Consumer Concerns

Consumers of quality broad sprectrum multivitamins should not to be alarmed by recent media reports on an observational study by Swedish researchers suggesting that "the use of multivitamins may increase the risk of breast cancer". Details of this study were published online on March 24, 2010 in the American Journal or Clinical Nutrition. Some recent media reports on this Swedish study exaggerated the authors' original claim, and have sparked panic among consumers. Experts in the complementary health industry around the world have expressed concerns over the validity of this study.

There are limitations to this study, which the authors themselves responsibly acknowledged in their discussion:

• "Dietary supplement use was assessed by using a self-administered questionnaire". Error in self-reporting may result in misclassification of multivitamin use by the researchers.
• "Information on multivitamin brand names was not available", therefore the researchers did not know the nutrient composition of the products, and were not able to identify the individual components of multivitamins that may be linked to the observed increase in breast cancer risk.
• "Another limitation is the observational design" of the study, thus unable to prove any causative link. Although the researchers have statistically adjusted analysis for known breast cancer risk factors, it is possible that not all factors were accounted for, which may have skewed the findings. The authors admitted that their findings may be due to "residual confounding".

According to this Swedish study carried out in just over 35,000 women with a follow-up period of 10 years, multivitamin use was associated with a statistically significant increased risk of breast cancer by 19% compared with non-users.

There are conflicting findings in the study. For example, the relative risk was lower in women who took supplements more often (>=7 times a week, 19%) than in women who took supplements less often (<7 times a week, 28%). The author failed to explain this confusing observation that contradicts their final conclusion.

It is important to note that there are other large studies that demonstrate no association between multivitamin supplement use and breast cancer risk in women (Meulepas JM et al; Public Health Nutr; 2009 Dec 3:1-6 http://www.ncbi.nlm.nih.gov/pubmed/19954572); or decreased risk for developing certain types of breast cancer (Ishitani K et al; Am J Epidemiol; 2008 May 15;167(10):1197-206. http://www.ncbi.nlm.nih.gov/pubmed/18344515).

This observational study merely suggested a possible risk in developing breast cancer among multivitamin users, though the validity of its results have been questioned by experts. It did not establish any evidence that multivitamin use could be the causal factors for developing breast cancer, nor increased risk for breast cancer. Based on this study alone, it is not possible to draw any final conclusion.

Below are the responses from experts around the world:

The Complementary Healthcare Council (CHC) of Australia has expressed “concerns over limitations to the study”, and advised that "Consumers need not panic over media reports". "Of further concern is that information on the brands of multivitamins taken by the participants was not collected; therefore the study was unable to determine whether there may be an association with one particular dietary supplement product or ingredient(s) at certain doses which has resulted in the assumption of multivitamins being the risk factor.” The CHC believes that more researches are needed before any association can be made between an increased risk of breast cancer and multivitamin use (Source: CHC Media Release, 8 April 2010).

Cancer Council Australia stated that "It is important to keep in perspective of the well established risk factors for breast cancer – i.e.. obesity, physical inactivity and drinking alcohol are much more significant risk factors for breast cancer". It advises that "women taking multivitamin supplements should not be alarmed by these findings.” (Source: Cancer Council Australia - Issues in the Media; http://www.cancer.org.au/Newsmedia/Issues_in_the_media.htm#333604)

According to Andrew Shao, senior vice president, scientific and regulatory affairs, Council of Responsible Nutrition (USA), “... The finding of an increased risk of breast cancer is puzzling, and in direct conflict with other similarly designed studies such as the well-regarded Nurses Health Study out of Harvard, which showed just the opposite—that multivitamin use was associated with a significant decrease in breast cancer risk. And there are a few other studies that show ‘no effect.’ So it is difficult to say what this study means on its own. To their credit, the authors are balanced in their discussion of the findings and are careful not to draw firm conclusions from this one study. More research is definitely needed to sort out the conflicting data. In the meantime, the message to consumers is still the same: it is better to meet your nutrient needs than not, and a simple, affordable daily multivitamin helps us all to achieve that. This study does not change that.” (Source: http://www.naturalproductsinsider.com/news/2010/04/multivitamins-lead-to-breast-cancer.aspx).

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