Multivitamin use and breast cancer outcomes in women with early-stage breast cancer: The life after cancer epidemiology study

Marilyn L. Kwan, Heather Greenlee, Valerie S. Lee, Adrienne Castillo, Erica P. Gunderson, Laurel A. Habel, Lawrence H. Kushi, Carol Sweeney, Emily K. Tam, Bette J. Caan

Research output: Contribution to journalArticlepeer-review

22 Scopus citations


Little is known about the relation of multivitamin use to breast cancer outcomes. 2,236 women diagnosed from 1997 to 2000 with early-stage breast cancer (Stage I ≥ 1 cm, II, or IIIA) were enrolled about 2 years post-diagnosis, primarily from the Kaiser Permanente Northern California Cancer Registry (83%). Multivitamin use pre-diagnosis and post-diagnosis was assessed via mailed questionnaire. Outcomes were ascertained yearly by self-report and verified by medical record review. Delayedentry Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI), adjusting for sociodemographic, tumor, and lifestyle factors. Overall, 54 and 72% of the cohort reported using multivitamins pre-and post-diagnosis, respectively. A total of 380 recurrences, 212 breast cancer deaths, and 396 total deaths were confirmed. Compared to never use, multivitamin use after diagnosis was not associated with any outcome (recurrence HR = 0.92; 95% CI: 0.71, 1.20; total mortality HR = 0.92; 95% CI: 0.71, 1.19). Compared to never use, persistent use of multivitamins from pre-to postdiagnosis was associated with a non-significant decreased risk of recurrence (HR = 0.76; 95% CI: 0.54, 1.06) and total mortality (HR = 0.79; 95% CI: 0.56, 1.12). The protective associations were limited to women who had been treated by radiation only (P for trend = 0.048 and 0.083 for recurrence and total mortality, respectively) and both radiation and chemotherapy (P for trend = 0.015 and 0.095 for recurrence and total mortality, respectively). In stratified analyses, women who consistently used multivitamins before and after diagnosis and ate more fruits/vegetables (P for trend = 0.008) and were more physically active (P for trend = 0.034) had better overall survival. Multivitamin use along with practice of other health-promoting behaviors may be beneficial in improving breast cancer outcomes in select groups of survivors.

Original languageEnglish (US)
Pages (from-to)195-205
Number of pages11
JournalBreast Cancer Research and Treatment
Issue number1
StatePublished - Nov 2011
Externally publishedYes


  • All-cause mortality
  • Breast cancer
  • Dietary supplements
  • Multivitamins
  • Prognosis
  • Recurrence
  • Survival
  • Vitamins

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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