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Cancer Epidemiology, Biomarkers & Prevention
Cancer Epidemiology, Biomarkers & Prevention
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A Prospective Study of Calcium Intake and Incident and Fatal Prostate Cancer

Edward Giovannucci, Yan Liu, Meir J. Stampfer and Walter C. Willett
Edward Giovannucci
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Yan Liu
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Meir J. Stampfer
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Walter C. Willett
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DOI: 10.1158/1055-9965.EPI-05-0586 Published February 2006
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Abstract

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; Ptrend = 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; Ptrend = 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; Ptrend = 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)

  • calcium
  • prostate cancer
  • cohort
  • epidemiology
  • dairy

Footnotes

  • Grant support: National Cancer Institute/NIH grant CA 55075; National Heart, Lung, and Blood Institute (Harvard) grant HL35464; and National Cancer Institute (Hopkins) grant CA58236.

  • The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked advertisement in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

    • Accepted December 5, 2005.
    • Received August 1, 2005.
    • Revision received November 8, 2005.
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Cancer Epidemiology Biomarkers & Prevention: 15 (2)
February 2006
Volume 15, Issue 2
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A Prospective Study of Calcium Intake and Incident and Fatal Prostate Cancer
Edward Giovannucci, Yan Liu, Meir J. Stampfer and Walter C. Willett
Cancer Epidemiol Biomarkers Prev February 1 2006 (15) (2) 203-210; DOI: 10.1158/1055-9965.EPI-05-0586

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A Prospective Study of Calcium Intake and Incident and Fatal Prostate Cancer
Edward Giovannucci, Yan Liu, Meir J. Stampfer and Walter C. Willett
Cancer Epidemiol Biomarkers Prev February 1 2006 (15) (2) 203-210; DOI: 10.1158/1055-9965.EPI-05-0586
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