text: Hot tea can increase the risk of a deadly cancer five-fold for people who also regularly drink alcohol, Chinese research suggests. 
   
   People who drink at least one alcoholic beverage and a "burning hot" cup of tea on a daily basis were five times more likely to develop esophageal cancer than people who drank tea at any temperature less than once a week, the study found. 
   
   The risks to smokers also increase with high-temperature tea drinking, said the study, which examined data on 456,155 Chinese adults ages 30 to 79. Drinking boiling hot tea every day was associated with roughly twice the risk of oesophageal cancer as consuming tea less than weekly for people who smoked. 
   
   Both smoking and drinking alcohol are already widely-known to be linked to oesophageal cancer, but the new study, which appeared in the Annals of Internal Medicine, proved that very hot tea can increase the risks. 
   
   Lv Jun, of Peking University Health Science Centre in China, who co-authored the study, told The Telegraph: “Boiling hot tea will harm the cells in the oesophagus. “If the person also drinks alcohol and smokes, then the harm caused will be more heightened.” 
   
   At the start of the study, none of the participants had cancer. Researchers followed half of the participants for at least nine years. ||||| (CNN) If you smoke cigarettes or drink alcohol daily, you may want to consider letting your tea cool before you enjoy it. Drinking tea while it's too hot could increase your risk of esophageal cancer, a new study suggests. 
   
   In the study, published Monday in the Annals of Internal Medicine, drinking "hot" or "burning hot" tea was associated with a two- to fivefold increase in esophageal cancer, but only in people who also smoked or drank alcohol. 
   
   Esophageal cancer is the eighth most common cancer in the world and is often fatal, killing approximately 400,000 people every year, according to the International Agency for Research on Cancer . It is usually caused by repeated injury to the esophagus due to smoke, alcohol, acid reflux and -- maybe -- hot liquids. 
   
   The study, the largest of its kind, followed close to 500,000 adults in China over an average of 9½ years. Because of the large size, it may set the bar for years to come, according to Neal Freedman , senior investigator at the National Cancer Institute in Bethesda, Maryland, who was not involved in the new research. 
   
   Participants who drank tea on a weekly basis were asked to describe its temperature as "warm," "hot" "or "burning hot." Drinking "hot" or "burning hot" tea was not, by itself, a predictor of esophageal cancer, which is good news for tea aficionados. 
   
   However, for people who smoked tobacco or drank alcohol -- both of which are known to cause esophageal cancer -- drinking "hot" or "burning hot" tea made their risk of cancer even higher, according to Jun Lv, a professor in the Department of Epidemiology and Biostatistics at Peking University and a lead author on the study. 
   
   "Drinking hot tea contributed to cancer only when it clustered with smoking and drinking alcohol excessively," Lv said. 
   
   The researchers collected information about tobacco and alcohol consumption at the beginning of the study. "Excessive alcohol consumption" was defined as 15 grams or more of alcohol per day -- slightly more than that found in a 12-ounce glass of beer, a 5-ounce glass of wine or a 1.5-ounce shot of distilled spirits. Tobacco use was defined as one or more cigarettes per day. 
   
   Very hot drinks could make the esophagus more vulnerable to known cancer-causing agents such as alcohol and smoke, Freedman said. 
   
   "Irritating the lining of the esophagus could lead to increased inflammation and more rapid turnover of the cells," he said. "Alternatively, hot liquids may impair the barrier function of the cells lining the esophagus, leaving the tissue open to greater damage from other carcinogens." 
   
   Participants did not objectively measure the temperature of their tea, one of the study's main limitations. However, previous research has suggested that drinking hot beverages at temperatures above 149 degrees Fahrenheit (65 degrees Celsius) could lead to esophageal cancer. 
   
   In a 2016 review in The Lancet Oncology, drinking beverages this hot was classified as "probably carcinogenic to humans." The review looked at all types of hot beverages, including coffee and tea. Only some of the studies in the review took alcohol and tobacco use into account. 
   
   In the United States and Europe, tea is rarely consumed at temperatures above 149 degrees -- but in places like Russia, Iran, Turkey and South America, it is common to drink tea that hot or even hotter. 
   
   "If you go to the Middle East or to Russia, they drink it out of a samovar that's constantly under heat," said Peter Goggi, president of the Tea Association of the USA . "It's very, very hot." 
   
   By contrast, "80% of the tea here is iced, so that's a completely different story," he said. "But even in the hot areas, which is in the Northeast and West Coast, most people will be adding something to it, whether it's a little sweetener or lemon," slightly decreasing the liquid's temperature. 
   
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   Tea also has many health benefits. According to a 2009 study in the journal Nature Reviews Cancer , components of tea leaves have been shown to have antioxidant properties and may protect against other types of cancers, particularly colon and prostate cancer. 
   
   "Tea is probably one of the most studied food and beverages in the world today," Goggi said. "Green tea has been shown to be a little more effective in cancer inhibition versus black tea, but black tea has been more effective in cardiovascular health." 
   
   So tea drinkers who don't smoke or drink alcohol excessively probably don't need to switch to a different beverage anytime soon, according to Lv. 
   
   "Of course, keeping away from both tobacco and excessive alcohol use is the most important means for esophageal cancer prevention," she added. ||||| TIME Health For more, visit TIME Health 
   
   Smoking cigarettes and drinking too much alcohol both raise your risk for developing esophageal cancer, which affects the tube connecting the throat to the stomach. Now, a new study published Monday in the Annals of Internal Medicine finds another lifestyle linked to the cancer, this one more surprising: drinking hot tea, if people also smoke and drink alcohol. 
   
   Among people who regularly smoked cigarettes and drank at least one drink per day, drinking hot tea was linked to a five-times higher risk of developing esophageal cancer, compared to those who didn’t do any of those three habits. In people who didn’t have those two vices, however, drinking tea did not seem to have a significant effect on cancer development. 
   
   “We found that the association between high-temperature tea consumption and esophageal cancer risk was dependent on alcohol and tobacco consumption,” said lead author Jun Lv, a professor of epidemiology and biostatistics at the Peking University School of Public Health in China, in an email to TIME. 
   
   In the study, researchers analyzed data from more than 456,000 Chinese adults between ages 30 and 79 who didn’t have cancer at the study’s start. People were asked to answer questions about their tea, alcohol and cigarette consumption. Then researchers followed the people in the study for about nine years to see how many developed esophageal cancer. (About 1,700 total people did.) 
   
   MORE: Coffee in California May Soon Come with a Cancer Warning 
   
   The researchers found that people who regularly drank hot tea, smoked and drank alcohol had the highest esophageal cancer risk. Those who regularly drank tea and either drank alcohol or smoked — but not both — also had an increased risk for developing cancer, but it was not as great. People who only drank hot tea did not see a significant increase in cancer risk. 
   
   The study was only observational, so a cause-and-effect link cannot be determined. But the authors speculate that hot tea may damage the tissue lining the esophagus, which could increase the chance of injury from other risk factors like smoking and drinking. Another potential way that hot tea may contribute to cancer risk, the authors write, is through the formation of inflammatory compounds, which occurs after repeated irritation to the esophagus. 
   
   In recent years, there has been some contradictory information about tea and cancer. In 2016, the World Health Organization concluded that hot beverages above 149 degrees F, including tea, were linked to an increase risk of esophageal cancer. However, tea has been singled out many times in the past for its potential cancer-fighting abilities. Green tea, in general, is associated with a lower risk of cancer. 
   
   The findings suggest that tea may contribute to cancer formation under the right circumstances, Lv says, but it’s probably not the main factor at work. “It’s important to abstain from high-temperature tea in excessive alcohol consumers and smokers for esophageal cancer prevention,” Lv wrote in an email. “Of course, keeping away from both tobacco and excessive alcohol use is the most important means for esophageal cancer prevention.”
target: – It's a specific health warning for a specific group of people: If you smoke, drink alcohol, and also happen to drink tea, let the latter cool down before you drink it. Failing to do so might raise your risk of esophageal cancer, suggests a study in the Annals of Internal Medicine by Chinese researchers. The idea is that hot tea (or, presumably, any hot beverage) can damage cells in the esophagus and make it more vulnerable to the damage caused by cigarettes and alcohol, the lead researcher tells the Telegraph. How hot is too hot? The researchers didn't specify, but CNN notes that previous research on hot beverages pegged the danger zone at 149 degrees Fahrenheit and above. "Irritating the lining of the esophagus could lead to increased inflammation and more rapid turnover of the cells," explains a National Cancer Institute investigator who was not involved with the study. "Alternatively, hot liquids may impair the barrier function of the cells lining the esophagus, leaving the tissue open to greater damage from other carcinogens." The observational study was a massive one, following nearly 500,000 Chinese adults ages 30 to 79 for about a decade. Those who drank hot tea and either smoked or used alcohol, but not both, also saw an increased risk of cancer, though it wasn't as great, reports Time. And hot tea alone did not carry a significant risk increase.