Neoplastic and antineoplastic effects of beta-carotene on colorectal adenoma recurrence: results of a randomized trial

J Natl Cancer Inst. 2003 May 21;95(10):717-22. doi: 10.1093/jnci/95.10.717.


Background: In two large, randomized prevention trials, supplementation with beta-carotene increased the risk of lung cancer. Subjects in these studies were predominantly cigarette smokers, and the adverse effects were concentrated among those who also drank alcohol. Although beta-carotene supplementation appeared not to increase the risk of cancer generally, it is not clear if smoking and/or alcohol use alters the effect of beta-carotene on carcinogenesis at sites outside the lung.

Methods: We studied the effect of beta-carotene supplementation on colorectal adenoma recurrence among subjects in a multicenter double-blind, placebo-controlled clinical trial of antioxidants for the prevention of colorectal adenomas. A total of 864 subjects who had had an adenoma removed and were polyp-free were randomly assigned (in a factorial design) to receive beta-carotene (25 mg or placebo) and/or vitamins C and E in combination (1000 mg and 400 mg, respectively, or placebo), and were followed with colonoscopy for adenoma recurrence 1 year and 4 years after the qualifying endoscopy. A total of 707 subjects had two follow-up examinations and provided smoking and alcohol use data. Adjusted multivariate risk ratios (RRs) and 95% confidence intervals (CIs) were used to assess the effects of beta-carotene on adenoma recurrence.

Results: Among subjects who neither smoked cigarettes nor drank alcohol, beta-carotene was associated with a marked decrease in the risk of one or more recurrent adenomas (RR = 0.56, 95% CI = 0.35 to 0.89), but beta-carotene supplementation conferred a modest increase in the risk of recurrence among those who smoked (RR = 1.36, 95% CI = 0.70 to 2.62) or drank (RR = 1.13, 95% CI = 0.89 to 1.43). For participants who smoked cigarettes and also drank more than one alcoholic drink per day, beta-carotene doubled the risk of adenoma recurrence (RR = 2.07, 95% CI = 1.39 to 3.08; P for difference from nonsmoker/nondrinker RR <.001).

Conclusion: Alcohol intake and cigarette smoking appear to modify the effect of beta-carotene supplementation on the risk of colorectal adenoma recurrence.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adenoma / chemically induced*
  • Adenoma / prevention & control*
  • Adult
  • Aged
  • Alcohol Drinking / adverse effects
  • Anticarcinogenic Agents / administration & dosage
  • Anticarcinogenic Agents / pharmacology*
  • Antioxidants / administration & dosage
  • Antioxidants / adverse effects
  • Antioxidants / pharmacology*
  • Colorectal Neoplasms / chemically induced*
  • Colorectal Neoplasms / prevention & control*
  • Double-Blind Method
  • Female
  • Humans
  • Male
  • Middle Aged
  • Smoking / adverse effects
  • Treatment Outcome
  • beta Carotene / administration & dosage
  • beta Carotene / adverse effects
  • beta Carotene / pharmacology*


  • Anticarcinogenic Agents
  • Antioxidants
  • beta Carotene