Cancer incidence and mortality after treatment with folic acid and vitamin B12
- PMID: 19920236
- DOI: 10.1001/jama.2009.1622
Cancer incidence and mortality after treatment with folic acid and vitamin B12
Abstract
Context: Recently, concern has been raised about the safety of folic acid, particularly in relation to cancer risk.
Objective: To evaluate effects of treatment with B vitamins on cancer outcomes and all-cause mortality in 2 randomized controlled trials.
Design, setting, and participants: Combined analysis and extended follow-up of participants from 2 randomized, double-blind, placebo-controlled clinical trials (Norwegian Vitamin Trial and Western Norway B Vitamin Intervention Trial). A total of 6837 patients with ischemic heart disease were treated with B vitamins or placebo between 1998 and 2005, and were followed up through December 31, 2007.
Interventions: Oral treatment with folic acid (0.8 mg/d) plus vitamin B(12) (0.4 mg/d) and vitamin B(6) (40 mg/d) (n = 1708); folic acid (0.8 mg/d) plus vitamin B(12) (0.4 mg/d) (n = 1703); vitamin B(6) alone (40 mg/d) (n = 1705); or placebo (n = 1721).
Main outcome measures: Cancer incidence, cancer mortality, and all-cause mortality.
Results: During study treatment, median serum folate concentration increased more than 6-fold among participants given folic acid. After a median 39 months of treatment and an additional 38 months of posttrial observational follow-up, 341 participants (10.0%) who received folic acid plus vitamin B(12) vs 288 participants (8.4%) who did not receive such treatment were diagnosed with cancer (hazard ratio [HR], 1.21; 95% confidence interval [CI], 1.03-1.41; P = .02). A total of 136 (4.0%) who received folic acid plus vitamin B(12) vs 100 (2.9%) who did not receive such treatment died from cancer (HR, 1.38; 95% CI, 1.07-1.79; P = .01). A total of 548 patients (16.1%) who received folic acid plus vitamin B(12) vs 473 (13.8%) who did not receive such treatment died from any cause (HR, 1.18; 95% CI, 1.04-1.33; P = .01). Results were mainly driven by increased lung cancer incidence in participants who received folic acid plus vitamin B(12). Vitamin B(6) treatment was not associated with any significant effects.
Conclusion: Treatment with folic acid plus vitamin B(12) was associated with increased cancer outcomes and all-cause mortality in patients with ischemic heart disease in Norway, where there is no folic acid fortification of foods.
Trial registration: clinicaltrials.gov Identifier: NCT00671346.
Comment in
-
Assessing cancer prevention studies--a matter of time.JAMA. 2009 Nov 18;302(19):2152-3. doi: 10.1001/jama.2009.1691. JAMA. 2009. PMID: 19920243 Free PMC article. No abstract available.
Similar articles
-
Mortality and cardiovascular events in patients treated with homocysteine-lowering B vitamins after coronary angiography: a randomized controlled trial.JAMA. 2008 Aug 20;300(7):795-804. doi: 10.1001/jama.300.7.795. JAMA. 2008. PMID: 18714059 Clinical Trial.
-
Effect of homocysteine lowering on mortality and vascular disease in advanced chronic kidney disease and end-stage renal disease: a randomized controlled trial.JAMA. 2007 Sep 12;298(10):1163-70. doi: 10.1001/jama.298.10.1163. JAMA. 2007. PMID: 17848650 Clinical Trial.
-
Effect of combined folic acid, vitamin B6, and vitamin B12 on cancer risk in women: a randomized trial.JAMA. 2008 Nov 5;300(17):2012-21. doi: 10.1001/jama.2008.555. JAMA. 2008. PMID: 18984888 Free PMC article. Clinical Trial.
-
Efficacy of Vitamin B Supplementation on Cognition in Elderly Patients With Cognitive-Related Diseases.J Geriatr Psychiatry Neurol. 2017 Jan;30(1):50-59. doi: 10.1177/0891988716673466. Epub 2016 Oct 17. J Geriatr Psychiatry Neurol. 2017. PMID: 28248558 Review.
-
Vitamin supplements and cardiovascular risk: review of the randomized trials of homocysteine-lowering vitamin supplements.Semin Thromb Hemost. 2000;26(3):341-8. doi: 10.1055/s-2000-8101. Semin Thromb Hemost. 2000. PMID: 11011852 Review.
Cited by
-
Construction and validation of a folate metabolism-related gene signature for predicting prognosis in HNSCC.J Cancer Res Clin Oncol. 2024 Apr 16;150(4):198. doi: 10.1007/s00432-024-05731-4. J Cancer Res Clin Oncol. 2024. PMID: 38625586 Free PMC article.
-
Nutrient intake and risk of multimorbidity: a prospective cohort study of 25,389 women.BMC Public Health. 2024 Mar 4;24(1):696. doi: 10.1186/s12889-024-18191-9. BMC Public Health. 2024. PMID: 38439008 Free PMC article.
-
Nanomaterials-Induced Redox Imbalance: Challenged and Opportunities for Nanomaterials in Cancer Therapy.Adv Sci (Weinh). 2024 Apr;11(16):e2308632. doi: 10.1002/advs.202308632. Epub 2024 Feb 21. Adv Sci (Weinh). 2024. PMID: 38380505 Free PMC article. Review.
-
Etiology, Clinical Manifestations, Diagnosis, and Treatment of Cobalamin (Vitamin B12) Deficiency.Cureus. 2024 Jan 12;16(1):e52153. doi: 10.7759/cureus.52153. eCollection 2024 Jan. Cureus. 2024. PMID: 38344487 Free PMC article. Review.
-
Folic acid: friend or foe in cancer therapy.J Int Med Res. 2024 Jan;52(1):3000605231223064. doi: 10.1177/03000605231223064. J Int Med Res. 2024. PMID: 38229460 Free PMC article. Review.
Publication types
MeSH terms
Substances
Associated data
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical