Epidemiology

Breast Cancer Research and Treatment

, Volume 139, Issue 2, pp 529-537

First online:

Postdiagnosis supplement use and breast cancer prognosis in the After Breast Cancer Pooling Project

  • Elizabeth M. PooleAffiliated withChanning Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical SchoolDepartment of Epidemiology, Harvard School of Public Health Email author 
  • , XiaoOu ShuAffiliated withDivision of Epidemiology, Department of Medicine, Vanderbilt University School of MedicineShanghai Institute for Preventive Medicine
  • , Bette J. CaanAffiliated withDivision of Research, Kaiser Permanente
  • , Shirley W. FlattAffiliated withCancer Prevention and Control Program, Moores UCSD Cancer Center, University of California
  • , Michelle D. HolmesAffiliated withChanning Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical SchoolDepartment of Epidemiology, Harvard School of Public Health
  • , Wei LuAffiliated withShanghai Municipal Center for Disease Control and Prevention
  • , Marilyn L. KwanAffiliated withDivision of Research, Kaiser Permanente
  • , Sarah J. NechutaAffiliated withDivision of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine
  • , John P. PierceAffiliated withCancer Prevention and Control Program, Moores UCSD Cancer Center, University of California
    • , Wendy Y. ChenAffiliated withChanning Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical SchoolDepartment of Medical Oncology, Dana-Farber Cancer Institute

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Abstract

Vitamin supplement use after breast cancer diagnosis is common, but little is known about long-term effects on recurrence and survival. We examined postdiagnosis supplement use and risk of death or recurrence in the After Breast Cancer Pooling Project, a consortium of four cohorts of 12,019 breast cancer survivors from the United States and China. Post-treatment supplement use (vitamins A, B, C, D, E, and multivitamins) was assessed 1–5 years postdiagnosis. Associations with risk of recurrence, breast cancer-specific mortality, or total mortality were analyzed in Cox proportional hazards models separately by cohort. Individual cohort results were combined using random effects meta-analysis. Interactions with smoking, treatment, and hormonal status were examined. In multivariate models, vitamin E was associated with a decreased risk of recurrence (RR: 0.88; 95 % CI 0.79–0.99), and vitamin C with decreased risk of death (RR: 0.81; 95 % CI 0.72–0.92). However, when supplements were mutually adjusted, all associations were attenuated. There were no statistically significant associations with breast cancer mortality. The use of antioxidant supplements (multivitamins, vitamin C, or E) was not associated with recurrence, but was associated with a 16 % decreased risk of death (95 % CI 0.72–0.99). In addition, vitamin D was associated with decreased risk of recurrence among ER positive, but not ER negative tumors (p-interaction = 0.01). In this large consortium of breast cancer survivors, post-treatment use of vitamin supplements was not associated with increased risk of recurrence or death. Post-treatment use of antioxidant supplements was associated with improved survival, but the associations with individual supplement were difficult to determine. Stratification by ER status and considering antioxidants as a group may be more clinically relevant when evaluating associations with cancer risk and mortality.

Keywords

Breast cancer Vitamins Survival Mortality