Green tea (Camellia sinensis) for the prevention of cancer New search for studies and content updated (no change to conclusions)

Abstract

Abstract Background

This review is an update of a previously published review in the Cochrane Database of Systematic Reviews (2009, Issue 3).Tea is one of the most commonly consumed beverages worldwide. Teas from the plant Camellia sinensis can be grouped into green, black and oolong tea, and drinking habits vary cross‐culturally. C sinensis contains polyphenols, one subgroup being catechins. Catechins are powerful antioxidants, and laboratory studies have suggested that these compounds may inhibit cancer cell proliferation. Some experimental and nonexperimental epidemiological studies have suggested that green tea may have cancer‐preventative effects.

Objectives

To assess possible associations between green tea consumption and the risk of cancer incidence and mortality as primary outcomes, and safety data and quality of life as secondary outcomes.

Search methods

We searched eligible studies up to January 2019 in CENTRAL, MEDLINE, Embase, ClinicalTrials.gov, and reference lists of previous reviews and included studies.

Selection criteria

We included all epidemiological studies, experimental (i.e. randomised controlled trials (RCTs)) and nonexperimental (non‐randomised studies, i.e. observational studies with both cohort and case‐control design) that investigated the association of green tea consumption with cancer risk or quality of life, or both.

Data collection and analysis

Two or more review authors independently applied the study criteria, extracted data and assessed methodological quality of studies. We summarised the results according to diagnosis of cancer type.

Main results

In this review update, we included in total 142 completed studies (11 experimental and 131 nonexperimental) and two ongoing studies. This is an additional 10 experimental and 85 nonexperimental studies from those included in the previous version of the review.

Eleven experimental studies allocated a total of 1795 participants to either green tea extract or placebo, all demonstrating an overall high methodological quality based on 'Risk of bias' assessment. For incident prostate cancer, the summary risk ratio (RR) in the green tea‐supplemented participants was 0.50 (95% confidence interval (CI) 0.18 to 1.36), based on three studies and involving 201 participants (low‐certainty evidence). The summary RR for gynaecological cancer was 1.50 (95% CI 0.41 to 5.48; 2 studies, 1157 participants; low‐certainty evidence). No evidence of effect of non‐melanoma skin cancer emerged (summary RR 1.00, 95% CI 0.06 to 15.92; 1 study, 1075 participants; low‐certainty evidence). In addition, adverse effects of green tea extract intake were reported, including gastrointestinal disorders, elevation of liver enzymes, and, more rarely, insomnia, raised blood pressure and skin/subcutaneous reactions. Consumption of green tea extracts induced a slight improvement in quality of life, compared with placebo, based on three experimental studies.

In nonexperimental studies, we included over 1,100,000 participants from 46 cohort studies and 85 case‐control studies, which were on average of intermediate to high methodological quality based on Newcastle‐Ottawa Scale 'Risk of bias' assessment. When comparing the highest intake of green tea with the lowest, we found a lower overall cancer incidence (summary RR 0.83, 95% CI 0.65 to 1.07), based on three studies, involving 52,479 participants (low‐certainty evidence). Conversely, we found no association between green tea consumption and cancer‐related mortality (summary RR 0.99, 95% CI 0.91 to 1.07), based on eight studies and 504,366 participants (low‐certainty evidence).

For most of the site‐specific cancers we observed a decreased RR in the highest category of green tea consumption compared with the lowest one. After stratifying the analysis according to study design, we found strongly conflicting results for some cancer sites: oesophageal, prostate and urinary tract cancer, and leukaemia showed an increased RR in cohort studies and a decreased RR or no difference in case‐control studies.

Authors' conclusions

Overall, findings from experimental and nonexperimental epidemiological studies yielded inconsistent results, thus providing limited evidence for the beneficial effect of green tea consumption on the overall risk of cancer or on specific cancer sites.

Some evidence of a beneficial effect of green tea at some cancer sites emerged from the RCTs and from case‐control studies, but their methodological limitations, such as the low number and size of the studies, and the inconsistencies with the results of cohort studies, limit the interpretability of the RR estimates. The studies also indicated the occurrence of several side effects associated with high intakes of green tea. In addition, the majority of included studies were carried out in Asian populations characterised by a high intake of green tea, thus limiting the generalisability of the findings to other populations. Well conducted and adequately powered RCTs would be needed to draw conclusions on the possible beneficial effects of green tea consumption on cancer risk.

Author(s)

Tommaso Filippini, Marcella Malavolti, Francesca Borrelli, Angelo A Izzo, Susan J Fairweather‐Tait, Markus Horneber, Marco Vinceti

Abstract

Plain language summary

Green tea for the prevention of cancer

Background
 There is a high consumption worldwide of green tea (Camellia sinensis), that contains polyphenols which have a powerful antioxidant activity that can prevent the formation of free radicals that may cause damage and cell death. Therefore it has been suggested that green tea might reduce cancer risk, a theory that has been tested through a number of studies on human populations, which examined the link between green tea consumption and cancer.

The aim of the review
 We assessed the association between green tea consumption and the risk of developing cancer in epidemiologic studies.

Main findings
 In this review we included 142 studies with more than 1.1 million participants looking for an association between green tea consumption and cancers of the digestive tract and the female reproductive system, breast, prostate, kidney and urinary tract, nasopharynx, lung, blood, skin, thyroid and brain. The majority of the studies were of medium to high quality in terms of how they were conducted. Overall, the evidence from the studies showed that the consumption of green tea consumption to reduce the risk of cancer was inconsistent.

Some studies suggested a beneficial effect on cancer risk, while others indicated no effect, and even suggested a slightly increased cancer risk. In particular, results from experimental studies suggested that green tea extract supplementation yielded a decreased risk for prostate cancer, but increased risk for gynaecological cancers. For non‐melanoma skin cancer no difference in cancer cases emerged. Green tea supplementation seemed to slightly improve quality of life compared with placebo, although it was associated with some adverse effects including gastrointestinal disorders, higher levels of liver enzymes, and, more rarely, insomnia, raised blood pressure and skin reactions.

In nonexperimental studies, comparing people consuming the highest amount of green tea to those in the lowest category of consumption, we found an indication of a lower occurrence of new cases of overall types of cancer, while no difference emerged for lethal cases. However, results according to the type of cancer and study design were inconsistent.

What are the conclusions? 
 A beneficial effect of green tea consumption on cancer prevention remains unproven so far. Caution is advised regarding supplementation with high‐dose green tea extracts due to the possible adverse effects.

Author(s)

Tommaso Filippini, Marcella Malavolti, Francesca Borrelli, Angelo A Izzo, Susan J Fairweather‐Tait, Markus Horneber, Marco Vinceti

Reviewer's Conclusions

Authors' conclusions

Implications for practice

Overall, findings from epidemiological studies yielded inconsistent results for the effect of green tea consumption on cancer risk, despite some indications of a beneficial effect of green tea on a few site‐specific cancers. In addition, the majority of included studies were carried out in Asian populations characterised by high intakes of green tea, thus limiting the generalisability of the findings to other populations. Therefore, the epidemiological evidence appears to be still inadequate to support a beneficial effect of green tea on cancer risk. In addition, the possibility that high consumption of green tea extracts may have adverse effects should be taken into careful consideration.

Implications for research

Recommendations for future research arise from the observation that evidence for green tea preventing cancer risk is still highly inconsistent. Some evidence of a beneficial effect of green tea on prostate cancer risk emerged from the randomised controlled trials (RCTs), but their methodological limitations, such as the low number and size of the studies, and the inconsistencies of the results limit the interpretability of their results. The other cancer outcomes investigated in RCTs, gynaecological cancer and non‐melanoma skin cancer, were not clearly associated with either beneficial or adverse effects, and also suggested the possible occurrence of side effects associated with high intake of green tea extracts. Well conducted and adequately powered RCTs, together with nonexperimental cohort design studies, are therefore clearly needed to elucidate the possible effects of green tea consumption on cancer risk in humans. RCTs should be carried out using low to moderate doses of green tea to avoid side effects and to reflect more closely the exposure patterns in most populations. They should also have an adequate sample size and allow a long period of follow‐up in order to detect long‐term and even small decreases in cancer risk.

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