Zinc and Breast Cancer Survival: A Prospective Cohort Study of Dietary Intake and Serum Levels

Abstract

Zinc has been suggested to play a role in breast cancer progression; however, no previous study on zinc levels and the potential effect on breast cancer survival has been conducted. This study investigates recurrence-free survival (RFS), breast cancer-specific survival (BCSS) and overall survival (OS) in relation to zinc levels, in serum and diet, overall and stratified for phosphorus and selenium levels. The Malmö Diet and Cancer Study, a prospective population-based cohort in Sweden including 17,035 women, was used to identify breast cancer patients diagnosed in the period 1991-2013. Diet was assessed by a validated modified diet history method. A Cox regression analysis yielded hazard ratios (HRs) with 95% confidence intervals adjusted for potential confounders. Out of 1062 patients with invasive breast cancer, 268 recurrences, 205 breast cancer deaths and 228 deaths from other causes were recorded. No overall associations were seen between zinc and RFS, BCSS or OS. However, in women with a high phosphorus intake, a higher BCSS and OS were seen in zinc intake Q2 to Q4 versus Q1; the adjusted HR was 0.41 (0.23-0.73) and 0.64 (0.41-1.00), respectively. The results indicate that the combination of intermediate/high zinc intake and high phosphorus intake may lead to a better breast cancer survival.

Keywords: breast cancer; cohort; phosphorus; selenium; survival; zinc.

Figure 1

Flowchart of inclusion and exclusion.

Figure 2

Kaplan-Meier curves for recurrence free survival (A,B), breast cancer-specific survival (C,D), and overall survival (E,F), by quartiles of zinc intake and serum zinc. Log-Rank-Test was used to evaluate differences. Residuals are presented as the median and interquartile range of total dietary intake of zinc. Quartiles of serum zinc are shown as median and interquartile range.