Are retinol, vitamin C, vitamin E, folate and carotenoids intake associated with bladder cancer risk? Results from the Netherlands Cohort Study

Abstract

Bladder cancer is the most common urological cancer, and is the seventh most common cancer among men, accounting for approximately 200 000 new cases per year worldwide (Parkin et al, 1999). Over the last four decades, many epidemiologic studies and several reviews have been conducted to investigate determinants of bladder cancer (Johansson and Cohen, 1997;Ross et al, 1996;Silverman et al, 1992; van der Meijden, 1998; World Cancer Research Fund & American Institute for Cancer Research, 1997). These studies suggested that bladder cancer is influenced by environmental factors, including cigarette smoking, fluid consumption, schistosomal infections, exposure to industrial chemicals (e.g. aromatic amines) and diet.Among the dietary factors, it has been suggested that vegetable and fruit consumption may protect against cancer at various anatomical sites. With respect to bladder cancer, most epidemiological studies support a possible protective effect of vegetable (Bruemmer et al, 1996;D'Avanzo et al, 1995;Michaud et al, 1999;Mills et al, 1991;Negri et al, 1991) and fruit consumption (Bruemmer et al, 1996;Chyou et al, 1993;Negri et al, 1991;Shibata et al, 1992), although some studies have reported no association for vegetable (Riboli et al, 1991;Shibata et al, 1992) or fruit consumption (Michaud et al, 1999;Riboli et al, 1991). There are many candidate agents in fruits and vegetables that influence bladder cancer risk, including carotenoids, vitamin C, vitamin E, and folate.In the present prospective study, we were able to explore the influence of the intake of different vitamins (i.e. retinol, vitamin C, vitamin E, and folate), and the use of vitamin-containing supplements on bladder cancer risk with substantially more cases than in previous studies. Furthermore, with the use of a recently developed food composition table on carotenoids in Dutch foods (1986), analyses were performed with α-carotene, β-carotene, lutein plus zeaxanthin, β-cryptoxanthin, and lycopene. MATERIALS AND METHODS CohortThe study design has been described in detail previously (van den Brandt et al, 1990a). The cohort includes 58 279 men and 62 573 women aged 55-69 years at baseline (1986). The study population originated from 204 municipal population registries throughout the country. The case cohort approach was used for data processing and analysis (Prentice, 1986). Following this approach, a subcohort of 3500 subjects (1688 men, 1812 women) was randomly sampled from the cohort after baseline exposure measurement. The subcohort has been followed up for vital status information. No subcohort members were lost to follow-up. Follow-upFollow-up for incident cancer was established by record linkage to cancer registries and the Dutch national database of pathology reports (van den Brandt et al, 1990b). The completeness of cancer follow-up was estimated to be over 95% (Goldbohm et al, 1994b Summary In the Netherlands Cohort Study among 120 852 subjects aged 55-69 years at baseline (1986), the association between vitamins and carotenoids intake, vit...

High Serum Level of Retinol and α-Tocopherol Affords Protection Against Oral Cancer in a Multiethnic Population

“…This lack of protective effect is consistent with several findings on other cancers such as prostate and bladder cancer (Nomura et al, 1997;Zeegers et al, 2001;Wang et al, 2009). However, studies on oral cancer reports otherwise.…”

Intakes of fruits and vegetables, carotenoids and vitamins A, E, C in relation to the risk of bladder cancer in the ATBC cohort study

“…No associations were observed for alphacarotene, beta-carotene, lycopene or lutein intakes in these publications, but an inverse association was reported for betacryptoxanthin in the Netherlands Cohort Study, which was particularly strong among heavy smokers (Zeegers et al, 2001a). Carotenoids have many properties that may be important in the prevention of carcinogenesis, antioxidation having been the primary focus in many studies.…”

“…To our knowledge, only three studies (Garcia et al, 1999;Michaud et al, 1999;Zeegers et al, 2001a) have published findings for the relation between individual carotenoid intakes and bladder cancer risk. No associations were observed for alphacarotene, beta-carotene, lycopene or lutein intakes in these publications, but an inverse association was reported for betacryptoxanthin in the Netherlands Cohort Study, which was particularly strong among heavy smokers (Zeegers et al, 2001a).…”

“…Three studies (Shibata et al, 1992;Bruemmer et al, 1996;Michaud et al, 2000) have observed inverse associations with supplement vitamin E (the first was not statistically significant). No associations were observed for intakes of specific carotenoids and risk of bladder cancer in two studies (Michaud et al, 2000;Zeegers et al, 2001a).…”

Consumption of vegetables and fruit and the risk of bladder cancer in the European Prospective Investigation into Cancer and Nutrition

“…23,31,32 Cigarette smoking is the most important established risk factor for bladder cancer. 4 The effect of vegetables and fruit intake on the risk of bladder cancer may differ between smokers and non smokers.…”