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Long-Term Use of Supplemental Multivitamins, Vitamin C, Vitamin E, and Folate Does Not Reduce the Risk of Lung Cancer

¹ Division of Pulmonary and Critical Care Medicine, and ² Department of Epidemiology, University of Washington, Seattle, Washington; ³ Epidemiologic Research and Information Center, and ⁴ Health Services Research and Development, VA Puget Sound Health Care System, Seattle, Washington; ⁵ Departments of Epidemiology and Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; and ⁶ Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, Washington

Correspondence and requests for reprints should be addressed to Christopher Slatore, M.D., University of Washington, Division of Pulmonary and Critical Care Medicine, 1959 NE Pacific Street, Box 356522, Seattle, WA 98195-6522. E-mail: cslatore{at}u.washington.edu

Rationale: Lung cancer is the leading cause of cancer-related mortality in the United States. Although supplements are used by half the population, limited information is available about their specific effect on lung cancer risk.

Objectives: To explore the association of supplemental multivitamins, vitamin C, vitamin E, and folate with incident lung cancer.

Methods: Prospective cohort of 77,721 men and women aged 50–76 years from Washington State in the VITAL (VITamins And Lifestyle) study. Cases were identified through the Seattle–Puget Sound SEER (Surveillance, Epidemiology, and End Results) cancer registry.

Measurements and Main Results: Hazard ratios (HRs) for incident lung cancer according to 10-year average daily use of supplemental multivitamins, vitamin C, vitamin E, and folate. A total of 521 cases of lung cancer were identified. Adjusting for smoking, age, and sex, there was no inverse association with any supplement. Supplemental vitamin E was associated with a small increased risk of lung cancer (HR, 1.05 for every 100-mg/d increase in dose; 95% confidence interval [CI], 1.00–1.09; P = 0.033). This risk of supplemental vitamin E was largely confined to current smokers (HR, 1.11 for every 100-mg/d increase; 95% CI, 1.03–1.19; P < 0.01) and was greatest for non–small cell lung cancer (HR, 1.07 for every 100-mg/d increase; 95% CI, 1.02–1.12; P = 0.004).

Conclusions: Supplemental multivitamins, vitamin C, vitamin E, and folate were not associated with a decreased risk of lung cancer. Supplemental vitamin E was associated with a small increased risk. Patients should be counseled against using these supplements to prevent lung cancer.

Key Words: bronchial neoplasm • diet • dietary supplements • public health

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject Lung cancer is the leading cause of cancer-related mortality in the United States. Although supplements are used by half the population, limited information is available about their specific effect on lung cancer risk. What This Study Adds to the Field Supplemental multivitamins, vitamin C, vitamin E, and folate are unlikely to decrease the risk of developing lung cancer. Use of supplemental vitamin E at high doses for a prolonged period of time may slightly increase this risk.

 

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