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Longitudinal study of serum carotenoid, retinol, and tocopherol concentrations in relation to breast cancer risk among postmenopausal women^1,2

¹ From the Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (GCK, MK, and TER); the Georgetown University Medical Center, Washington, DC (LLA-C); the Division of Research, Kaiser Permanente Northern California, Oakland, CA (BJC); LA Biomedical Research Institute at Harbor–UCLA Medical Center, Torrance, CA (RTC); the Fred Hutchinson Cancer Research Center, Seattle, WA (MLN); and the School of Public Health, University of Alabama at Birmingham, Birmingham, AL (JMS).

² Address correspondence to GC Kabat, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461. E-mail: gkabat{at}aecom.yu.edu.

Background: Prospective studies have examined the association of serum and plasma carotenoids and micronutrients and breast cancer; however, to date, studies have only assessed exposure at one point in time.

Objective: This study analyzed baseline and repeated serum measurements of carotenoids, retinol, and tocopherols to assess their associations with postmenopausal breast cancer risk.

Design: Serum concentrations of -carotene, β-carotene, β-cryptoxanthin, lycopene, lutein + zeaxanthin, retinol, -tocopherol, and -tocopherol were measured in a 6% sample of women in the Women's Health Initiative clinical trials at baseline and at years 1, 3, and 6 and in a 1% sample of women in the observational study at baseline and at year 3. The association of baseline compounds and breast cancer risk was estimated by Cox proportional hazards models. In addition, repeated measurements were analyzed as time-dependent covariates. Of 5450 women with baseline measurements, 190 incident cases of breast cancer were ascertained over a median of 8.0 y of follow-up.

Results: After multivariable adjustment, risk of invasive breast cancer was inversely associated with baseline serum -carotene concentrations (hazard ratio for highest compared with the lowest tertile: 0.55; 95% CI: 0.34, 0.90; P = 0.02) and positively associated with baseline lycopene (hazard ratio: 1.47; 95% CI: 0.98, 2.22; P = 0.06). Analysis of repeated measurements indicated that -carotene and β-carotene were inversely associated with breast cancer and that -tocopherol was associated with increased risk.

Conclusions: The present study, which was the first to assess repeated measurements of serum carotenoids and micronutrients in relation to breast cancer, adds to the evidence of an inverse association of specific carotenoids with breast cancer. The positive associations observed for lycopene and -tocopherol require confirmation. This trial was registered at clinicaltrials.gov as NCT00000611.