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Baseline serum folate, vitamin B12 and the risk of prostate and breast cancer using data from the Swedish AMORIS cohort

  • Essén, Anneli1
  • Santaolalla, Aida1
  • Garmo, Hans1, 2
  • Hammar, Niklas3, 4
  • Walldius, Göran5
  • Jungner, Ingmar6
  • Malmström, Håkan3, 7
  • Holmberg, Lars1, 8
  • Van Hemelrijck, Mieke1, 3
  • 1 King’s College London, Research Oncology, Translational Oncology & Urology Research (TOUR), Guy’s Hospital, School of Cancer and Pharmaceutical Sciences, 3rd Floor, Bermondsey Wing, London, SE1 9RT, UK , London (United Kingdom)
  • 2 Regional Cancer Centre, Uppsala, Sweden , Uppsala (Sweden)
  • 3 Karolinska Institutet, Unit of Epidemiology, Institute of Environmental Medicine, Stockholm, Sweden , Stockholm (Sweden)
  • 4 Global Medical Affairs, AstraZeneca, Medical Evidence & Observational Research, Mölndal, Sweden , Mölndal (Sweden)
  • 5 Karolinska Institutet, Department of Cardiovascular Epidemiology, Institute of Environmental Medicine, Stockholm, Sweden , Stockholm (Sweden)
  • 6 Karolinska Institutet and CALAB Research, Department of Clinical Epidemiology, Stockholm, Sweden , Stockholm (Sweden)
  • 7 Swedish Orphan Biovitrum AB, Biostatistics, Research & Development, Stockholm, Sweden , Stockholm (Sweden)
  • 8 Uppsala University, Department of Surgical Sciences, Uppsala, Sweden , Uppsala (Sweden)
Published Article
Cancer Causes & Control
Publication Date
Apr 24, 2019
DOI: 10.1007/s10552-019-01170-6
Springer Nature


PurposeThe roles of folate and vitamin B12 in prostate cancer (PCa) or breast cancer (BC) development are unclear. We investigated their roles using the prospective Swedish Apolipoprotein MOrtality RISk (AMORIS) study.Methods8,783 men and 19,775 women with vitamin B12 and folate serum measurements were included. Their associations with PCa and BC risk categories were evaluated using Cox proportional hazards regression.ResultsDuring mean follow-up of 13 years, 703 men developed PCa. There was an inverse association between folate > 32 nmol/L and high-risk PCa [hazard ratio (HR) 0.12, 95% confidence interval (CI) 0.02–0.90], and a positive association between folate < 5 nmol/L and metastatic PCa (HR 5.25, 95% CI 1.29–21.41), compared with folate 5–32 nmol/L. No associations with vitamin B12 were found. 795 women developed BC during mean follow-up of 14 years. When restricting to the fasting population, there was a positive association between folate > 32 nmol/L and BC (HR 1.47, 95% CI 1.06–2.04).ConclusionHigh folate levels may protect against PCa and low folate levels may increase risk of metastatic PCa. High fasting folate levels may be associated with an increased BC risk. Vitamin B12 was not found to be linked with risk of PCa or BC. Longitudinal studies with serum and dietary information could help define new prevention targets and add information on the role of folate fortification.

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