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The plasma level of retinol, vitamins A, C and α-tocopherol could reduce breast cancer risk? A meta-analysis and meta-regression

  • Original Article - Cancer Research
  • Published:
Journal of Cancer Research and Clinical Oncology Aims and scope Submit manuscript

Abstract

Purpose

Plasma antioxidants are supposed to be directly related to breast cancer risk. However, the results remain inconsistent. Herein, we carried this meta-analysis to comprehensively summarize the associations between plasma retinol, vitamins A, C and α-tocopherol and breast cancer risk.

Methods

We searched PubMed, Embase and the Cochrane Databases (through September 24, 2014) and the reference lists of the retrieved articles in English with sufficient information to estimate relative risk or odds ratio and the 95 % confidence intervals (CIs), or with mean serum/plasma level of vitamins and SD/SEM/p value in breast cancer and controls. Two reviewers independently extracted data using a standardized form, with any discrepancy adjudicated by the third reviewer.

Results

Forty studies entered this meta-analysis. For the pooled OR, no significant association between plasma retinol and breast cancer was observed (p = 0.13). Significant association was observed between plasma α-tocopherol and breast cancer (pooled OR 0.42, 95 % CI 0.25, 0.72, p = 0.00) in the subgroup with the median lowest level of 5.74–9.16 μmol/L. For the weighted mean difference (WMD), the plasma α-tocopherol and vitamin C level between breast cancer and controls were significantly different [WMD = −0.93 μmol/L (95 % CI −1.26, −0.61, p = 0.00) and −2.51 μmol/L (95 % CI −4.00, −1.02, p = 0.00), respectively]. No significant association between plasma retinol and vitamin A and breast cancer was observed.

Conclusions

Severe α-tocopherol deficiency could increase breast cancer risk. The association between plasma vitamin C and breast cancer was only significant in case–control studies. There was no significant association between other vitamins and breast cancer risk.

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References

  • Abiaka C, Al-Awadi F, Gulshan S, Al-Sayer H, Behbehani A, Farghaly M, Simbeye A (2001) Plasma concentrations of alpha-tocopherol and urate in patients with different types of cancer. J Clin Pharm Ther 26:265–270

    Article  CAS  PubMed  Google Scholar 

  • Aggarwal BB, Sundaram C, Prasad S, Kannappan R (2010) Tocotrienols, the vitamin E of the 21st century: its potential against cancer and other chronic diseases. Biochem Pharmacol 80:1613–1631. doi:10.1016/j.bcp.2010.07.043

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Aghvami T, Djalali M, Keshavarz A, Sadeghi MR, Zeraati H, Sadrzadeh Yeganeh H, Negahdar M (2006) Plasma level of antioxidant vitamins and lipid peroxidation in breast cancer patients. Iran J Public Health 35:42–47

    CAS  Google Scholar 

  • Al-Saleh I, Al-Doush I (2002) Serum selenium and dl-(alpha)-tocopherol levels in women with breast cancer. Trace Elem Electrolytes 19:118–124

    CAS  Google Scholar 

  • Altucci L, Gronemeyer H (2001) The promise of retinoids to fight against cancer. Nat Rev Cancer 1:181–193. doi:10.1038/35106036

    Article  CAS  PubMed  Google Scholar 

  • Armstrong B, Doll R (1975) Environmental factors and cancer incidence and mortality in different countries, with special reference to dietary practices. Int J Cancer 15:617–631

    Article  CAS  PubMed  Google Scholar 

  • Ascherio A, Stampfer MJ, Colditz GA, Rimm EB, Litin L, Willett WC (1992) Correlations of vitamin A and E intakes with the plasma concentrations of carotenoids and tocopherols among American men and women. J Nutr 122:1792–1801

    CAS  PubMed  Google Scholar 

  • Badid N et al (2010) Oxidant/antioxidant status, lipids and hormonal profile in overweight women with breast cancer. Pathol Oncol Res 16:159–167. doi:10.1007/s12253-009-9199-0

    Article  CAS  PubMed  Google Scholar 

  • Basu TK, Hill GB, Ng D, Abdi E, Temple N (1989) Serum vitamins A and E, beta-carotene, and selenium in patients with breast cancer. J Am Coll Nutr 8:524–529

    Article  CAS  PubMed  Google Scholar 

  • Begg CB, Mazumdar M (1994) Operating characteristics of a rank correlation test for publication bias. Biometrics 50:1088–1101

    Article  CAS  PubMed  Google Scholar 

  • Berlin JA, Longnecker MP, Greenland S (1993) Meta-analysis of epidemiologic dose–response data. Epidemiology 4:218–228

    Article  CAS  PubMed  Google Scholar 

  • Buell P (1973) Changing incidence of breast cancer in Japanese-American women. J Natl Cancer Inst 51:1479–1483

    CAS  PubMed  Google Scholar 

  • Chene G, Thompson SG (1996) Methods for summarizing the risk associations of quantitative variables in epidemiologic studies in a consistent form. Am J Epidemiol 144:610–621

    Article  CAS  PubMed  Google Scholar 

  • Ching S, Ingram D, Hahnel R, Beilby J, Rossi E (2002) Serum levels of micronutrients, antioxidants and total antioxidant status predict risk of breast cancer in a case control study. J Nutr 132:303–306

    CAS  PubMed  Google Scholar 

  • Chitkara N, Dadoo RC, Bansal S, Chugh K, Aggarwal SK, Lal H (1996) Plasma vitamin E levels in carcinoma breast. Indian J Clin Biochem 11:162–164

    Article  CAS  Google Scholar 

  • de Cavanagh EM, Honegger AE, Hofer E, Bordenave RH, Bullorsky EO, Chasseing NA, Fraga C (2002) Higher oxidation and lower antioxidant levels in peripheral blood plasma and bone marrow plasma from advanced cancer patients. Cancer 94:3247–3251. doi:10.1002/cncr.10611

    Article  PubMed  Google Scholar 

  • Deharveng G, Charrondiere UR, Slimani N, Southgate DA, Riboli E (1999) Comparison of nutrients in the food composition tables available in the nine European countries participating in EPIC. European Prospective Investigation into Cancer and Nutrition. Eur J Clin Nutr 53:60–79

    Article  CAS  PubMed  Google Scholar 

  • Dehghan M, Akhtar-Danesh N, McMillan CR, Thabane L (2007) Is plasma vitamin C an appropriate biomarker of vitamin C intake? A systematic review and meta-analysis. Nutr J 6:41. doi:10.1186/1475-2891-6-41

    Article  PubMed Central  PubMed  Google Scholar 

  • Dorgan JF, Sowell A, Swanson CA, Potischman N, Miller R, Schussler N, Stephenson HE Jr (1998) Relationships of serum carotenoids, retinol, alpha-tocopherol, and selenium with breast cancer risk: results from a prospective study in Columbia, Missouri (United States). Cancer Causes Control 9:89–97

    Article  CAS  PubMed  Google Scholar 

  • Dorjgochoo T et al (2009) Plasma carotenoids, tocopherols, retinol and breast cancer risk: results from the Shanghai Women Health Study (SWHS). Breast Cancer Res Treat 117:381–389. doi:10.1007/s10549-008-0270-4

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315:629–634

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Epplein M et al (2009) Plasma carotenoids, retinol, and tocopherols and postmenopausal breast cancer risk in the Multiethnic Cohort Study: a nested case–control study. Breast Cancer Res 11:R49. doi:10.1186/bcr2338

    Article  PubMed Central  PubMed  Google Scholar 

  • Fleiss JL (1993) The statistical basis of meta-analysis. Stat Methods Med Res 2:121–145

    Article  CAS  PubMed  Google Scholar 

  • Foster RL (2012) Reporting guidelines: CONSORT, PRISMA, and SQUIRE. J Spec Pediatr Nurs 17:1–2. doi:10.1111/j.1744-6155.2011.00319.x

    Article  PubMed  Google Scholar 

  • Freedman LS, Schatzkin A, Midthune D, Kipnis V (2011) Dealing with dietary measurement error in nutritional cohort studies. J Natl Cancer Inst 103:1086–1092. doi:10.1093/jnci/djr189

    Article  PubMed Central  PubMed  Google Scholar 

  • Fulan H et al (2011) Retinol, vitamins A, C, and E and breast cancer risk: a meta-analysis and meta-regression. Cancer Causes Control 22:1383–1396. doi:10.1007/s10552-011-9811-y

    Article  PubMed  Google Scholar 

  • Gerber M et al (1988) Liposoluble vitamins and lipid parameters in breast cancer. A joint study in northern Italy and southern France. Int J Cancer 42:489–494

    Article  CAS  PubMed  Google Scholar 

  • Gerber M, Richardson S, de Paulet PC, Pujol H, de Paulet AC (1989) Relationship between vitamin E and polyunsaturated fatty acids in breast cancer. Nutritional and metabolic aspects. Cancer 64:2347–2353

    Article  CAS  PubMed  Google Scholar 

  • Gerber M, Richardson S, Salkeld R, Chappuis P (1991) Antioxidants in female breast cancer patients. Cancer Invest 9:421–428

    Article  CAS  PubMed  Google Scholar 

  • Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560. doi:10.1136/bmj.327.7414.557

    Article  PubMed Central  PubMed  Google Scholar 

  • Hou MF et al (1998) Serum vitamin A level in breast cancer patients Kaohsiung. J Med Sci 14:673–678

    CAS  Google Scholar 

  • Hulten K, Van Kappel AL, Winkvist A, Kaaks R, Hallmans G, Lenner P, Riboli E (2001) Carotenoids, alpha-tocopherols, and retinol in plasma and breast cancer risk in northern Sweden. Cancer Causes Control 12:529–537

    Article  CAS  PubMed  Google Scholar 

  • Ito Y, Gajalakshmi KC, Sasaki R, Suzuki K, Shanta V (1999) A study on serum carotenoid levels in breast cancer patients of Indian women in Chennai (Madras), India. J Epidemiol 9:306–314

    Article  CAS  PubMed  Google Scholar 

  • Kabat GC et al (2009) Longitudinal study of serum carotenoid, retinol, and tocopherol concentrations in relation to breast cancer risk among postmenopausal women. Am J Clin Nutr 90:162–169. doi:10.3945/ajcn.2009.27568

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Kelsey JL, Horn-Ross PL (1993) Breast cancer: magnitude of the problem and descriptive epidemiology. Epidemiol Rev 15:7–16

    CAS  PubMed  Google Scholar 

  • Kim MK, Ahn SH, Lee-Kim YC (2001) Relationship of serum (alpha)-tocopherol, carotenoids and retinol with the risk of breast cancer. Nutr Res 21:797–809

    Article  CAS  Google Scholar 

  • Kim MK, Park YG, Gong G, Ahn SH (2002) Breast cancer, serum antioxidant vitamins, and p53 protein overexpression. Nutr Cancer 43:159–166. doi:10.1207/s15327914nc432_6

    Article  CAS  PubMed  Google Scholar 

  • Kim M-K, Ahn SH, Son BH, Sung M-K (2010) Plasma antioxidant concentration, not superoxide dismutase polymorphism, is associated with breast cancer risk in Korean women. Nutr Res 30:705–713. doi:10.1016/j.nutres.2010.09.012

    Article  CAS  PubMed  Google Scholar 

  • Knekt P (1988) Serum vitamin E level and risk of female cancers. Int J Epidemiol 17:281–286

    Article  CAS  PubMed  Google Scholar 

  • Knekt P et al (1990) Serum vitamin A and subsequent risk of cancer: cancer incidence follow-up of the Finnish Mobile Clinic Health Examination Survey. Am J Epidemiol 132:857–870

    CAS  PubMed  Google Scholar 

  • London SJ et al (1992) Carotenoids, retinol, and vitamin E and risk of proliferative benign breast disease and breast cancer. Cancer Causes Control 3:503–512

    Article  CAS  PubMed  Google Scholar 

  • Maillard V et al (2009) Serum carotenoid, tocopherol and retinol concentrations and breast cancer risk in the E3N-EPIC study. Int J Cancer 127:1188–1196. doi:10.1002/ijc.25138

    Article  Google Scholar 

  • Marubini E et al (1988) The relationship of dietary intake and serum levels of retinol and beta-carotene with breast cancer. Results of a case–control study. Cancer 61:173–180

    Article  CAS  PubMed  Google Scholar 

  • McPherson RAPM (2011) Henry’s clinical diagnosis and management by laboratory methods, 22nd edn. Elsevier Saunders, Philadelphia

    Google Scholar 

  • Potischman N et al (1990) Breast cancer and dietary and plasma concentrations of carotenoids and vitamin A. Am J Clin Nutr 52:909–915

    CAS  PubMed  Google Scholar 

  • Ramaswamy G, Krishnamoorthy L (1996) Serum carotene, vitamin A, and vitamin C levels in breast cancer and cancer of the uterine cervix. Nutr Cancer 25:173–177. doi:10.1080/01635589609514439

    Article  CAS  PubMed  Google Scholar 

  • Ray G, Husain SA (2001) Role of lipids, lipoproteins and vitamins in women with breast cancer. Clin Biochem 34:71–76

    Article  CAS  PubMed  Google Scholar 

  • Russell MJ, Thomas BS, Bulbrook RD (1988) A prospective study of the relationship between serum vitamins A and E and risk of breast cancer. Br J Cancer 57:213–215

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Sato R, Helzlsouer KJ, Alberg AJ, Hoffman SC, Norkus EP, Comstock GW (2002) Prospective study of carotenoids, tocopherols, and retinoid concentrations and the risk of breast cancer. Cancer Epidemiol Biomarkers Prev 11:451–457

    CAS  PubMed  Google Scholar 

  • Schrijver J, Alexieva-Figusch J, Van Breederode N, Van Gilse HA (1987) Investigations on the nutritional status of advanced breast cancer patients. The influence of long-term treatment with megestrol acetate or tamoxifen. Nutr Cancer 10:231–245

    Article  CAS  PubMed  Google Scholar 

  • Shah FD, Patel JB, Shukla SN, Shah PM, Patel PS (2009) Evaluation of plasma non-enzymatic antioxidants in breast cancer etiology. Asian Pac J Cancer Prev 10:91–96

    PubMed  Google Scholar 

  • Sharhar S et al (2008) Antioxidant intake and status, and oxidative stress in relation to breast cancer risk: a case–control study. Asian Pac J Cancer Prev 9:343–349

    PubMed  Google Scholar 

  • Simon MS, Djuric Z, Dunn B, Stephens D, Lababidi S, Heilbrun LK (2000) An evaluation of plasma antioxidant levels and the risk of breast cancer: a pilot case control study. Breast J 6:388–395

    Article  PubMed  Google Scholar 

  • Stroup DF et al (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of Observational Studies in Epidemiology (MOOSE) group. JAMA 283:2008–2012

    Article  CAS  PubMed  Google Scholar 

  • Tamimi RM (2005) Plasma carotenoids, retinol, and tocopherols and risk of breast cancer. Am J Epidemiol 161:153–160. doi:10.1093/aje/kwi030

    Article  PubMed  Google Scholar 

  • Thomas DB, Karagas MR (1987) Cancer in first and second generation Americans. Cancer Res 47:5771–5776

    CAS  PubMed  Google Scholar 

  • Toniolo P, Van Kappel AL, Akhmedkhanov A, Ferrari P, Kato I, Shore RE, Riboli E (2001) Serum carotenoids and breast cancer. Am J Epidemiol 153:1142–1147

    Article  CAS  PubMed  Google Scholar 

  • Torun M, Akgul S, Sargin H (1995a) Serum vitamin E level in patients with breast cancer. J Clin Pharm Ther 20:173–178

    Article  CAS  PubMed  Google Scholar 

  • Torun M, Yardim S, Gonenc A, Sargin H, Menevse A, Simsek B (1995b) Serum beta-carotene, vitamin E, vitamin C and malondialdehyde levels in several types of cancer. J Clin Pharm Ther 20:259–263

    Article  CAS  PubMed  Google Scholar 

  • Trock BJ, Hilakivi-Clarke L, Clarke R (2006) Meta-analysis of soy intake and breast cancer risk. J Natl Cancer Inst 98:459–471

    Article  CAS  PubMed  Google Scholar 

  • Ullah MF, Khan HY, Zubair H, Shamim U, Hadi SM (2011) The antioxidant ascorbic acid mobilizes nuclear copper leading to a prooxidant breakage of cellular DNA: implications for chemotherapeutic action against cancer. Cancer Chemother Pharmacol 67:103–110. doi:10.1007/s00280-010-1290-4

    Article  CAS  PubMed  Google Scholar 

  • WHO (2011(WHO/NMH/NHD/MNM/11.3)) Serum retinol concentrations for determining the prevalence of vitamin A deficiency in populations Vitamin and Mineral Nutrition Information System. World Health Organization, Geneva

  • Zaroukian S, Pineault R, Gandini S, Lacroix A, Ghadirian P (2005) Correlation between nutritional biomarkers and breast cancer: a case–control study. The Breast 14:209–223. doi:10.1016/j.breast.2005.01.001

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

Thanks for the grants from the National Natural Science Foundation of China (No. 81172743).

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All the authors declare that we have no potential conflict of interest.

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Correspondence to Yashuang Zhao or Da Pang.

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Fulan Hu and Zhiwei Wu have contributed equally to this paper.

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Hu, F., Wu, Z., Li, G. et al. The plasma level of retinol, vitamins A, C and α-tocopherol could reduce breast cancer risk? A meta-analysis and meta-regression. J Cancer Res Clin Oncol 141, 601–614 (2015). https://doi.org/10.1007/s00432-014-1852-7

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