Smoking is by far the most important risk factor for lung cancer. When people stop smoking their risk decreases but it remains high compared to people who have not smoked; finding ways to reduce this remaining risk is important. A study led by the International Agency for Research on Cancer (IARC) and published today in JAMA1 shows a reduction in lung cancer risk among people with higher levels of vitamin B6 and methionine. The observed decrease is large, with risk being more than halved in those with high levels of both, and if proven to be causal would suggest ways in which diet could be used to change lung cancer risk. This analysis was funded by the World Cancer Research Fund.

Background

Lung cancer is the most common cancer in the world with an estimated 1.6 million new cases in 2008, representing 1 in 8 of all new cancers. It is also the most common form of cancer death in the world comprising nearly 1 in 5 of all deaths from cancer. Tobacco smoking is responsible for at least 8 out of 10 cases of lung cancer, although many of these occur among people who have stopped smoking but remain at increased risk. Identifying ways to reduce lung cancer risk could have important public health benefits, especially among people who have stopped smoking.

Diet Plays an Important Part in Cancer Risk

Appropriate levels of B-vitamins are vital for the cell to make and maintain DNA and disruption of these processes has been suspected of playing a role in cancer. Foods containing high levels of B-vitamins and related compounds may therefore be important in reducing risk. Compounds that interact closely with B-vitamins include methionine, an essential amino acid, and homocysteine. Vitamin B9 (or folate) can be found in fruits and green leafy vegetables; vitamin B6 is common in fish, meat, potatoes and whole grains; and methionine is present in various seeds, nuts, cereals, fish and meats.

Measuring Intake of B-12 Vitamins as a Marker of Cancer Risk

Estimating vitamin levels taken from blood samples before any disease onset provides a direct measure of vitamin status. This is important for vitamins that come from many food sources and are therefore difficult to measure using questionnaires. It is however only possible to do such studies when blood samples have been collected on many thousands of volunteers who are then followed up to see who develops a cancer and who does not.

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The Largest Ever Study on Diet and Cancer

The EPIC study is the largest, so-called prospective, study of diet and nutrition in the world. Coordinated through IARC and Imperial College London, this study includes questionnaire information on 520,000 European volunteers, 385,000 of whom also gave a blood sample. All participants were free of cancer at the start and were followed up for an average of 5 years.