Open Access Highly Accessed Research article

Changes in vitamin and mineral supplement use after breast cancer diagnosis in the Pathways Study: a prospective cohort study

Heather Greenlee12*, Marilyn L Kwan3, Isaac J Ergas3, Garrett Strizich1, Janise M Roh3, Allegra T Wilson3, Marion Lee4, Karen J Sherman5, Christine B Ambrosone6, Dawn L Hershman127, Alfred I Neugut127 and Lawrence H Kushi3

Author Affiliations

1 Mailman School of Public Health, Columbia University, New York, NY 10032, USA

2 Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY 10032, USA

3 Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612, USA

4 University of California San Francisco, San Francisco, CA 94143, USA

5 Group Health Research Institute, Seattle, WA 98101, USA

6 Roswell Park Cancer Institute, Buffalo, NY 14263, USA

7 College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA

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BMC Cancer 2014, 14:382  doi:10.1186/1471-2407-14-382

Published: 29 May 2014



Vitamin and mineral supplement use after a breast cancer diagnosis is common and controversial. Dosages used and the timing of initiation and/or discontinuation of supplements have not been clearly described.


We prospectively examined changes in use of 17 vitamin/mineral supplements in the first six months following breast cancer diagnosis among 2,596 members (28% non-white) of Kaiser Permanente Northern California. We used multivariable logistic regression to examine demographic, clinical, and lifestyle predictors of initiation and discontinuation.


Most women used vitamin/mineral supplements before (84%) and after (82%) diagnosis, with average doses far in excess of Institute of Medicine reference intakes. Over half (60.2%) reported initiating a vitamin/mineral following diagnosis, 46.3% discontinuing a vitamin/mineral, 65.6% using a vitamin/mineral continuously, and only 7.2% not using any vitamin/mineral supplement before or after diagnosis. The most commonly initiated supplements were calcium (38.2%), vitamin D (32.01%), vitamin B6 (12.3%) and magnesium (11.31%); the most commonly discontinued supplements were multivitamins (17.14%), vitamin C (15.97%) and vitamin E (45.62%). Higher education, higher intake of fruits/vegetables, and receipt of chemotherapy were associated with initiation (p-values <0.05). Younger age and breast-conserving surgery were associated with discontinuation (p-values <0.05).


In this large cohort of ethnically diverse breast cancer patients, high numbers of women used vitamin/mineral supplements in the 6 months following breast cancer diagnosis, often at high doses and in combination with other supplements. The immediate period after diagnosis is a critical time for clinicians to counsel women on supplement use.

Breast cancer; Cohort studies; Vitamins; Multivitamins; Dietary supplements