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Inorganic phosphate and the risk of cancer in the Swedish AMORIS study

Wahyu Wulaningsih1, Karl Michaelsson2, Hans Garmo13, Niklas Hammar45, Ingmar Jungner6, Göran Walldius4, Lars Holmberg13 and Mieke Van Hemelrijck1*

Author Affiliations

1 King’s College London, School of Medicine, Division of Cancer Studies, Cancer Epidemiology Unit, London, UK

2 Department of Surgical Sciences, Uppsala University, Uppsala, Sweden

3 Regional Cancer Centre, Uppsala University Hospital, Uppsala, Sweden

4 Department of Epidemiology, Insitute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden

5 AstraZeneca Sverige, Södertalje, Sweden

6 Department of Medicine, Clinical Epidemiological Unit, Karolinska Institutet and CALAB Research, Stockholm, Sweden

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BMC Cancer 2013, 13:257  doi:10.1186/1471-2407-13-257

Published: 24 May 2013



Both dietary and serum levels of inorganic phosphate (Pi) have been linked to development of cancer in experimental studies. This is the first population-based study investigating the relation between serum Pi and risk of cancer in humans.


From the Swedish Apolipoprotein Mortality Risk (AMORIS) study, we selected all participants (> 20 years old) with baseline measurements of serum Pi, calcium, alkaline phosphatase, glucose, and creatinine (n = 397,292). Multivariable Cox proportional hazards regression analyses were used to assess serum Pi in relation to overall cancer risk. Similar analyses were performed for specific cancer sites.


We found a higher overall cancer risk with increasing Pi levels in men ( HR: 1.02 (95% CI: 1.00-1.04) for every SD increase in Pi), and a negative association in women (HR: 0.97 (95% CI: 0.96-0.99) for every SD increase in Pi). Further analyses for specific cancer sites showed a positive link between Pi quartiles and the risk of cancer of the pancreas, lung, thyroid gland and bone in men, and cancer of the oesophagus, lung, and nonmelanoma skin cancer in women. Conversely, the risks for developing breast and endometrial cancer as well as other endocrine cancer in both men and women were lower in those with higher Pi levels.


Abnormal Pi levels are related to development of cancer. Furthermore, the in verse association between Pi levels and risk of breast, endometrial and other endocrine cancers may indicate the role of hormonal factors in the relation between Pi metabolism and cancer.

Cancer; Inorganic phosphate; Prospective cohort study