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Cited by 104Antioxidant Activity and Oxidative StressSmoking Behavior and CessationLung Cancer Diagnosis and Treatment

The DOI matches its Crossref record; 28 of the 29 references it cites were found in a registry or an index.

β-Carotene Supplementation and Lung Cancer Incidence in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study: The Role of Tar and Nicotine

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Middha, Pooja, Weinstein, Stephanie J, Männistö, Satu, Albanes, Demetrius, Mondul, Alison M·2019·Nicotine & Tobacco Research
DOI 10.1093/ntr/nty115PMC PMC6636175
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Abstract

Introduction: The Alpha-Tocopherol, Beta-Carotene Cancer Prevention (ATBC) Study demonstrated that β-carotene supplementation increases lung cancer incidence in smokers. Further, cigarettes with higher tar and nicotine content are associated with a higher risk of lung cancer. However, no studies have examined whether the increased risk associated with β-carotene supplementation in smokers varies by the tar or nicotine content of cigarettes. Methods: The ATBC Study was a randomized, double-blind intervention trial conducted in southwest Finland. A total of 29 133 male smokers, aged 50–69 years, were enrolled and randomly assigned to one of four groups (α-tocopherol, β-carotene, both, or placebo). Cox proportional hazards models were used to estimate the hazard ratio (HR) and 95% confidence intervals (CI) of lung cancer risk by β-carotene trial assignment stratified by a priori categories of cigarette tar and nicotine content. Results: The β-carotene supplementation group had significantly higher risk of developing lung cancer in all categories of tar content (yes vs. no β-carotene supplementation—ultralight cigarettes [≤7 mg tar]: HR = 1.31, 95% CI = 0.91 to 1.89; nonfiltered cigarettes [≥21 mg tar]: HR = 1.22, 95% CI = 0.91 to 1.64; p for interaction = .91). Similarly, there was no interaction with nicotine content (yes vs. no β-carotene supplementation—ventilated cigarettes [≤0.8 µg nicotine]: HR = 1.23, 95% CI = 0.98 to 1.54; nonfiltered cigarettes [≥1.3 µg nicotine]: HR = 1.22, 95% CI = 0.91 to 1.64; p for interaction = .83). Conclusion: These findings support the conclusion that supplementation with β-carotene increases the risk of lung cancer in smokers regardless of the tar or nicotine content of cigarettes smoked. Our data suggest that all smokers should continue to avoid β-carotene supplementation. Implications: Previous studies demonstrated that β-carotene supplementation increases risk of lung cancer in smokers. This study moves the field forward by examining the potential for modification of risk of lung cancer with different levels of tar and nicotine in cigarettes smoked, as interaction with carcinogens in these components of cigarette smoke is hypothesized to be the mechanism by which β-carotene increases risk. Our study provides evidence that the increased risk of lung cancer in smokers who take β-carotene supplements is not dependent upon the tar or nicotine level of cigarettes smoked and suggests that all smokers should continue to avoid β-carotene supplementation.

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  1. US Department of Health, Education and Welfare, 1979, Smoking and Health: A Report of the Surgeon General
  2. Benowitz, 2001, Compensatory smoking of low yield cigarettes, 39

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Metadata

Authors
Middha, P., Weinstein, S. J., Männistö, S., Albanes, D., & Mondul, A. M.
Affiliations
  • University of Michigan (US)
  • National Institutes of Health (US)
  • Finnish Institute for Health and Welfare (FI)
Corresponding author
Mondul, Alison M
ORCID
Venue
Nicotine & Tobacco Research
Publisher
Oxford University Press (OUP)
Published
2018-06-08
Volume
21
Issue
8
Pages
1045-1050
ISSN
  • 1462-2203 (ISSN-L)
  • 1469-994X
DOI
10.1093/ntr/nty115
PMC
PMC6636175
OpenAlex
W2806458401
Cited by
104
References
29
Citations by year
2026: 10 · 2025: 9 · 2024: 19 · 2023: 14 · 2022: 21 · 2021: 16 · 2020: 6 · 2019: 6 · 2018: 3
FWCI
5.31
Type
journal article
Language
en
Open access
Licence
public-domain
Locations
  • Nicotine & Tobacco Research (publishedVersion, public-domain)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • US National Cancer Institute
  • National Institutes of Health
  • US Public Health Service (HHSN261201500005C)
Topics
  • Health Sciences › Medicine › Biochemistry (medical) › Antioxidant Activity and Oxidative Stress
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Smoking Behavior and Cessation
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Diagnosis and Treatment
Keywords
beta-carotene supplementation, lung cancer incidence, smokers, filtered cigarettes, Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study, vitamin supplementation, alpha-tocopherol, tobacco control, lung cancer screening
MeSH terms
Provitamins, Aged, Antioxidants, Double-Blind Method, Finland, Follow-Up Studies, Humans, Lung Neoplasms, Male, Middle Aged, Nicotine, Smoking, Tars, Incidence, beta Carotene, Dietary Supplements, alpha-Tocopherol

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