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The Effect of -Tocopherol and ß-Carotene Supplementation on Colorectal Adenomas in Middle-Aged Male Smokers¹

Department of Nutrition, National Public Health Institute, FIN-00300 Helsinki, Finland [N. M., J. V., M. V., J. K. H.], and Division of Clinical Sciences, National Cancer Institute, NIH, Bethesda, Maryland 20892 [D. A., J. A. T.]

Epidemiological and experimental studies have indicated that dietary factors such as vitamin C, vitamin E, and ß-carotene are associated with the risk of colorectal cancer. This study was carried out within the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study (ATBC Study), whose participants were randomly assigned to four supplementation groups: (a) -tocopherol (AT), 50 mg/day; (b) ß-carotene (BC), 20 mg/day; (c) both AT and BC; and (d) placebo. We included the 15,538 ATBC Study participants who had been randomized within the areas of three major cities in southern Finland. Cases of colorectal adenoma (n = 146) were identified by the pathology laboratories in the study areas, and these participants’ medical records were collected and reviewed. -tocopherol supplementation increased the risk for adenomas (relative risk, 1.66; 95% confidence interval, 1.19–2.32), whereas ß-carotene supplementation had no effect on the risk (relative risk, 0.98; 95% confidence interval, 0.71–1.35). Slightly more prediagnosis rectal bleeding and intestinal pain occurred in those adenoma cases who received -tocopherol supplements than in those who did not. Thus, some bias may have resulted, with -tocopherol supplementation leading to more colonoscopies and, thus, to an increased detection of incident polyps in this group. This is further supported by the trial finding that -tocopherol supplementation did not increase the risk of colorectal cancer.

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