International Journal of Epidemiology, Vol 19, S32-S42, Copyright © 1990 by International Epidemiological Association
ET Fontham
Since the first report of a protective effect of dietary vitamin A on lung
cancer risk was issued in 1975, a succession of retrospective
(case-control) and prospective (cohort) epidemiological studies have
examined the association. Food frequency questionnaires have been used to
assess dietary intake of food groups and to generate indices of specific
dietary components, in particular retinol and carotene. Serum levels of
retinol, carotenoids, and other micronutrients have been determined as
well, and related to risk of lung cancer. The dietary studies have been
notably consistent, finding an approximate 50% reduction in risk associated
with high compared to low consumption of carotene-containing fruits and
vegetables. Unresolved issues include gender differences, histological
specificity and the interaction with cigarette smoking as well as the role
of other possible protective factors found in these foods--indoles, vitamin
C, trace minerals. Most studies in which serum beta-carotene was assayed in
prospectively collected blood samples have found lower levels of
beta-carotene in people who subsequently developed lung cancer. Unlike
carotene, blood retinol levels do not reflect dietary intake under normal
conditions and, as might be expected, have failed to show a consistent
relation with risk of lung cancer. Although epidemiological studies have
not strongly supported the role of preformed retinol as a protective agent,
animal studies have provided convincing evidence that retinol and synthetic
retinoids are protective against epithelial tumours including those of the
lung. A number of on-going clinical trials are testing the efficacy of
retinol, beta-carotene, synthetic retinoids and alpha- tocopherol for
preventing cancer of the lung, especially in high risk groups such as heavy
smokers, miners and asbestos workers. It is hoped that these trials will
help explain the nature of the observed protective effect of fruit and
vegetables.
ARTICLES
Protective dietary factors and lung cancer
Department of Pathology, Louisiana State University Medical Center, New Orleans 70112.
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