Multivitamin Supplements May Reduce Breast Cancer Mortality

Can A Multivitamin A Day Keep Breast Cancer At Bay?

 Author: Dr. Stephen Chaney

3d rendered illustration - breast cancerA few weeks ago I wrote about soy and breast cancer survival. You’ve probably seen the latest headlines: “Multivitamin Supplements May Reduce Breast Cancer Mortality” and are wondering if they could possibly be true. After all, wasn’t it just a short time ago that the headlines said “Multivitamin supplements have no effect on breast cancer mortality” or that “Multivitamins may increase your risk of death”?

With all the conflicting headlines, you have every right to be skeptical about the latest news. So perhaps we should start with looking at the previous studies and discussing why they disagree.

What do we know about multivitamin use and breast cancer survival?

 Three very large studies have reported no correlation between multivitamin use and breast cancer incidence. So it is pretty clear that multivitamins don’t prevent breast cancer.

However, breast cancer incidence and breast cancer survival are two different things. In the first case you are starting with healthy women and asking how many of them develop cancer. That is what we scientists call a primary prevention study. It is very difficult to prove the effectiveness of any intervention in a primary prevention study. In the second case you are starting with a sick population and asking if an intervention provides a benefit. It is much easier to prove whether or not an intervention is effective in this kind of study.

There, have been several small studies looking at the effect of vitamin supplementation in women who already had breast cancer. While the results have been mixed, the majority of the studies showed that vitamin supplementation did appear to reduce breast cancer recurrence and mortality.

What makes this study different?

The women in this study were part of 161,608 women enrolled the Women’s Health Initiative (WHI) study to investigate the effects of multivitamin use in post-menopausal women. In fact, this was one of the studies to report no effect of multivitamin use on the incidence of breast cancer (Neuhouser et al, Arch. Intern. Med., 169: 294-304, 2009).

What the present study did was to look at the those women in the WHI who did develop breast cancer during the previous study and followed them for an additional 7.9 years to see if multivitamin use affected breast cancer survival (Wasserthiel-Smoller et al, Breast Cancer Res. Treat., 141: 495-505, 3013).

This is the largest study of its kind (7,728 women). It started with an older and sicker group of women than previous studies.  All of the women were 50-79 years old at the time the study began, and all of them had invasive breast cancer at the time of enrollment into the study.

The results were quite impressive. Multivitamin use improved survival by 30%, and the results were highly significant.

Strengths of the Study:

  • This was a large and very well controlled study. The authors did an excellent job of controlling for confounding variables that might have affected the outcome.
  • Multivitamin use was measured at multiple time points. It was assessed at enrollment into the original WHI study and at each subsequent doctor visit. The multivitamin usage for the purpose of data analysis was the usage at the time of breast cancer diagnosis, but the authors also corrected for any change in vitamin use post-diagnosis.
  • The study was in agreement with the majority of previous studies, further strengthening the conclusion that multivitamin use in women with breast cancer improves the likelihood of survival.

Weaknesses of the Study:

  • Because previous studies have been mixed with respect to the effect of multivitamins on breast cancer survival, further placebo controlled intervention studies will be required before multivitamin use becomes part of the standard of treatment for breast cancer patients.
  • Most of the women in the study were post-menopausal. It is unclear if multivitamins will provide the same benefit to pre-menopausal women with breast cancer.
  • This study measured consistent multivitamin use before and after the diagnosis of breast cancer. It did not look at women who began multivitamin use after diagnosis. So we have no idea whether starting multivitamin use after diagnosis would have also been beneficial.

The Bottom Line:

1)    This study strongly suggests that multivitamin use may help improve your chances of survival if you are unlucky enough to develop breast cancer.  While more studies are still needed, this study certainly strengthens the argument for multivitamin use.

2)    The rap on multivitamins has always been that they aren’t needed by healthy people who have a good diet. However, multivitamins are important for assuring good nutritional status if your diet is not optimal or if you have increased nutritional needs – either because of your genetic makeup or because of illness.

3)    The difficulty is that you usually don’t know if your genetics increases your vitamin needs, and once your disease has progressed far enough to be diagnosed it may be too late to improve disease outcome.  That’s why many experts consider a multivitamin supplement as an inexpensive form of nutritional and health insurance. I concur.

4)    As for the fear that multivitamins might just kill you, that hypothesis has been disproven by several subsequent studies including one published just a couple of weeks ago (Macpherson et al, Am. J. Clin. Nutr., doi: 10.3945/ajcn.112.o49304).

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Soy And Breast Cancer Recurrence

The Truth About Soy And Breast Cancer

 Author: Dr. Stephen Chaney

SoybeanYou’ve probably heard the warnings: “Soy may increase the risk of breast cancer!” “Women with breast cancer shouldn’t use soy!”

The first warning was never true. Numerous clinical studies have shown that consumption of soy protein is associated with a lower risk of developing breast cancer.

Furthermore, the science behind the second warning has never been very strong. The concerns that soy might stimulate the growth of breast cancer cells was based primarily on cell culture experiments and one experiment in mice – even though a second experiment in mice came to the exact opposite conclusion.

Was The Hypothesis That Soy Could Increase The Risk Of Breast Cancer Recurrence Plausible?

The possibility that soy isoflavones could stimulate the growth of estrogen- responsive breast cancer was biochemically plausible because soy isoflavones bind to the estrogen receptor and have a very weak stimulatory effect (much weaker than estrogen itself).

Even that evidence was not definitive because soy isoflavones also turn on several tumor suppressor pathways in breast cells and help strengthen the immune system – so they could just as easily inhibit the growth of breast cancer cells.

However, because the concerns were plausible and had not been definitively disproved, most experts, including me, recommended for several years that women with estrogen- responsive breast cancer might want to avoid soy protein.

Has The Hypothesis Been Rigorously Tested?

In fact, the definitive clinical studies have been performed, and it turns out for women who are breast cancer survivors, consumption of soy foods does not increase either the risk of breast cancer recurrence or of dying from breast cancer.

The first of these studies was reported in the December 2009 issue of the Journal of the American Medical Association by researchers at Vanderbilt University and Shanghai Institute of Preventive Medicine (Shu et al, JAMA, 302: 2437-2443, 2009).

It was a large, well designed, study that enrolled 5042 Chinese women aged 20 to 75 years old who had been diagnosed with breast cancer and followed them for an average period of 3.9 years.

The women were divided into four groups based on the soy content of their diet (ranging from 5 grams/day to 15 grams/day). The results were clear cut. Breast cancer survivors with the highest soy intake had 25% less chance of breast cancer recurrence and 25% less chance of dying from breast cancer than the women with the lowest soy intake.

The effect was equally strong for women with estrogen receptor-positive and estrogen receptor negative cancers, for early stage and late stage breast cancer and for pre- and post-menopausal women. In short this was a very robust study.

The study also showed that soy protein intake did not interfere with tamoxifen, a drug that blocks the binding of estrogen to its receptor on cancer cells. Tamoxifen is used for both for treating estrogen-responsive breast cancer and preventing its recurrence. In this study, the reduction in the risk of breast cancer recurrence & death was just as great whether the breast cancer survivors were taking tamoxifen or not.

In fact, tamoxifen was protective only for women with low soy intake. It conferred no extra protection for the women at the highest level of soy intake because the soy isoflavones were also blocking the binding of estrogen to its receptor.

Other Clinical Studies

If that were the only published clinical study to test the soy-breast cancer hypothesis, I and other experts would be very cautious about making definitive statements. However, at least four more clinical studies have been published since then, both in Chinese and American populations. The studies have either shown no significant effect of soy on breast cancer recurrence or a protective effect. None of them have shown any detrimental effects of soy consumption by breast cancer survivors.

A meta-analysis of all 5 studies was published earlier this year (Chi et al, Asian Pac J Cancer Prev., 14: 2407-2412, 2013). This study combined the data from 11,206 breast cancer survivors in the US and China. Those with the highest soy consumption had a 23% decrease in recurrence and a 15% decrease in mortality from breast cancer.

The Bottom Line:

What does this mean for you if you are a breast cancer survivor?

1)     There are many reasons to include soy protein foods as part of a healthy diet. Soy foods are one of the highest quality vegetable protein sources and provide a great alternative to many of the high fat, high cholesterol animal proteins in the American diet.

2)     I personally feel that these studies are clear cut enough that breast cancer survivors no longer need to fear soy protein as part of a healthy diet.

3)     The responsible websites agree with this assessment. For example, WebMD and the American Institute for Cancer Research (AICR) both say that breast cancer survivors need no longer worry about eating moderate amounts of soy foods.

4)     The irresponsible websites (I won’t name names, but you know who they are) are still warning breast cancer survivors to avoid soy completely. As a scientist I really have problem with people who are unwilling to change their opinions in the face of overwhelming scientific evidence to the contrary.

5)     Of course, some of those bloggers have now shifted their arguments to say that it is unfermented or genetically modified soy that causes breast cancer. Those statements are equally bogus – but that’s another story for another time.

6)     Finally, I want to emphasize that the published studies merely show that soy does not increase the risk of breast cancer and is safe to use for breast cancer survivors. None of those studies suggest that soy is an effective treatment for breast cancer. The protective effects of soy are modest at best. If you have breast cancer, consult with your physician about the best treatment options for you.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.