An inverse association between ovarian cancer risk, carotenoids and antioxidant vitamins has been suggested by several epidemiologic studies and 1 experimental trial of a vitamin A analogue. From a population-based study of 549 cases of ovarian cancer and 516 controls, we estimated the consumption of the antioxidant vitamins A, C, D and E and various carotenoids, including alpha-and beta-carotene and lycopene, using a validated dietary questionnaire. Multivariate logistic regression was used to calculate the exposure odds ratios adjusted for established ovarian cancer risk factors. Intakes of carotene, especially alpha-carotene, from food and supplements were significantly and inversely associated with risk for ovarian cancer, predominantly in postmenopausal women. Intake of lycopene was significantly and inversely associated with risk for ovarian cancer, predominantly in premenopausal women. Food items most strongly related to decreased risk for ovarian cancer were raw carrots and tomato sauce. Carotenoids include substances able to be converted into vitamin A, such as alpha-and beta-carotene, as well as other compounds, which cannot be converted into vitamin A but have more potent antioxidant properties, such as lycopene from tomatoes. Together with vitamins A, C and E, the carotenoids are believed to be important in cancer prevention because of their properties as antioxidants or their ability to affect cell differentiation or proliferation. Whether these substances affect risk for ovarian cancer is of interest given its high case-fatality ratio. Three case-control studies have reported that either beta-carotene or vitamin A might be inversely related to ovarian cancer risk. [1][2][3] In addition, an experimental trial to assess whether the vitamin A analogue, fenretinide, might prevent a second breast cancer yielded the surprising finding of a decreased risk for ovarian cancer. 4 In our report, we assessed the association between ovarian cancer and vitamins A, C, E and the carotenoids using data from a population-based case-control study. Taking the lead from an investigation of breast cancer suggesting that menopausal status might modify the association between carotenoids and breast cancer risk, 5 we examined whether menopausal status also influenced associations with ovarian cancer.
MATERIAL AND METHODSThe parent study has been described previously. 6 Briefly, between May 1992 and March 1997, 1,080 incident cases of ovarian cancer among women residing in eastern Massachusetts or New Hampshire were identified through hospital tumor boards and statewide cancer registries. We excluded 203 of these cases because they had died (n ϭ 91), moved or had no phone (n ϭ 51), did not speak English (n ϭ 14) or had a nonovarian primary on review (n ϭ 47); 877 eligible women remained. Physicians denied access to 126 (14%) of these women, 136 (16%) declined to participate and 52 (6%) cases with nonepithelial tumors were excluded, leaving 563 cases with epithelial ovarian cancer, including tumors of borderline malignancy, ...