title: Incidence of cancer and mortality following alpha-tocopherol and beta-carotene supplementation: a postintervention follow-up.
abstract: BACKGROUND
  In the Finnish Alpha-Tocopherol, Beta-Carotene Cancer Prevention (ATBC) Study, alpha-tocopherol supplementation decreased prostate cancer incidence, whereas beta-carotene increased the risk of lung cancer and total mortality. Postintervention follow-up provides information regarding duration of the intervention effects and may reveal potential late effects of these antioxidants.
  
  
  OBJECTIVE
  To analyze postintervention effects of alpha-tocopherol and beta-carotene on cancer incidence and total and cause-specific mortality.
  
  
  METHODS
  Postintervention follow-up assessment of cancer incidence and cause-specific mortality (6 years [May 1, 1993-April 30, 1999]) and total mortality (8 years [May 1, 1993-April 30, 2001]) of 25 563 men. In the ATBC Study, 29 133 male smokers aged 50 to 69 years received alpha-tocopherol (50 mg), beta-carotene (20 mg), both agents, or placebo daily for 5 to 8 years. End point information was obtained from the Finnish Cancer Registry and the Register of Causes of Death. Cancer cases were confirmed through medical record review.
  
  
  METHODS
  Site-specific cancer incidence and total and cause-specific mortality and calendar time-specific risk for lung cancer incidence and total mortality.
  
  
  RESULTS
  Overall posttrial relative risk (RR) for lung cancer incidence (n = 1037) was 1.06 (95% confidence interval [CI], 0.94-1.20) among recipients of beta-carotene compared with nonrecipients. For prostate cancer incidence (n = 672), the RR was 0.88 (95% CI, 0.76-1.03) for participants receiving alpha-tocopherol compared with nonrecipients. No late preventive effects on other cancers were observed for either supplement. There were 7261 individuals who died by April 30, 2001, during the posttrial follow-up period; the RR was 1.01 (95% CI, 0.96-1.05) for alpha-tocopherol recipients vs nonrecipients and 1.07 (95% CI, 1.02-1.12) for beta-carotene recipients vs nonrecipients. Regarding duration of intervention effects and potential late effects, the excess risk for beta-carotene recipients was no longer evident 4 to 6 years after ending the intervention and was primarily due to cardiovascular diseases.
  
  
  CONCLUSIONS
  The beneficial and adverse effects of supplemental alpha-tocopherol and beta-carotene disappeared during postintervention follow-up. The preventive effects of alpha-tocopherol on prostate cancer require confirmation in other trials. Smokers should avoid beta-carotene supplementation.
authors.affiliation: National Public Health Institute, Helsinki, Finland.
authors.forename: Jarmo
authors.initials: J
authors.lastname: Virtamo
authors.forename: Pirjo
authors.initials: P
authors.lastname: Pietinen
authors.forename: Jussi K
authors.initials: JK
authors.lastname: Huttunen
authors.forename: Pasi
authors.initials: P
authors.lastname: Korhonen
authors.forename: Nea
authors.initials: N
authors.lastname: Malila
authors.forename: Mikko J
authors.initials: MJ
authors.lastname: Virtanen
authors.forename: Demetrius
authors.initials: D
authors.lastname: Albanes
authors.forename: Phil R
authors.initials: PR
authors.lastname: Taylor
authors.forename: Paul
authors.initials: P
authors.lastname: Albert
mesh_terms: D000368:Aged; D000975:Antioxidants / Q000627:therapeutic use*; D002423:Cause of Death; D019587:Dietary Supplements; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology* / Q000517:prevention & control; D011471:Prostatic Neoplasms / Q000453:epidemiology; D012306:Risk; D012907:Smoking / Q000009:adverse effects*; D024502:alpha-Tocopherol / Q000627:therapeutic use*; D019207:beta Carotene / Q000627:therapeutic use*
chemical_list: D000975:Antioxidants; D019207:beta Carotene; D024502:alpha-Tocopherol