title: Changes in vitamin and mineral supplement use after breast cancer diagnosis in the Pathways Study: a prospective cohort study.
abstract: BACKGROUND
  Vitamin and mineral supplement use after a breast cancer diagnosis is common and controversial. Dosages used and the timing of initiation and/or discontinuation of supplements have not been clearly described.
  
  
  METHODS
  We prospectively examined changes in use of 17 vitamin/mineral supplements in the first six months following breast cancer diagnosis among 2,596 members (28% non-white) of Kaiser Permanente Northern California. We used multivariable logistic regression to examine demographic, clinical, and lifestyle predictors of initiation and discontinuation.
  
  
  RESULTS
  Most women used vitamin/mineral supplements before (84%) and after (82%) diagnosis, with average doses far in excess of Institute of Medicine reference intakes. Over half (60.2%) reported initiating a vitamin/mineral following diagnosis, 46.3% discontinuing a vitamin/mineral, 65.6% using a vitamin/mineral continuously, and only 7.2% not using any vitamin/mineral supplement before or after diagnosis. The most commonly initiated supplements were calcium (38.2%), vitamin D (32.01%), vitamin B6 (12.3%) and magnesium (11.31%); the most commonly discontinued supplements were multivitamins (17.14%), vitamin C (15.97%) and vitamin E (45.62%). Higher education, higher intake of fruits/vegetables, and receipt of chemotherapy were associated with initiation (p-values <0.05). Younger age and breast-conserving surgery were associated with discontinuation (p-values <0.05).
  
  
  CONCLUSIONS
  In this large cohort of ethnically diverse breast cancer patients, high numbers of women used vitamin/mineral supplements in the 6 months following breast cancer diagnosis, often at high doses and in combination with other supplements. The immediate period after diagnosis is a critical time for clinicians to counsel women on supplement use.
authors.affiliation: Mailman School of Public Health, Columbia University, New York, NY 10032, USA. hg2120@columbia.edu.
authors.forename: Heather
authors.initials: H
authors.lastname: Greenlee
authors.forename: Marilyn L
authors.initials: ML
authors.lastname: Kwan
authors.forename: Isaac J
authors.initials: IJ
authors.lastname: Ergas
authors.forename: Garrett
authors.initials: G
authors.lastname: Strizich
authors.forename: Janise M
authors.initials: JM
authors.lastname: Roh
authors.forename: Allegra T
authors.initials: AT
authors.lastname: Wilson
authors.forename: Marion
authors.initials: M
authors.lastname: Lee
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Sherman
authors.forename: Christine B
authors.initials: CB
authors.lastname: Ambrosone
authors.forename: Dawn L
authors.initials: DL
authors.lastname: Hershman
authors.forename: Alfred I
authors.initials: AI
authors.lastname: Neugut
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Kushi
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000178:diet therapy* / Q000453:epidemiology* / Q000473:pathology; D002140:California; D019587:Dietary Supplements; D005260:Female; D006801:Humans; D008019:Life Style; D016015:Logistic Models; D053858:Metabolic Networks and Pathways; D008875:Middle Aged; D008903:Minerals / Q000008:administration & dosage*; D011446:Prospective Studies; D014815:Vitamins / Q000008:administration & dosage*
chemical_list: D008903:Minerals; D014815:Vitamins