Breast Cancer Research and Treatment

, Volume 141, Issue 3, pp 495–505 | Cite as

Multivitamin and mineral use and breast cancer mortality in older women with invasive breast cancer in the women’s health initiative

  • S. Wassertheil-SmollerEmail author
  • A. P. McGinn
  • N. Budrys
  • R. Chlebowski
  • G. Y. Ho
  • K. C. Johnson
  • D. S. Lane
  • W. Li
  • M. L. Neuhouser
  • J. Saquib
  • J. M. Shikany
  • Y. Song
  • C. Thomson


Multivitamin use is common in the United States. It is not known whether multivitamins with minerals supplements (MVM) used by women already diagnosed with invasive breast cancer would affect their breast cancer mortality risk. To determine prospectively the effects of MVM use on breast cancer mortality in postmenopausal women diagnosed with invasive breast cancer, a prospective cohort study was conducted of 7,728 women aged 50–79 at enrollment in the women’s health initiative (WHI) in 40 clinical sites across the United States diagnosed with incident invasive breast cancer during WHI and followed for a mean of 7.1 years after breast cancer diagnosis. Use of MVM supplements was assessed at WHI baseline visit and at visit closest to breast cancer diagnosis, obtained from vitamin pill bottles brought to clinic visit. Outcome was breast cancer mortality. Hazard ratios and 95 % confidence intervals (CIs) for breast cancer mortality comparing MVM users to non-users were estimated using Cox proportional hazard regression models. Analyses using propensity to take MVM were done to adjust for potential differences in characteristics of MVM users versus non-users. At baseline, 37.8 % of women reported MVM use. After mean post-diagnosis follow-up of 7.1 ± 4.1 (SD) years, there were 518 (6.7 %) deaths from breast cancer. In adjusted analyses, breast cancer mortality was 30 % lower in MVM users as compared to non-users (HR = 0.70; 95 % CI 0.55, 0.91). This association was highly robust and persisted after multiple adjustments for potential confounding variables and in propensity score matched analysis (HR = 0.76; 95 % CI 0.60–0.96). Postmenopausal women with invasive breast cancer using MVM had lower breast cancer mortality than non-users. The results suggest a possible role for daily MVM use in attenuating breast cancer mortality in women with invasive breast cancer but the findings require confirmation.


Breast cancer Multivitamins Vitamins Women’s health initiative WHI Breast cancer mortality 



The authors thank the WHI participants, Investigators and staff for their important contributions. The Women’s Health Initiative (WHI) program is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, U.S. Department of Health and Human Services through contracts N01WH22110, 24152, 32100-2, 32105-6, 32108-9, 32111-13, 32115, 32118-32119, 32122, 42107-26, 42129-32, and 44221. The funding organization (NIH) had no role in the design and conduct of the study; analysis or interpretation of the data or preparation, review, or approval of the manuscript or the decision to submit the manuscript for publication. The funding organization was involved in designing the WHI protocol and in management of WHI.

Conflict of interest

All authors state they have no conflicts of interest.


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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • S. Wassertheil-Smoller
    • 1
    Email author
  • A. P. McGinn
    • 1
  • N. Budrys
    • 2
  • R. Chlebowski
    • 3
  • G. Y. Ho
    • 1
  • K. C. Johnson
    • 4
  • D. S. Lane
    • 5
  • W. Li
    • 6
  • M. L. Neuhouser
    • 7
  • J. Saquib
    • 8
  • J. M. Shikany
    • 9
  • Y. Song
    • 10
  • C. Thomson
    • 11
  1. 1.Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxUSA
  2. 2.Department of Obstetrics and GynecologyUniversity of Oklahoma Health Science CenterOklahoma CityUSA
  3. 3.Los Angeles Biomedical Research Institute at Harbor-UCLA Medical CenterTorranceUSA
  4. 4.Department of Preventive MedicineUniversity of Tennessee Health Science CenterMemphisUSA
  5. 5.Department of Preventive MedicineStony Brook University School of MedicineStony BrookUSA
  6. 6.Division of Preventive and Behavioral MedicineUniversity of Massachusetts Medical SchoolWorcesterUSA
  7. 7.Division of Public Health SciencesFred Hutchinson Cancer Research CenterSeattleUSA
  8. 8.Stanford Prevention Research CenterStanford UniversityStanfordUSA
  9. 9.Division of Preventive Medicine, School of MedicineUniversity of Alabama at BirminghamBirminghamUSA
  10. 10.Division of Preventive MedicineBrigham and Women’s Hospital, Harvard Medical SchoolBostonUSA
  11. 11.Zuckerman College of Public HealthUniversity of Arizona Cancer CenterTucsonUSA

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