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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
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Submitted on September 20, 2007
Accepted on November 7, 2007

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

Christopher G Slatore1*, Alyson J Littman2, David H Au3, Jessie A Satia4, and Emily White5

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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