Elsevier

Oral Oncology

Volume 46, Issue 2, February 2010, Pages 82-86
Oral Oncology

Review
Maté drinking and oral and oro-pharyngeal cancer: A systematic review and meta-analysis

https://doi.org/10.1016/j.oraloncology.2009.07.006Get rights and content

Summary

In Latin America, maté is consumed as a beverage regularly. Among the cancers that are associated with maté drinking is oral and oro-pharyngeal cancer, incidence of which is high in the region. In order to further understand this association between maté drinking and the risk of oral and oro-pharyngeal cancer, we performed a systematic review and meta-analysis of related studies. All relevant studies published in English as original articles up to June 2009 were identified through a literature search using PubMed and Medline and by reviewing the references from the retrieved articles. Four case–control studies done in Latin America were identified. There were 879 maté users and 1128 non- or low-maté users in those studies with a total of 566 oral and oro-pharyngeal cancers. The adjusted association between maté drinking and oral and oro-pharyngeal cancer was significant within 3 of those studies. Meta-analysis yielded a significant summary odds ratio (OR) of 2.11 (95% confidence interval = 1.39–3.19). Population Attributable Risk for maté drinking was 16%. While the epidemiological data indicate that maté users have an increased risk of oral and oro-pharyngeal cancer, little is known about whether this increased risk is due to the high temperature of the beverage when it is consumed or due to certain carcinogenic constituents that are present in maté. More human and animal studies are needed before a conclusion can be made on the oral and oro-pharyngeal carcinogenic risk of maté to humans.

Introduction

Cancers of the lip, tongue, and mouth (ICD-10: C00–06), oropharynx (ICD-10: C09–10), and other pharyngeal sites (ICD-10: C11–13) are among the most common cancers in the world.1 Annually 275,000 new oral cancer cases and 130,300 new pharyngeal cancer cases are expected globally. Among the areas of high incidence of oral and oro-pharyngeal cancer are parts of Latin America. Cancers of mouth and pharynx rank fifth in men and sixth in women in South America and the Caribbean. In this region, Argentina, Southern Brazil, and Uruguay show the highest rates of oral and oro-pharyngeal cancers. Brazilian males only fall behind males of France and India in terms of the highest risk in the world for cancer of mouth.2 It is conceivable that certain specific life-style related risk factors in these populations play a role in the etiology of oral and oro-pharyngeal cancer. Maté drinking could be one such factor.

Dried leaves and stemlets of the perennial tree Ilex paraguarensis (or Yerbe-Maté, Jesuit’s tea, Chimarrao, or Paraguayan tea) are brewed and consumed as a beverage in many countries in South America. An aqueous infusion is prepared by repeatedly adding almost boiling water to about 50 g of dried I. paraguarensis leaves. The quechua word ‘maté’ means a cup or a vessel used for drinking. In Latin America, maté is often drunk out of a dried gourd using a metal straw called ‘bombilla;. Hot maté is mainly consumed in Argentina, Bolivia, Brazil, Chile, Ecuador, Paraguay, and Uruguay, and cold maté is consumed in Paraguay, and southwestern Brazil. Maté drinking is also common in other countries such as Germany, Syria, Lebanon, and northern Israel. This product is now penetrating other markets including the United States, mostly in the form of commercially packed individual tea bags of 1–2 g. South American gauchos used maté as a stimulant and a vital part of their diet.[3], [4], [5] Maté is now gaining recognition as a nutraceutical for its antioxidant properties as well as the perceived hypocholesterolemic, hepatoprotective, diuretic, central nervous system stimulant properties.6 Over 50% of adult males and females in some countries are known to consume maté and the average annual consumption of maté is estimated to be over 5 kg per person.7

Even though maté contains useful minerals such as phosphorous, iron, and calcium, and vitamin C, B1 and B2, hot maté is considered carcinogenic to humans.8 Several epidemiological studies have shown that maté drinking is a risk factor for a number of cancers. These include laryngeal cancer,9 lung cancer,10 esophageal cancer,[11], [12] renal and bladder cancer,13 and oro-pahryngeal cancer.[3], [14], [15] On the other hand, maté is shown to demonstrate anticancer properties as well. Proteosome inhibitors such as 3,5-dicaffeoylquinic acid that are found in maté may offer some of this anticancer effect.6 Maté also attenuates the DNA damage caused by thermal injury and nitrosamines in rats16 and inhibits proliferation of oral cancer cells in vitro that is potentially mediated via inhibition of topoisomerase II.17 If epidemiological evidence suggests that maté drinking is associated with oral and oro-pharyngeal cancer while maté is also cancer protective and is capable of inhibiting tumor cell proliferation, it is important to further examine the nature of this association between maté drinking and oral and oro-pharyngeal cancer. With this objective in mind, we conducted a systematic review of the studies that were related to maté drinking and oral cancer and also performed a meta-analysis using the limited relevant published studies.

Section snippets

Materials and methods

We conducted a comprehensive systematic bibliographic search using the search terms maté, maté drinking, maté beverage, cancer, oral cancer, tongue cancer, and oro-pharyngeal cancer. Medilne, and Pubmed databases were searched up to June 2009. If there were additional articles listed in the reference sections of those articles, these additional articles were also obtained and reviewed. Inclusion criteria used were the availability of original data from epidemiological studies, data on primary

Results

Database search resulted in 18 articles. Eleven of those were related to esophageal cancer, five oral and oro-pharyngeal cancer, and one each related to bladder or lung cancer. Of the five oral and oro-pharyngeal cancer related articles, one article did not have sufficient data on the exposure assessment (Fig. 1). Remaining articles were included in the meta-analysis.[14], [15], [19], [20]

De Stefani et al. 15 conducted a case–control study of oral and pharyngeal cancer (excluding lip, salivary

Discussion

In 1991, International Agency for Research on Cancer (IARC) considered the carcinogenic risk of maté to humans as of Group 3 evidence (not classifiable as to its carcinogenicity to humans) and hot maté as of Group 2A evidence (probably carcinogenic to humans).8 Since then, there has been one other case–control study15 on this topic which is included in this review. Our objective was to evaluate all available evidence using both a systematic review and meta-analysis. As we discussed earlier,

Conflict of Interest Statement

None declared.

References (26)

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