© The Author 2007. Published by Oxford University Press.
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Multivitamin Use and Risk of Prostate Cancer in the National Institutes of Health–AARP Diet and Health Study
Affiliations of authors: Divisions of Cancer Prevention (KAL), Cancer Epidemiology and Genetics (KAL, MEW, TM, A. Schatzkin, MFL), and Cancer Control and Population Sciences (A. Subar), National Cancer Institute, Bethesda, MD; AACR, Washington, DC (AH)
Correspondence to: Karla A. Lawson, PhD, 6120 Executive Blvd, EPS Ste 320, Rockville, MD 20852-7232 (e-mail: lawsonka{at}mail.nih.gov).
Background: Multivitamin supplements are used by millions of Americans because of their potential health benefits, but the relationship between multivitamin use and prostate cancer is unclear.
Methods: We prospectively investigated the association between multivitamin use and risk of prostate cancer (localized, advanced, and fatal) in 295344 men enrolled in the National Institutes of Health (NIH)–AARP Diet and Health Study who were cancer free at enrollment in 1995 and 1996. During 5 years of follow-up, 10241 participants were diagnosed with incident prostate cancer, including 8765 localized and 1476 advanced cancers. In a separate mortality analysis with 6 years of follow-up, 179 cases of fatal prostate cancer were ascertained. Multivitamin use was assessed at baseline as part of a self-administered, mailed food-frequency questionnaire. Relative risks (RRs) and 95% confidence intervals (CIs) were calculated by use of Cox proportional hazards regression, adjusted for established or suspected prostate cancer risk factors.
Results: No association was observed between multivitamin use and risk of localized prostate cancer. However, we found an increased risk of advanced and fatal prostate cancers (RR = 1.32, 95% CI = 1.04 to 1.67 and RR = 1.98, 95% CI = 1.07 to 3.66, respectively) among men reporting excessive use of multivitamins (more than seven times per week) when compared with never users. The incidence rates per 100000 person-years for advanced and fatal prostate cancers for those who took a multivitamin more than seven times per week were 143.8 and 18.9, respectively, compared with 113.4 and 11.4 in never users. The positive associations with excessive multivitamin use were strongest in men with a family history of prostate cancer or who took individual micronutrient supplements, including selenium, 
-carotene, or zinc.
Conclusion: These results suggest that regular multivitamin use is not associated with the risk of early or localized prostate cancer. The possibility that men taking high levels of multivitamins along with other supplements have increased risk of advanced and fatal prostate cancers is of concern and merits further evaluation.
| CONTEXT AND CAVEATS Prior knowledge Previous epidemiologic studies have suggested that multivitamin supplement use may be associated with more rapid prostate cancer progression. Study design In a prospective cohort study, demographic data and information pertaining to multivitamin and individual supplement use were obtained via questionnaire; information on prostate cancer diagnosis was accessed via certified cancer registries. Contribution This large study was confirmatory of previous reports of an association between multivitamin use and advanced prostate cancer. It also found potential associations of various individual vitamins and mineral supplements with prostate cancer that should be investigated further. Implications Despite the perceived health benefits of multivitamin supplements, the risks associated with their use need to be explored further. Limitations Differences between heavy users of multivitamins and nonusers that may not be controlled for in a study of this type may obscure the true relationship between multivitamin use and prostate cancer.
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Manuscript received September 28, 2006; revised March 9, 2007; accepted April 6, 2007.
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J Natl Cancer Inst 2007 99: 1491-1492.
J Natl Cancer Inst 2007 99: 742-743.
J Natl Cancer Inst 2007 99: 741.
J Natl Cancer Inst 2007 99: 741.
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