Changes in vitamin and mineral supplement use after breast cancer diagnosis in the Pathways Study: a prospective cohort study

Heather Greenlee, Marilyn L Kwan, Isaac J Ergas, Garrett Strizich, Janise M Roh, Allegra T Wilson, Marion Lee, Karen J Sherman, Christine B Ambrosone, Dawn L Hershman, Alfred I Neugut, Lawrence H Kushi, Heather Greenlee, Marilyn L Kwan, Isaac J Ergas, Garrett Strizich, Janise M Roh, Allegra T Wilson, Marion Lee, Karen J Sherman, Christine B Ambrosone, Dawn L Hershman, Alfred I Neugut, Lawrence H Kushi

Abstract

Background: Vitamin and mineral supplement use after a breast cancer diagnosis is common and controversial. Dosages used and the timing of initiation and/or discontinuation of supplements have not been clearly described.

Methods: We prospectively examined changes in use of 17 vitamin/mineral supplements in the first six months following breast cancer diagnosis among 2,596 members (28% non-white) of Kaiser Permanente Northern California. We used multivariable logistic regression to examine demographic, clinical, and lifestyle predictors of initiation and discontinuation.

Results: Most women used vitamin/mineral supplements before (84%) and after (82%) diagnosis, with average doses far in excess of Institute of Medicine reference intakes. Over half (60.2%) reported initiating a vitamin/mineral following diagnosis, 46.3% discontinuing a vitamin/mineral, 65.6% using a vitamin/mineral continuously, and only 7.2% not using any vitamin/mineral supplement before or after diagnosis. The most commonly initiated supplements were calcium (38.2%), vitamin D (32.01%), vitamin B6 (12.3%) and magnesium (11.31%); the most commonly discontinued supplements were multivitamins (17.14%), vitamin C (15.97%) and vitamin E (45.62%). Higher education, higher intake of fruits/vegetables, and receipt of chemotherapy were associated with initiation (p-values <0.05). Younger age and breast-conserving surgery were associated with discontinuation (p-values <0.05).

Conclusions: In this large cohort of ethnically diverse breast cancer patients, high numbers of women used vitamin/mineral supplements in the 6 months following breast cancer diagnosis, often at high doses and in combination with other supplements. The immediate period after diagnosis is a critical time for clinicians to counsel women on supplement use.

Figures

Figure 1
Figure 1
Change in supplement use from breast cancer diagnosis to 6 months post diagnosis. For each type of dietary supplement, this figure displays the percent of participants who were never users (blue), continuous users (yellow), discontinuers (red) and initiators (green) from the time of breast cancer diagnosis to 6 months post diagnosis.

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