Published ahead of print on November 7, 2007, doi:10.1164/rccm.200709-1398OC Am. J. Respir. Crit. Care Med., Volume 177, Number 5, March 2008, 524-530 A more recent version of this article appeared on March 1, 2008
Submitted on September 20, 2007 Supplemental Multivitamins, Vitamin C, Vitamin E, and Folate Does Not Reduce the Risk of Lung CancerChristopher G Slatore1*,1 Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA, USA, 2 Department of Epidemiology, University of Washington, Seattle, WA, USA; Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, WA, USA, 3 Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA, USA; Health Services Research and Development, VA Puget Sound Health Care System, Seattle, WA, USA, 4 Departments of Epidemiology and Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 5 Department of Epidemiology, University of Washington, Seattle, WA, USA; Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, WA, USA * To whom correspondence should be addressed. E-mail: cslatore{at}u.washington.edu.
Rationale: Lung cancer is the leading cause of cancer-related mortality in the US. Although supplements are used by half the population, limited information is available about their specific effect on lung cancer risk. Objective: 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 VITamins And Lifestyle VITAL study. Cases were identified through the Seattle-Puget Sound SEER cancer registry. Measurements: Hazard ratios (HRs) for incident lung cancer according to 10 year average daily use of supplemental multivitamins, vitamin C, vitamin E, and folate. Results: 521 cases of lung cancer were identified. Adjusting for smoking, age, and gender, 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/day increase in dose, 95% CI, 1.00 - 1.09, P = .033). This risk of supplemental vitamin E was largely confined to current smokers (HR 1.11 for every 100 mg/day increase, 95% CI, 1.03 - 1.19, P <.01) and was greatest for non-small cell lung cancer (HR 1.07 for every 100 mg/day increase, 95% CI, 1.02 - 1.12, P = .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
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