Folic Acid Fortification May Be Linked To Increased Colon Cancer Risk

Main Category: Colorectal Cancer
Also Included In: Nutrition / Diet;  Clinical Trials / Drug Trials
Article Date: 04 Apr 2009 - 3:00 PDT

email to a friend   printer friendly   view / write opinions   rate article

The rate of colorectal cancer in Chile may have increased since that country began fortifying wheat flour with folic acid, reports a study in the European Journal of Gastroenterology & Hepatology. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health, a leading provider of information and business intelligence for students, professionals, and institutions in medicine, nursing, allied health, pharmacy and the pharmaceutical industry.

"Our data provide new evidence that a folate fortification program could be associated with an additional risk of colon cancer," according to the new report by Dr. Sandra Hirsch and colleagues of University of Chile, Santiago.

Possible Increase in Colon Cancer after Start of Folic Acid Fortification

The researchers analyzed changes in colon cancer rates since the Chilean government introduced a mandatory program of folic acid fortification of wheat flour in 2000. Several countries have implemented similar policies in recent years, with the goal of preventing spina bifida and other neural tube defects. In Chile, the rate of neural tube defects decreased by 40 percent in the first year after the start of folic acid fortification.

The researchers compared hospital discharge data on colon cancer rates in Chile in four-year periods before and after folic acid fortification: 1992-96 versus 2001-04. Although no causative relationship can be proven, the data suggested a significant "temporal relationship" between folic acid supplementation and colorectal cancer. Reported cases of colon cancer increased by 162 percent in people aged 45 to 64 and by 190 percent in people aged 65 to 79.

After adjustment for other factors, discharge diagnoses of colon cancer in these age groups were two to three times more frequent after the start of folic acid fortification. Most other diseases showed no consistent pattern of changes. There was a small increase in breast cancer, which may have been related to early detection and universal treatment programs for breast cancer.

Evidence Is Weaker than Similar Changes Reported in U.S. and Canada

Chile is the third country to report an apparent increase in colorectal cancer after introducing a national folic acid fortification program. A 2007 paper suggested increases in colorectal cancer after folic acid fortification was introduced in the United States and Canada in the mid-1990s. Chile uses a higher "dose" of folic acid than the two North American countries. Folic acid fortification has not yet been introduced in Europe.

There are other possible explanations for the rise in colon cancer in Chile, including increases in obesity and other risk factors.

Another important limitation of the study was the use of hospital discharge data to identify cases of colon cancer. "Discharge rates are influenced by health care politics, increasing access to healthcare for new strata of the population with increased cancer risk, and so forth," comments Dr. Reinhold Stockbrugger, one of the editors of The European Journal of Gastroenterology & Hepatology. "This study provides only a weak, indirect indication of a causal relationship between folate enrichment and colorectal cancer, though similar to that reported in the U.S. and Canada."

About The European Journal of Gastroenterology & Hepatology

The European Journal of Gastroenterology & Hepatology publishes papers reporting original clinical and scientific research which are of a high standard and which contribute to the advancement of knowledge in the field of gastroenterology and hepatology. Visit the journal website at http://www.eurojgh.com.

About Lippincott Williams & Wilkins

Lippincott Williams & Wilkins (LWW) is a leading international publisher for healthcare professionals and students with nearly 300 periodicals and 1,500 books in more than 100 disciplines publishing under the LWW brand, as well as content-based sites and online corporate and customer services. LWW is part of Wolters Kluwer Health, a leading provider of information and business intelligence for students, professionals and institutions in medicine, nursing, allied health, pharmacy and the pharmaceutical industry.

Wolters Kluwer Health is a division of Wolters Kluwer, a leading global information services and publishing company. The company provides products and services for professionals in the health, tax, accounting, corporate, financial services, legal, and regulatory sectors. Wolters Kluwer had 2008 annual revenues of €3.4 billion ($4.9 billion), employs approximately 20,000 people worldwide, and maintains operations in over 35 countries across Europe, North America, Asia Pacific, and Latin America. Wolters Kluwer is headquartered in Amsterdam, the Netherlands. Its shares are quoted on Euronext Amsterdam (WKL) and are included in the AEX and Euronext 100 indices. Visit http://www.wolterskluwer.com for information about our market positions, customers, brands, and organization.

Lippincott Williams & Wilkins
530 Walnut St.
Philadelphia
PA 19106
United States
http://www.lww.com