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Is Vitamin A Intake Linked to Cutaneous Squamous Cell Carcinoma Risk?

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Key Points

  • After grouping the study participants into five categories by vitamin A intake levels, the researchers found that people in the category with the highest average daily total vitamin A intake were 17% less likely to get skin cancer than those in the category with the lowest total vitamin A intake.
  • The majority of vitamin A came from the participants’ diets—particularly from fruits and vegetables—rather than from animal-based foods or vitamin supplements.
  • Researchers also found that eating high levels of other plant-based pigments similar to vitamin A—such as lycopene, commonly found in tomatoes and watermelon—was associated with decreased risk of skin cancer.

People whose diets included high levels of vitamin A had a 17% reduction in risk for developing cutaneous squamous cell carcinoma, as compared to those who ate modest amounts of foods and supplements rich in vitamin A. These findings were published by Kim et al in JAMA Dermatology.

Vitamin A is known to be essential for the healthy growth and maturation of skin cells, but prior studies on its effectiveness in reducing skin cancer risk have been mixed, said study author Eunyoung Cho, ScD, Associate Professor of Dermatology and Epidemiology at Brown University. “Our study provides another reason to eat lots of fruits and vegetables as part of a healthy diet,” said Dr. Cho, who is also  Associate Epidemiologist at Brigham and Women's Hospital. “Skin cancer, including squamous cell carcinoma, is hard to prevent, but this study suggests that eating a healthy diet rich in vitamin A may be a way to reduce your risk, in addition to wearing sunscreen and reducing sun exposure.”

Methods

Researchers looked at the diet and skin cancer results of participants in two large, long-term observational studies: the Nurses’ Health Study and the Health Professionals Follow-Up Study. Between the two studies, some 123,000 participants were white, had no prior history of cancer, and completed the dietary reports multiple times. Among these individuals included in the team’s subsequent analysis, a total of 3,978 cases of squamous cell carcinoma were reported and verified within the 24- or 26-year follow-up periods. 

Both studies also asked the participants about hair color, the number of severe sunburns they had received in their lifetime, and any family history of skin cancer, and the researchers adjusted for these and other factors. The studies did not, however, ask participants about their avoidance of midday sun, known to be a major risk factor for skin cancer.

Results

After grouping the study participants into five categories by vitamin A intake levels, the researchers found that people in the category with the highest average daily total vitamin A intake were 17% less likely to get skin cancer than those in the category with the lowest total vitamin A intake. Those in the highest category reported eating on average the amount of vitamin A equivalent to one medium baked sweet potato or two large carrots each day. Those in the lowest category reported eating a daily average amount of vitamin A equivalent to one-third cup of sweet potato fries or one small carrot, which is still above the U.S. Recommended Dietary Allowance of vitamin A. 

The team also found that the majority of vitamin A came from the participants’ diets—particularly from fruits and vegetables—rather than from animal-based foods or vitamin supplements. Plant-based sources of vitamin A include not only sweet potatoes and carrots, but leafy green vegetables and fruits like apricots and cantaloupe. Milk, some types of fish, and liver are sources of animal-based vitamin A.

The researchers also found that eating high levels of other plant-based pigments similar to vitamin A—such as lycopene, commonly found in tomatoes and watermelon—was associated with decreased risk of skin cancer.

Because the analysis was based on studies surveying a large number of people about the foods they ate and observing whether or not they got skin cancer, rather than a randomized clinical trial, it cannot establish cause and effect. It’s possible that another factor may have led to the differences, such as the fact that people who consumed more vitamin A also tended to drink less alcohol. 

As a next step, Dr. Cho would like to conduct a clinical trial to see if vitamin A supplements can help to prevent squamous cell carcinoma. However, she added, conducting a dietary clinical trial is quite challenging on a technical level, as is ensuring that participants actually stick to the diet.

“If a clinical trial cannot be done, then a large-scale prospective study like this is the best alternative for studying diet,” concluded Dr. Cho.

Disclosure: The research was supported by the National Institutes of Health as well as a research career development award from the Dermatology Foundation. For full disclosures of the study authors, visit jamanetwork.com.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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