8 maart 2011: Toegevoegd aan onderstaande informatie het abstract van deze studie:

Cancer Epidemiol Biomarkers Prev. 2011 Mar;20(2):262-71. Epub 2010 Dec 21.

Vitamin supplement use during breast cancer treatment and survival: a prospective cohort study.

Nechuta S, Lu W, Chen Z, Zheng Y, Gu K, Cai H, Zheng W, Shu XO.

Corresponding Author: Xiao Ou Shu, Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 600, IMPH, Nashville, TN 37203. Xiao-ou.shu@vanderbilt.edu.

Abstract

BACKGROUND: Antioxidants may protect normal cells from the oxidative damage that occurs during radiotherapy and certain chemotherapy regimens; however, the same mechanism could protect tumor cells and potentially reduce effectiveness of cancer treatments. We evaluated the association of vitamin supplement use in the first 6 months after breast cancer diagnosis and during cancer treatment with total mortality and recurrence.

METHODS: We conducted a population-based prospective cohort study of 4,877 women aged 20 to 75 years diagnosed with invasive breast cancer in Shanghai, China, between March 2002 and April 2006. Women were interviewed approximately 6 months after diagnosis and followed up by in-person interviews and record linkage with the vital statistics registry.

RESULTS: During a mean follow-up of 4.1 years, 444 deaths and 532 recurrences occurred. Vitamin use shortly after breast cancer diagnosis was associated with reduced mortality and recurrence risk, adjusted for multiple lifestyle factors, sociodemographics, and known clinical prognostic factors. Women who used antioxidants (vitamin E, vitamin C, multivitamins) had 18% reduced mortality risk (HR = 0.82, 95% CI: 0.65-1.02) and 22% reduced recurrence risk (HR = 0.78, 95% CI: 0.63-0.95). The inverse association was found regardless of whether vitamin use was concurrent or nonconcurrent with chemotherapy, but was present only among patients who did not receive radiotherapy.

CONCLUSIONS: Vitamin supplement use in the first 6 months after breast cancer diagnosis may be associated with reduced risk of mortality and recurrence. Impact: Our results do not support the current recommendation that breast cancer patients should avoid use of vitamin supplements. Cancer Epidemiol Biomarkers Prev; 20(2); 262-71. ©2010 AACR.

PMID: 21177425 [PubMed - in process]

31 december 2010: Bron: Cancer Epidemiol Biomarkers Prev. Published online December 21, 2010.

Vrouwen met borstkanker die naast hun behandeling met chemo extra voedingssupplementen nemen en dan vooral vitamine C en E en een multivitamine hebben daarmee een 18% grotere kans om hun borstkanker te overleven en er niet aan te overlijden. Ook verminderen ze met inname van extra vitamines en mineralen de kans op een recidief met 22%. Dit blijkt uit een retropostpectieve studie van 4 jaar onder 4887 vrouwen met invasieve borstkanker. Opvallend is dat ook bij de groep vrouwen die multivitamines nemen naast hun chemokuren het positieve efect hetzelfde blijft. Afgelopen jaren is er discussie ontstaan en ook orthomoleculaire artsen in nederland houden daar rekening mee dat met name vitamine C naast chemo niet zinvol zou zijn, zelfs schadelijk zou kunnen zijn. Deze studie weerlegt deze opvatting en is er juist sprake van het omgekeerde. Het effect op niet overlijden aan de borstkanker blijkt 18% te bedragen en met de extra vitamines werd het risico op een recidief verlaagd met 22%. Beide resultaten zijn dan ook statistisch significant. Alleen wie ook bestraald wordt heeft weinig tot geen positief effect te verwachten van de extra vitamines en blijkt de sterfte en recidiefkansen gelijk aan statistisch verwacht. Lees in Medscape een groot verklarend artikel over deze studie en hieronder de resultaten uit de studie.

Vitamin use — and the use of vitamins C and E in particular — appeared to be associated with reduced risk for mortality and recurrence for women with invasive breast cancer

Source: Medscape

Lower Risk for Mortality and Recurrence

In this study, Dr. Shu and colleagues evaluated the associations of total mortality and breast cancer recurrence with vitamin supplement use in a population-based prospective cohort study of 4877 women diagnosed with invasive breast cancer. The study was conducted in Shanghai, China, between March 2002 and April 2006, and patients were interviewed approximately 6 months after their diagnosis.

At an average of 4.1 years of follow-up (range, 0.5 - 6.2 years), 444 women had died (389 from breast cancer, 55 from other causes). A total of 4325 patients remained disease free during the follow-up period, and 532 experienced a disease recurrence.

Of the breast cancer survivors, approximately 36.4% ever used any type of vitamin supplement after their diagnosis. Vitamin C was the most commonly used (17.5%), followed by B vitamins (16.3%), vitamin E (7.6%), vitamin A (1.7%), and vitamin D (0.4%). In addition, about 11% reported using multivitamins.

Vitamin users tended to have higher levels of education, income, daily intake of cruciferous vegetables, and soy protein and were more likely to have a lower body mass index. They were also more likely to be nonsmokers and to report consumption of tea and regular exercise.

The use of vitamins also did not significantly vary as far as age at diagnosis, joint estrogen receptor and progesterone receptor tumor status, TNM stage, type of cancer treatment (chemotherapy, radiotherapy, tamoxifen use), number of pregnancies, family history of breast cancer, alcohol intake, or meat intake.

Overall, use of vitamins within the first 6 months of cancer diagnosis (including any vitamins, multivitamins, vitamin E alone, vitamin C alone, and any antioxidants) was associated with a lower risk for total mortality and breast cancer recurrence, with the largest risk reduction observed in patients who used vitamins C or E for a longer duration after diagnosis.

More specifically, the authors note, women who used vitamin C for more than 3 months had a 44% decrease in risk for mortality (adjusted HR, 0.56; 95% CI, 0.37 - 0.87) and a 38% decrease in risk for disease recurrence (adjusted HR, 0.62; 95% CI, 0.43 - 0.90).

On a similar note, women who used vitamin E for more than 3 months had a reduced risk for both mortality (adjusted HR, 0.52; 95% CI, 0.27 - 1.01) and recurrence (adjusted HR, 0.57; 95% CI, 0.32 - 1.01), although point estimates were of marginal statistical significance.

Associations With Radiotherapy

The researchers also investigated the effect of radiotherapy (which was used in about one third of women) on the outcomes seen with vitamin use.

Among the women who did not receive radiotherapy (n = 3280), vitamin use was associated with a lower risk for both mortality and recurrence. This association was the strongest observed for use of any antioxidant (adjusted HR for mortality, 0.65; 95% CI, 0.47 - 0.92; adjusted HR for recurrence, 0.63; 95% CI, 0.46 - 0.86).

Patients who used vitamins and did not receive radiotherapy were at reduced risk for mortality (adjusted HR, 0.67; 95% CI, 0.48 - 0.94) and recurrence (adjusted HR, 0.66; 95% CI, 0.49 - 0.89) compared with those who did not receive radiotherapy or use vitamins.

Women who did undergo radiotherapy (n = 1597) showed slightly worse outcomes, but the results were not statistically significant. Women who underwent radiotherapy and who did not take antioxidant vitamins were at nonsignificant increased risk for mortality (adjusted HR, 1.26; 95% CI, 0.92 - 1.72) and recurrence (adjusted HR, 1.26; 95% CI, 1.00 - 1.57).

Similarly, patients treated with radiotherapy and who used antioxidant vitamins also had nonsignificant increased risk for mortality (adjusted HR, 1.27; 95% CI, 0.99 - 1.64) and recurrence (adjusted HR, 1.17; 95% CI, 0.88 - 1.54).

The study was funded by grants from the Department of Defense Breast Cancer Research Program and the National Cancer Institute. The authors have disclosed no relevant financial relationships.

Cancer Epidemiol Biomarkers Prev. Published online December 21, 2010.

invasieve borstkanker, bestraling, vitamine E, chemo, vitamine C, voedingssupplementen


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