title: Long-term use of supplemental multivitamins, vitamin C, vitamin E, and folate does not reduce the risk of lung cancer.
abstract: BACKGROUND
  Lung cancer is the leading cause of cancer-related mortality in the United States. Although supplements are used by half the population, limited information is available about their specific effect on lung cancer risk.
  
  
  OBJECTIVE
  To explore the association of supplemental multivitamins, vitamin C, vitamin E, and folate with incident lung cancer.
  
  
  METHODS
  Prospective cohort of 77,721 men and women aged 50-76 years from Washington State in the VITAL (VITamins And Lifestyle) study. Cases were identified through the Seattle-Puget Sound SEER (Surveillance, Epidemiology, and End Results) cancer registry.
  
  
  RESULTS
  Hazard ratios (HRs) for incident lung cancer according to 10-year average daily use of supplemental multivitamins, vitamin C, vitamin E, and folate. A total of 521 cases of lung cancer were identified. Adjusting for smoking, age, and sex, there was no inverse association with any supplement. Supplemental vitamin E was associated with a small increased risk of lung cancer (HR, 1.05 for every 100-mg/d increase in dose; 95% confidence interval [CI], 1.00-1.09; P = 0.033). This risk of supplemental vitamin E was largely confined to current smokers (HR, 1.11 for every 100-mg/d increase; 95% CI, 1.03-1.19; P < 0.01) and was greatest for non-small cell lung cancer (HR, 1.07 for every 100-mg/d increase; 95% CI, 1.02-1.12; P = 0.004).
  
  
  CONCLUSIONS
  Supplemental multivitamins, vitamin C, vitamin E, and folate were not associated with a decreased risk of lung cancer. Supplemental vitamin E was associated with a small increased risk. Patients should be counseled against using these supplements to prevent lung cancer.
authors.affiliation: University of Washington, Division of Pulmonary and Critical Care Medicine, 1959 NE Pacific Street, Box 356522, Seattle, WA 98195-6522, USA. cslatore@u.washington.edu
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Slatore
authors.forename: Alyson J
authors.initials: AJ
authors.lastname: Littman
authors.forename: David H
authors.initials: DH
authors.lastname: Au
authors.forename: Jessie A
authors.initials: JA
authors.lastname: Satia
authors.forename: Emily
authors.initials: E
authors.lastname: White
mesh_terms: D000368:Aged; D001205:Ascorbic Acid / Q000008:administration & dosage; D018890:Chemoprevention / Q000379:methods; D004032:Diet; D019587:Dietary Supplements; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage; D006801:Humans; D008175:Lung Neoplasms / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D014810:Vitamin E / Q000008:administration & dosage / Q000009:adverse effects; D014815:Vitamins / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D014815:Vitamins; D014810:Vitamin E; D005492:Folic Acid; D001205:Ascorbic Acid