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Multivitamin and Alcohol Intake and Folate Receptor Expression in Ovarian Cancer

Departments of ¹ Health Sciences Research, ² Laboratory Medicine and Pathology, and ³ Surgical Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota and ⁴ H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida

Requests for reprints: Linda E. Kelemen, Department of Health Sciences Research, Mayo Clinic College of Medicine, 200 First Street Southwest, Rochester, MN 55905. Phone: 507-538-5980; Fax: 507-266-2478. E-mail: LKelemen{at}post.harvard.edu

Folate receptor (FR) expression in epithelial ovarian cancer may be related to folate intake. We examined this association using multivitamin intake, a proxy for folic acid, and assessed whether the relation was modified by alcohol intake, a folate agonist. Cases (n = 148) with suspected epithelial ovarian cancer, of ages 20 years, were seen at Mayo Clinic, Minnesota, between 2000 and 2004; those with tumor specimens (n = 108) were included in analyses. Outpatient controls (n = 148) without cancer and with at least one ovary intact were matched to cases by age (within 5 years) and state of residence. Multivitamin (4 pills/wk) and weekly alcohol (5 drinks) intakes were assessed. Tumor specimens were analyzed immunohistochemically for FR. Multivariable rate ratios (RR) and 95% confidence intervals (CI) were estimated using unconditional logistic regression. In case-control analysis, the RRs of multivitamin intake with absent/weak/moderate and strong-expressing FR tumors were 0.30 (95% CI, 0.12-0.70) and 0.47 (95% CI, 0.24-0.91), respectively. For alcohol, the associations were 0.84 (95% CI, 0.24-2.86) and 1.65 (95% CI, 0.69-3.93), respectively. In case-case analysis, the RR associated with developing strong-expressing versus other FR tumors was 3.13 (95% CI, 1.14-8.65) for multivitamins and 1.58 (95% CI, 0.45-5.60) for alcohol. The data did not support evidence for an interaction between multivitamin and alcohol intake with risk of developing a strong-expressing FR tumor. The association of multivitamin intake with ovarian cancer may depend on FR expression level.