• Reported shorter time from pouring tea to drinking, that is less than 5 minutes wait, is associated with esophageal cancer.

Recommendations:

• Tea making patterns are different in different regions in the world. It is also different in different regions in India. In some part all tea powder, sugar and milk are heated together at the same time. Hence when tea is ready, it is very hot. But in some part first black tea is prepared and then milk and sugar are added. The later process is more preferable as adding milk and sugar will bring down the temperature of the tea.
• Preferred temperature of drinking hot beverages is less than 60°C.
• As there is no known health benefit from drinking very hot beverages, it will be reasonable to advise people to wait for their hot beverages to cool down before drinking.
• The time of pour to drink should be more than 5-10 minutes.
• Green Tea- A number of study have concluded that Green tea can inhibit cancer including esophageal cancer. This is due to the chemical composition of it. But if you consume it very hot it increases esophageal cancer as discuss earlier. Hence if green tea is taken lukewarm it is beneficial in cancer prevention, but if taken hot may increase esophageal cancer risk.
• Besides tea, coffee and green tea; other hot beverages should be consumed after cooling.

Previous Articles:

Passive Smoking and related cancer

Alcohol drinking and related Cancer

Obesity and related Cancer

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Reference

• Influence of mate drinking, hot beverages and diet on esophageal cancer risk in South America, Int. J. Cancer: 88, 658–664 (2000)
• A prospective study of tea drinking temperature and risk of esophageal squamous cell carcinoma by Farhad Islami. DOI: 10.1002/ijc.32220. International journal of cancer 2019.
• Green tea drinking, high tea temperature and esophageal cancer in high- and low-risk areas of Jiangsu Province, China: A population-based case–control study by Ming Wu. Int. J. Cancer: 124, 1907–1913 (2009)

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