Prediagnostic circulating carotenoids and lethal breast cancer risk: a novel analytic approach applied to a nested case-control study

@article{peng2026prediagnostic,
  title = {{Prediagnostic circulating carotenoids and lethal breast cancer risk: a novel analytic approach applied to a nested case-control study}},
  author = {Cheng Peng and Boyang Chai and Rulla M Tamimi and Wendy Y Chen and Michelle D Holmes and Walter C Willett and A Heather Eliassen and Bernard Rosner},
  journal = {The American journal of clinical nutrition},
  year = {2026},
  month = sep,
  doi = {10.1016/j.ajcnut.2026.101514},
  url = {https://doi.org/10.1016/j.ajcnut.2026.101514},
  note = {CC BY-NC-ND 4.0},
}

TY  - JOUR
TI  - Prediagnostic circulating carotenoids and lethal breast cancer risk: a novel analytic approach applied to a nested case-control study
AU  - Cheng Peng
AU  - Boyang Chai
AU  - Rulla M Tamimi
AU  - Wendy Y Chen
AU  - Michelle D Holmes
AU  - Walter C Willett
AU  - A Heather Eliassen
AU  - Bernard Rosner
PY  - 2026
DA  - 2026/09/08
JO  - The American journal of clinical nutrition
DO  - 10.1016/j.ajcnut.2026.101514
UR  - https://doi.org/10.1016/j.ajcnut.2026.101514
AB  - Background:: Identifying prediagnostic modifiable factors that are associated with lethal breast cancer risk may provide prevention strategies for fatal disease.  Objectives:: We sought to examine whether prediagnostic circulating carotenoids and retinol concentrations are associated with a lower risk of lethal breast cancer using multistate modeling.  Methods:: This is a nested case-control study including 3516 controls and 2583 incident invasive breast cancer cases, among whom 190 developed lethal breast cancer (experienced recurrence or died due to breast cancer) over three 10-year intervals. Prediagnostic plasma carotenoids (α-carotene, β-carotene, β-cryptoxanthin, lycopene, and lutein/zeaxanthin) and retinol were assayed using high-performance liquid chromatography; total carotenoids were calculated as the sum of individual carotenoids. On the basis of a multistate model that combined separate estimates for breast cancer incidence and recurrence/mortality due to breast cancer among invasive cases, we examined the association between prediagnostic circulating carotenoids and retinol and the probability of transitioning from disease-free to invasive breast cancer to breast cancer recurrence/death within 10 years.  Results:: Compared with the lowest quintile, females in the highest quintile of β-carotene had a 41% lower risk of lethal breast cancer (hazard ratio (HR) = 0.59, (95% confidence interval (CI): 0.41, 0.83), Ptrend<0.01); for β-cryptoxanthin, HR was 0.68 (95% CI: 0.47, 0.97); for total carotenoids, risk of lethal breast cancer was 48% lower (HR = 0.52 (95% CI: 0.36, 0.74), Ptrend<0.01, which for β-carotene and total carotenoids captured the combined protective effects of incidence and recurrence/mortality, while for β-cryptoxanthin, reflected protective effects of recurrence/mortality but not for incidence. For β-carotene, stronger inverse associations were observed for postmenopausal females Pheterogeneity<0.01, and marginally stronger for ever smokers (Pheterogeneity=0.11), and for females with BMI < 25 kg/m2 Pheterogeneity=0.10. Other plasma carotenoids or retinol were not associated with reduced lethal breast cancer risk.  Conclusions:: Higher prediagnostic β-carotene, β-cryptoxanthin, and total carotenoid concentrations may be associated with a lower likelihood of progression from a cancer-free state to fatal breast cancer.
SN  - 0002-9165
SN  - 1938-3207
ER  -