Breast Cancer Research and Treatment

, Volume 134, Issue 3, pp 1269–1277 | Cite as

Selenium intake and breast cancer mortality in a cohort of Swedish women

  • Holly R. HarrisEmail author
  • Leif Bergkvist
  • Alicja Wolk


Selenium is an important cofactor in the production of antioxidant enzymes that may influence cancer progression. Selenium intake and cancer survival has not been extensively studied; however, selenium supplementation has been demonstrated to reduce cancer mortality in nutritional intervention trials. We investigated whether dietary selenium intake was associated with survival among 3,146 women diagnosed with invasive breast cancer in the population-based Swedish Mammography Cohort. Selenium intake before breast cancer diagnosis was estimated using a food frequency questionnaire completed in 1987. Cox proportional hazard models were used to calculate hazard ratios (HRs) and 95 % confidence intervals (95 % CIs) for death from breast cancer, non-breast cancer death, and death from any cause. During 28,172 person-years of follow-up from 1987 to 2009, there were 416 breast cancer–specific deaths and 964 total deaths. Dietary selenium intake was inversely associated with breast cancer–specific mortality and overall mortality. Women in the highest quartile of selenium intake had a multivariable HR (95 % CI) of death from breast cancer of 0.69 (0.52–0.92) compared with those in the lowest quartile (P trend = 0.009). The inverse association between dietary selenium intake and breast cancer death appeared strongest among women who had ever smoked (HR = 0.34; 95 % CI 0.14–0.83; P trend = 0.01) comparing the highest to lowest quartile. Our findings suggest that selenium intake before breast cancer diagnosis may improve breast cancer–specific survival and overall survival. However, these results may be limited to populations with low intakes of selenium.


Breast cancer Diet Epidemiology Selenium Survival 



Swedish Mammography Cohort


Body mass index


Standard deviation


Estrogen receptor


Progesterone receptor


Food frequency questionnaire


International classification of diseases


Hazard ratio


Confidence interval



This work was supported by the Swedish Cancer Foundation, the Swedish Research Council/Committee for Infrastructure, the Swedish Foundation for International Cooperation in Research and Higher Education, and the Regional Research Fund Uppsala-Örebro Region.

Conflict of interest

The authors declare that they have no conflicts of interest.


  1. 1.
    Ip C (1986) The chemopreventive role of selenium in carcinogenesis. Adv Exp Med Biol 206:431–447PubMedGoogle Scholar
  2. 2.
    AICR (2007) Food, nutrition, physical activity, and the prevention of cancer: a global perspective. AICR, Washington, DCGoogle Scholar
  3. 3.
    Blot WJ, Li J-Y, Taylor PR, Guo W, Dawsey S, Wang G-Q, Yang CS, Zheng S-F, Gail M, Li G-Y et al (1993) Nutrition intervention trials in Linxian, China: supplementation with specific vitamin/mineral combinations, cancer incidence, and disease-specific mortality in the general population. J Natl Cancer Inst 85(18):1483–1491PubMedCrossRefGoogle Scholar
  4. 4.
    Clark L, Combs G, Turnbull B, Slate E, Chalker D, Chow J, Davis L, Glover R, Graham G, Gross E et al (1996) Effects of selenium supplementation for cancer prevention in patients with carcinma of the skin. A randomized controlled trial. Nutritional Prevention of Cancer Study Group. JAMA 276(24):1957–1963PubMedCrossRefGoogle Scholar
  5. 5.
    Klein E, Thompson I, Tangen C, Crowley J, Lucia M, Goodman P, Minasian L, Ford L, Parnes HG, JM Karp D et al (2011) Vitamin E and the risk of prostate cancer: The Selenium and Vitamin E Cancer Prevention Trial (SELECT). JAMA 306(14):1549–1556PubMedCrossRefGoogle Scholar
  6. 6.
    Holmes MD, Stampfer MJ, Colditz GA, Rosner B, Hunter DJ, Willett WC (1999) Dietary factors and the survival of women with breast carcinoma. Cancer 86(5):826–835PubMedCrossRefGoogle Scholar
  7. 7.
    Saquib J, Rock CL, Natarajan L, Saquib N, Newman VA, Patterson RE, Thomson CA, Al-Delaimy WK, Pierce JP (2011) Dietary intake, supplement use, and survival among women diagnosed with early-stage breast cancer. Nutr Cancer 63(3):327–333PubMedCrossRefGoogle Scholar
  8. 8.
    Wolk A, Larsson SC, Johansson J-E, Ekman P (2006) Long-term fatty fish consumption and renal cell carcinoma incidence in women. JAMA 296(11):1371–1376PubMedCrossRefGoogle Scholar
  9. 9.
    Mattsson B, Wallgren A (1984) Completeness of the Swedish Cancer Register. Non-notified cancer cases recorded on death certificates in 1978. Acta Radiol Oncol 23:305–313PubMedCrossRefGoogle Scholar
  10. 10.
    Larsson SC, Bergkvist L, Wolk A (2009) Long-term meat intake and risk of breast cancer by oestrogen and progesterone receptor status in a cohort of Swedish women. Eur J Cancer 45(17):3042–3046PubMedCrossRefGoogle Scholar
  11. 11.
    Bergström L, E Kylberg E, U Hagman U, H Erikson H, Bruce Å (1991) The food composition database KOST: The National Food Adminsitration’s Information System for nutritive values of food. Vår Fö da 43:439–447Google Scholar
  12. 12.
    Wolk A, Vessby B, Ljung H, Barrefors P (1998) Evaluation of a biological marker of dairy fat intake. Am J Clin Nutri 68(2):291–295Google Scholar
  13. 13.
    Larsson SC, Wolk A (2005) No association of meat, fish, and egg consumption with ovarian cancer risk. Cancer Epidemiol Biomarkers Prev 14(4):1024–1025PubMedCrossRefGoogle Scholar
  14. 14.
    Willett W, Stampfer MJ (1986) Total energy intake: implications for epidemiologic analyses. Am J Epidemiol 124(1):17–27PubMedGoogle Scholar
  15. 15.
    Garland M, Morris JS, Stampfer MJ, Colditz GA, Spate VL, Baskett CK, Rosner B, Speizer FE, Willett WC, Hunter DJ (1995) Prospective study of toenail selenium levels and cancer among women. J Natl Cancer Inst 87(7):497–505PubMedCrossRefGoogle Scholar
  16. 16.
    Laclaustra M, Stranges S, Navas-Acien A, Ordovas JM, Guallar E (2010) Serum selenium and serum lipids in US adults: National Health and Nutrition Examination Survey (NHANES) 2003–2004. Atherosclerosis 210(2):643–648PubMedCrossRefGoogle Scholar
  17. 17.
    Björnberg KA, Vahter M, Grawé KP, Berglund M (2005) Methyl mercury exposure in Swedish women with high fish consumption. Sci Total Environ 341(1–3):45–52PubMedCrossRefGoogle Scholar
  18. 18.
    Comstock GW, Helzlsouer KJ, Bush TL (1991) Prediagnostic serum levels of carotenoids and vitamin E as related to subsequent cancer in Washington County, Maryland. Am J Clin Nutr 53(1):260S–264SPubMedGoogle Scholar
  19. 19.
    Knekt P, Aromaa A, Maatela J, Aaran R-K, Nikkari T, Hakama M, Hakulinen T, Peto R, Saxen E, Teppo L (1988) Serum vitamin E and risk of cancer among Finnish men during a 10-year follow-up. Am J Epidemiol 127(1):28–41PubMedGoogle Scholar
  20. 20.
    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(2):153–160PubMedCrossRefGoogle Scholar
  21. 21.
    Yoshizawa K, Willett WC, Morris SJ, Stampfer MJ, Spiegelman D, Rimm EB, Giovannucci E (1998) Study of prediagnostic selenium level in toenails and the risk of advanced prostate cancer. J Natl Cancer Inst 90(16):1219–1224PubMedCrossRefGoogle Scholar
  22. 22.
    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(6):547–556PubMedCrossRefGoogle Scholar
  23. 23.
    No authors listed (1994) The effect of vitamin E and beta carotene on the incidence of lung cancer and other cancers in male smokers. N Engl J Med 330(15):1029–1035Google Scholar
  24. 24.
    Omenn GS, Goodman GE, Thornquist MD, Balmes J, Cullen MR, Glass A, Keogh JP, Meyskens FL, Valanis B, Williams JH et al (1996) Effects of a combination of beta carotene and vitamin A on lung cancer and cardiovascular disease. N Engl J Med 334(18):1150–1155PubMedCrossRefGoogle Scholar
  25. 25.
    Duffield-Lillico AJ, Dalkin BL, Reid ME, Turnbull BW, Slate EH, Jacobs ET, Marshall JR, Clark LC, Nutritional Prevention of Cancer Study G (2003) Selenium supplementation, baseline plasma selenium status and incidence of prostate cancer: an analysis of the complete treatment period of the Nutritional Prevention of Cancer Trial. BJU International 91(7):608–612PubMedCrossRefGoogle Scholar
  26. 26.
    Wei W-Q, Abnet CC, Qiao Y-L, Dawsey SM, Dong Z-W, Sun X-D, Fan J-H, Gunter EW, Taylor PR, Mark SD (2004) Prospective study of serum selenium concentrations and esophageal and gastric cardia cancer, heart disease, stroke, and total death. Am J Clin Nutr 79(1):80–85PubMedGoogle Scholar
  27. 27.
    Lippman S, Klein E, Goodman P, Lucia M, Thompson I, Ford L, Parnes H, Minasian L, Gaziano J, Hartline J et al (2009) Effect of selenium and vitamin E on risk of prostate cancer and other cancers: the Selenium and Vitamin E Cancer Prevention Trial (SELECT). JAMA 301(1):39–51PubMedCrossRefGoogle Scholar
  28. 28.
    Baliga M, Wang H, Zhuo P, Schwartz J, Diamond A (2007) Selenium and GPx-1 overexpression protect mammalian cells against UV-induced DNA damage. Biol Trace Elem Res 115(3):227–241PubMedCrossRefGoogle Scholar
  29. 29.
    Schrauzer G (2008) Effects of selenium and low levels of lead on mammary tumor development and growth in MMTV-infected female mice. Biol Trace Elem Res 125(3):268–275PubMedCrossRefGoogle Scholar
  30. 30.
    Rayman MP (2000) The importance of selenium to human health. Lancet 356(9225):233–241PubMedCrossRefGoogle Scholar
  31. 31.
    Thomson C, Robinson M, Butler J, Whanger P (1993) Long-term supplementation with selenate and selennomethionine: selenium and glutathione peroxidase (EC in blood components of New Zealand women. Br J Nutr 69:577–588PubMedCrossRefGoogle Scholar
  32. 32.
    Yanbaeva DG, Dentener MA, Creutzberg EC, Wesseling G, Wouters EFM (2007) Systemic effects of smoking*. Chest 131(5):1557–1566PubMedCrossRefGoogle Scholar
  33. 33.
    Bates CJ, Thane CW, Prentice A, Trevor Delves H (2002) Selenium status and its correlates in a British National Diet and Nutrition Survey: people aged 65 years and over. J Trace Elem Med Biol 16(1):1–8PubMedCrossRefGoogle Scholar
  34. 34.
    Wojewoda M, Duszyński J, Szczepanowska J (2010) Antioxidant defence systems and generation of reactive oxygen species in osteosarcoma cells with defective mitochondria: effect of selenium. Biochim Biophys Acta 1797(6–7):890–896PubMedGoogle Scholar
  35. 35.
    Longnecker MP, Stram DO, Taylor PR, Levander OA, Marmion H, Veillon C, McAdam PA, Patterson KY, Holden JM, Morris JS et al (1996) Use of selenium concentration in whole blood, serum, toenails, or urine as a surrogate measure of selenium intake. Epidemiology 7(4):384–390PubMedCrossRefGoogle Scholar
  36. 36.
    Maunsell E, Drolet M, Brisson J, Robert J, Deschênes L (2002) Dietary change after breast cancer: extent, predictors, and relation with psychological distress. J Clin Oncol 20(4):1017–1025PubMedCrossRefGoogle Scholar
  37. 37.
    Salminen EK, Lagstrom HK (2000) Does breast cancer change patients’ dietary habits? Eur J Clin Nutr 54(11):844–848PubMedCrossRefGoogle Scholar
  38. 38.
    Velentzis L, Keshtgar M, Woodside J, Leathem A, Titcomb A, Perkins K, Mazurowska M, Anderson V, Wardell K, Cantwell M (2011) Significant changes in dietary intake and supplement use after breast cancer diagnosis in a UK multicentre study. Breast Cancer Res Treat 128(2):473–482PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC. 2012

Authors and Affiliations

  • Holly R. Harris
    • 1
    • 2
    Email author
  • Leif Bergkvist
    • 3
  • Alicja Wolk
    • 1
  1. 1.Division of Nutritional EpidemiologyThe National Institute for Environmental Medicine, Karolinska InstitutetStockholmSweden
  2. 2.Obstetrics and Gynecology Epidemiology CenterBrigham and Women’s HospitalBostonUSA
  3. 3.Department of Surgery and Centre for Clinical ResearchCentral HospitalVästeråsSweden

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