This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Giovannucci, E. Articles by Willett, W. C. Search for Related Content PubMed PubMed Citation Articles by Giovannucci, E. Articles by Willett, W. C.

A Prospective Study of Calcium Intake and Incident and Fatal Prostate Cancer

¹ Channing Laboratory, Department of Medicine, Harvard Medical School and Brigham and Women's Hospital and Departments of ² Nutrition and ³ Epidemiology, Harvard School of Public Health, Boston, Massachusetts

Requests for reprints: Edward Giovannucci, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115. Phone: 617-432-4648; Fax: 617-432-2435. E-mail: edward.giovannucci{at}channing.harvard.edu

Prostate cancer is the most common incident cancer and the second leading cause of cancer mortality in U.S. males. Higher milk intake has been relatively consistently associated with an increased risk of prostate cancer, especially advanced prostate cancer. Some data suggest that high intake of calcium might account for this association, but this relationship remains controversial. We hypothesized that high calcium intake, possibly by lowering 1,25(OH)₂ vitamin D levels, is associated with poorer differentiation in prostate cancer and thereby with fatal prostate cancer. We examined calcium intake in relation to prostate cancer risk using data from the Health Professionals Follow-up Study, a prospective cohort study of 47,750 male health professionals with no history of cancer other than nonmelanoma skin cancer at baseline. We assessed total, dietary, and supplementary calcium intake in 1986, 1990, 1994, and 1998, using a validated food frequency questionnaire. We calculated the multivariable relative risk (RR) and 95% confidence intervals (95% CI) using Cox proportional hazards regression. Over 16 years of follow-up, we identified 3,544 total cases of prostate cancer, 523 advanced (extraprostatic) cases, and 312 fatal cases. Higher calcium intake was not appreciably associated with total or nonadvanced prostate cancer but was associated with a higher risk of advanced and fatal prostate cancer [for fatal prostate cancer, compared with men whose long-term calcium intake was 500-749 mg/d (excluding supplement use of <5 years); those with intakes of 1,500-1,999 mg/d had a RR, 1.87; 95% CI, 1.17-3.01; and those with 2,000 mg/d had a RR, 2.43; 95% CI, 1.32-4.48; P_trend = 0.003]. Dietary calcium and supplementary calcium were independently associated with an increased risk. For high-grade prostate cancer (Gleason 7), an association was observed for high versus low calcium intake (RR, 1.89; 95% CI, 1.32-2.71; P_trend = 0.005), but a nonsignificant, inverse association was observed for organ-confined, low-grade prostate cancer (RR, 0.79; 95% CI, 0.50-1.25; P_trend = 0.09). In a sample of this cohort, higher calcium intake was associated with lower circulating 1,25(OH)₂ vitamin D levels. Our findings suggest that calcium intakes exceeding 1,500 mg/d may be associated with a decrease in differentiation in prostate cancer and ultimately with a higher risk of advanced and fatal prostate cancer but not with well-differentiated, organ-confined cancers. (Cancer Epidemiol Biomarkers Prev 2006;15(2):203–10)

This article has been cited by other articles:

				S. Pilz, H. Dobnig, B. Winklhofer-Roob, G. Riedmuller, J. E. Fischer, U. Seelhorst, B. Wellnitz, B. O. Boehm, and W. Marz Low Serum Levels of 25-Hydroxyvitamin D Predict Fatal Cancer in Patients Referred to Coronary Angiography Cancer Epidemiol. Biomarkers Prev., May 1, 2008; 17(5): 1228 - 1233. [Abstract] [Full Text] [PDF]

				N. Kurahashi, M. Inoue, M. Iwasaki, S. Sasazuki, a. S. Tsugane, and for the Japan Public Health Center-Based Prospecti Dairy Product, Saturated Fatty Acid, and Calcium Intake and Prostate Cancer in a Prospective Cohort of Japanese Men Cancer Epidemiol. Biomarkers Prev., April 1, 2008; 17(4): 930 - 937. [Abstract] [Full Text] [PDF]

				J. C van der Pols, C. Bain, D. Gunnell, G. Davey Smith, C. Frobisher, and R. M Martin Childhood dairy intake and adult cancer risk: 65-y follow-up of the Boyd Orr cohort Am. J. Clinical Nutrition, December 1, 2007; 86(6): 1722 - 1729. [Abstract] [Full Text] [PDF]

				J. Ahn, D. Albanes, U. Peters, A. Schatzkin, U. Lim, M. Freedman, N. Chatterjee, G. L. Andriole, M. F. Leitzmann, R. B. Hayes, et al. Dairy Products, Calcium Intake, and Risk of Prostate Cancer in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial Cancer Epidemiol. Biomarkers Prev., December 1, 2007; 16(12): 2623 - 2630. [Abstract] [Full Text] [PDF]

				S.-Y. Park, S. P. Murphy, L. R. Wilkens, D. O. Stram, B. E. Henderson, and L. N. Kolonel Calcium, Vitamin D, and Dairy Product Intake and Prostate Cancer Risk: The Multiethnic Cohort Study Am. J. Epidemiol., December 1, 2007; 166(11): 1259 - 1269. [Abstract] [Full Text] [PDF]

				Y. Park, P. N. Mitrou, V. Kipnis, A. Hollenbeck, A. Schatzkin, and M. F. Leitzmann Calcium, Dairy Foods, and Risk of Incident and Fatal Prostate Cancer: The NIH-AARP Diet and Health Study Am. J. Epidemiol., December 1, 2007; 166(11): 1270 - 1279. [Abstract] [Full Text] [PDF]

				M. L. Neuhouser, M. J. Barnett, A. R. Kristal, C. B. Ambrosone, I. King, M. Thornquist, and G. Goodman (n-6) PUFA Increase and Dairy Foods Decrease Prostate Cancer Risk in Heavy Smokers J. Nutr., July 1, 2007; 137(7): 1821 - 1827. [Abstract] [Full Text] [PDF]

				D. A. Straub Calcium Supplementation in Clinical Practice: A Review of Forms, Doses, and Indications Nutr Clin Pract, June 1, 2007; 22(3): 286 - 296. [Abstract] [Full Text] [PDF]

				D. R. Shahar, R. Abel, A. Elhayany, H. Vardi, and D. Fraser Does Dairy Calcium Intake Enhance Weight Loss Among Overweight Diabetic Patients? Diabetes Care, March 1, 2007; 30(3): 485 - 489. [Abstract] [Full Text] [PDF]

				M. E. Martinez and E. T. Jacobs Calcium Supplementation and Prevention of Colorectal Neoplasia: Lessons From Clinical Trials J Natl Cancer Inst, January 17, 2007; 99(2): 99 - 100. [Full Text] [PDF]

				L. H. Kushi, T. Byers, C. Doyle, E. V. Bandera, M. McCullough, T. Gansler, K. S. Andrews, M. J. Thun, and The American Cancer Society 2006 Nutrition and Phy American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention: Reducing the Risk of Cancer With Healthy Food Choices and Physical Activity CA Cancer J Clin, September 1, 2006; 56(5): 254 - 281. [Abstract] [Full Text] [PDF]