Abstract
Objective The influence of vitamin supplements on breast cancer risk is unclear and the interactive effects of dietary and supplemental sources are unknown. This study investigated (1) the association between self-reported vitamin supplement use (multivitamin, A, B, C, and E) and breast cancer and (2) the combined effect of vitamin supplements in relation to dietary vitamin intakes on breast cancer risk. Methods The Shanghai Breast Cancer Study was a population-based case-control study conducted in Shanghai in 1996–1998 (Phase I) and 2002–2004 (Phase II). Participants were aged 25–64 (Phase I) and 20–70 years (Phase II). The analyses included 3,454 incident breast cancer cases and 3,474 controls. Unconditional logistic regression models were used to determine adjusted odds ratios (ORs) for breast cancer risk associated with vitamin supplement use. Results Overall, breast cancer risk was not related to any vitamin supplement intake. However, a 20% reduction in breast cancer risk was observed with vitamin E supplement use among women with low-dietary vitamin E intake (OR = 0.8; 95% confidence interval (CI), 0.6–1.0). A non-significant 20% risk reduction was observed among vitamin B supplement users with low B dietary intake (OR = 0.8; 95% CI, 0.6–1.1). Frequent use of a vitamin B supplement was adversely associated with breast cancer risk among those with high dietary vitamin B intake (OR = 1.4; 95% CI: 0.9–2.1; P for interaction = 0.07). Conclusions This study suggests that vitamins E and B supplements may confer protection against breast cancer among women who have low dietary intake of those vitamins.
Similar content being viewed by others
References
Satia-Abouta J, Kristal AR, Patterson RE, Littman AJ, Stratton KL, White E (2003) Dietary supplement use and medical conditions: the VITAL study. Am J Prev Med 24:43–51
Joint Expert Consultation on Human Vitamin and Minerial Requirements (2004) Vitamin and mineral requirements in human nutrition. WHO and FAO Publications
Hoggatt KJ, Bernstein L, Reynolds P, Anton-Culver H, Deapen D, Peel D, Pinder R, Ross RK, West DW, Wright W, Ziogas A, Horn-Ross PL (2002) Correlates of vitamin supplement use in the United States: data from the California Teachers Study cohort. Cancer Causes Control 13:735–740
Machlin LJ, Bendich A (1987) Free radical tissue damage: protective role of antioxidant nutrients. FASEB J 1:441–445
Garland M, Willett WC, Manson JE, Hunter DJ (1993) Antioxidant micronutrients and breast cancer. J Am Coll Nutr 12:400–411
Fenech M (2002) Biomarkers of genetic damage for cancer epidemiology. Toxicology 181–182:411–416
Collins AR (1998) Molecular epidemiology in cancer research. Mol Aspects Med 19:359–432
Willett WC (2001) Diet and breast cancer. J Intern Med 249:395–411
Maillard V, Hoinard C, Arab K, Jourdan ML, Bougnoux P, Chajes V (2006) Dietary beta-carotene inhibits mammary carcinogenesis in rats depending on dietary alpha-linolenic acid content. Br J Nutr 96:18–21
Sato R, Helzlsouer KJ, Alberg AJ, Hoffman SC, Norkus EP, Comstock GW (2002) Prospective study of carotenoids, tocopherols, and retinoid concentrations and the risk of breast cancer. Cancer Epidemiol Biomarkers Prev 11:451–457
Howe GR, Hirohata T, Hislop TG, Iscovich JM, Yuan JM, Katsouyanni K, Lubin F, Marubini E, Modan B, Rohan T, Toniolo P, Yu S (1990) Dietary factors and risk of breast cancer: combined analysis of 12 case-control studies. J Natl Cancer Inst 82:561–569
Hunter DJ, Manson JE, Colditz GA, Stampfer MJ, Rosner B, Hennekens CH, Speizer FE, Willett WC (1993) A prospective study of the intake of vitamins C, E, and A and the risk of breast cancer. N Engl J Med 329:234–240
Kushi LH, Fee RM, Sellers TA, Zheng W, Folsom AR (1996) Intake of vitamins A, C, and E and postmenopausal breast cancer. The Iowa Women’s Health Study. Am J Epidemiol 144:165–174
Lee MM, Chang IY, Horng CF, Chang JS, Cheng SH, Huang A (2005) Breast cancer and dietary factors in Taiwanese women. Cancer Causes Control 16:929–937
Gandini S, Merzenich H, Robertson C, Boyle P (2000) Meta-analysis of studies on breast cancer risk and diet: the role of fruit and vegetable consumption and the intake of associated micronutrients. Eur J Cancer 36:636–646
Nissen SB, Tjonneland A, Stripp C, Olsen A, Christensen J, Overvad K, Dragsted LO, Thomsen B (2003) Intake of vitamins A, C, and E from diet and supplements and breast cancer in postmenopausal women. Cancer Causes Control 14:695–704
White E, Patterson RE, Kristal AR, Thornquist M, King I, Shattuck AL, Evans I, Satia-Abouta J, Littman AJ, Potter JD (2004) Vitamins and lifestyle cohort study: study design and characteristics of supplement users. Am J Epidemiol 159:83–93
Rock CL (2007) Multivitamin-multimineral supplements: who uses them? Am J Clin Nutr 85:277S–279S
Malin AS, Qi D, Shu XO, Gao YT, Friedmann JM, Jin F, Zheng W (2003) Intake of fruits, vegetables and selected micronutrients in relation to the risk of breast cancer. Int J Cancer 105:413–418
Matthews CE, Shu XO, Yang G, Jin F, Ainsworth BE, Liu D, Gao YT, Zheng W (2003) Reproducibility and validity of the Shanghai Women’s Health Study physical activity questionnaire. Am J Epidemiol 158:1114–1122
Sciences CAOM (1991) Food composition tables. People’s Health Publishing House, Beijing
Shu XO, Yang G, Jin F, Liu D, Kushi L, Wen W, Gao YT, Zheng W (2004) Validity and reproducibility of the food frequency questionnaire used in the Shanghai Women’s Health Study. Eur J Clin Nutr 58:17–23
Shrubsole MJ, Jin F, Dai Q, Shu XO, Potter JD, Hebert JR, Gao YT, Zheng W (2001) Dietary folate intake and breast cancer risk: results from the Shanghai Breast Cancer Study. Cancer Res 61:7136–7141
Moorman PG, Ricciuti MF, Millikan RC, Newman B (2001) Vitamin supplement use and breast cancer in a North Carolina population. Public Health Nutr 4:821–827
Dorgan JF, Schatzkin A (1991) Antioxidant micronutrients in cancer prevention. Hematol Oncol Clin North Am 5:43–68
Mason JB, Choi SW (2000) Folate and carcinogenesis: developing a unifying hypothesis. Adv Enzyme Regul 40:127–141
Choi SW, Mason JB (2002) Folate status: effects on pathways of colorectal carcinogenesis. J Nutr 132:2413S–2418S
Chamras H, Barsky SH, Ardashian A, Navasartian D, Heber D, Glaspy JA (2005) Novel interactions of vitamin E and estrogen in breast cancer. Nutr Cancer 52:43–48
Fairfield KM, Fletcher RH (2002) Vitamins for chronic disease prevention in adults: scientific review. JAMA 287:3116–3126
World Cancer Research Fund/American Inst for Cancer Research (1997) Vitamins. In: Potter JD Food, nutrition and the prevention of cancer: a global perspective. World Cancer Research Fund/American Inst for Cancer Research, Washington, DC
Diplock AT (1994) Antioxidants and disease prevention. Mol Aspects Med 15:293–376
Zhang SM (2004) Role of vitamins in the risk, prevention, and treatment of breast cancer. Curr Opin Obstet Gynecol 16:19–25
Kline K, Lawson KA, Yu W, Sanders BG (2003) Vitamin E and breast cancer prevention: current status and future potential. J Mammary Gland Biol Neoplasia 8:91–102
Bonilla-Fernandez P, Lopez-Cervantes M, Torres-Sanchez LE, Tortolero-Luna G, Lopez-Carrillo L (2003) Nutritional factors and breast cancer in Mexico. Nutr Cancer 45:148–155
Michels KB, Holmberg L, Bergkvist L, Ljung H, Bruce A, Wolk A (2001) Dietary antioxidant vitamins, retinol, and breast cancer incidence in a cohort of Swedish women. Int J Cancer 91:563–567
Lee IM, Cook NR, Gaziano JM, Gordon D, Ridker PM, Manson JE, Hennekens CH, Buring JE (2005) Vitamin E in the primary prevention of cardiovascular disease and cancer: the Women’s Health Study: a randomized controlled trial. JAMA 294:56–65
Verhoeven DT, Assen N, Goldbohm RA, Dorant E, van’t Veer V, Sturmans F, Hermus RJ, van den Brandt PA (1997) Vitamins C and E, retinol, beta-carotene and dietary fibre in relation to breast cancer risk: a prospective cohort study. Br J Cancer 75:149–155
Lee IM, Cook NR, Manson JE, Buring JE (2002) Randomised beta-carotene supplementation and incidence of cancer and cardiovascular disease in women: is the association modified by baseline plasma level? Br J Cancer 86:698–701
Tamimi RM, Hankinson SE, Campos H, Spiegelman D, Zhang S, Colditz GA, Willett WC, Hunter DJ (2005) Plasma carotenoids, retinol, and tocopherols and risk of breast cancer. Am J Epidemiol 161:153–160
Bohlke K, Spiegelman D, Trichopoulou A, Katsouyanni K, Trichopoulos D (1999) Vitamins A, C and E and the risk of breast cancer: results from a case-control study in Greece. Br J Cancer 79:23–29
Zhang S, Hunter DJ, Forman MR, Rosner BA, Speizer FE, Colditz GA, Manson JE, Hankinson SE, Willett WC (1999) Dietary carotenoids and vitamins A, C, and E and risk of breast cancer. J Natl Cancer Inst 91:547–556
Longnecker MP, Newcomb PA, Mittendorf R, Greenberg ER, Willett WC (1997) Intake of carrots, spinach, and supplements containing vitamin A in relation to risk of breast cancer. Cancer Epidemiol Biomarkers Prev 6:887–892
Rohan TE, Howe GR, Friedenreich CM, Jain M, Miller AB (1993) Dietary fiber, vitamins A, C, and E, and risk of breast cancer: a cohort study. Cancer Causes Control 4:29–37
Levi F, Pasche C, Lucchini F, La Vecchia C (2001) Dietary intake of selected micronutrients and breast-cancer risk. Int J Cancer 91:260–263
Do MH, Lee SS, Jung PJ, Lee MH (2003) Intake of dietary fat and vitamin in relation to breast cancer risk in Korean women: a case-control study. J Korean Med Sci 18:534–540
Stolzenberg-Solomon RZ, Chang SC, Leitzmann MF, Johnson KA, Johnson C, Buys SS, Hoover RN, Ziegler RG (2006) Folate intake, alcohol use, and postmenopausal breast cancer risk in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. Am J Clin Nutr 83:895–904
Lewis SJ, Harbord RM, Harris R, Smith GD (2006) Meta-analyses of observational and genetic association studies of folate intakes or levels and breast cancer risk. J Natl Cancer Inst 98:1607–1622
Lajous M, Lazcano-Ponce E, Hernandez-Avila M, Willett W, Romieu I (2006) Folate, vitamin B(6), and vitamin B(12) intake and the risk of breast cancer among Mexican women. Cancer Epidemiol Biomarkers Prev 15:443–448
Zhang SM, Willett WC, Selhub J, Hunter DJ, Giovannucci EL, Holmes MD, Colditz GA, Hankinson SE (2003) Plasma folate, vitamin B6, vitamin B12, homocysteine, and risk of breast cancer. J Natl Cancer Inst 95:373–380
Eichholzer M, Luthy J, Moser U, Fowler B (2001) Folate and the risk of colorectal, breast and cervix cancer: the epidemiological evidence. Swiss Med Wkly 131:539–549
Kim YI (2006) Does a high folate intake increase the risk of breast cancer? Nutr Rev 64:468–475
Cho E, Spiegelman D, Hunter DJ, Chen WY, Zhang SM, Colditz GA, Willett WC (2003) Premenopausal intakes of vitamins A, C, and E, folate, and carotenoids, and risk of breast cancer. Cancer Epidemiol Biomarkers Prev 12:713–720
London SJ, Stein EA, Henderson IC, Stampfer MJ, Wood WC, Remine S, Dmochowski JR, Robert NJ, Willett WC (1992) Carotenoids, retinol, and vitamin E and risk of proliferative benign breast disease and breast cancer. Cancer Causes Control 3:503–512
Schwenke DC, Rudel LL, Sorci-Thomas MG, Thomas MJ (2002) Alpha-tocopherol protects against diet induced atherosclerosis in New Zealand white rabbits. J Lipid Res 43:1927–1938
Patterson RE, Neuhouser ML, White E, Hunt JR, Kristal AR (1998) Cancer-related behavior of vitamin supplement users. Cancer Epidemiol Biomarkers Prev 7:79–81
Touvier M, Kesse E, Volatier JL, Clavel-Chapelon F, Boutron-Ruault MC (2006) Dietary and cancer-related behaviors of vitamin/mineral dietary supplement users in a large cohort of French women. Eur J Nutr 45:205–214
Acknowledgments
This research was funded by grant RO1CA64277 from the National Cancer Institute. The authors wish to express their gratitude to Dr. Fan Jin for her contributions in coordinating data collection in Shanghai, Bethanie Hull for her technical assistance in the preparation of this manuscript, and all of the study participants and research staff of the Shanghai Breast Cancer Study.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Dorjgochoo, T., Shrubsole, M.J., Shu, X.O. et al. Vitamin supplement use and risk for breast cancer: the Shanghai Breast Cancer Study. Breast Cancer Res Treat 111, 269–278 (2008). https://doi.org/10.1007/s10549-007-9772-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10549-007-9772-8