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Plasma Carotenoid- and Retinol-Weighted Multi-SNP Scores and Risk of Breast Cancer in the National Cancer Institute Breast and Prostate Cancer Cohort Consortium

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Plasma Carotenoid- and Retinol-Weighted Multi-SNP Scores and Risk of Breast Cancer in the National Cancer Institute Breast and Prostate Cancer Cohort Consortium Published OnlineFirst March 20, 2013; DOI: 10.1158/1055-9965.EPI-13-0017 Cancer Epidemiology, Research Article Biomarkers & Prevention Plasma Carotenoid- and Retinol-Weighted Multi-SNP Scores and Risk of Breast Cancer in the National Cancer Institute Breast and Prostate Cancer Cohort Consortium Sara J. Hendrickson1,2, Sara Lindstrom€ 2, A. Heather Eliassen2,4, Bernard A. Rosner4, Constance Chen2, Myrto Barrdahl7, Louise Brinton9, Julie Buring5,6, Federico Canzian8, Stephen Chanock10, Francoise¸ Clavel-Chapelon12,13, Jonine D. Figueroa9, Susan M. Gapstur15, Montserrat Garcia-Closas16, Mia M. Gaudet15, Christopher A. Haiman19, Aditi Hazra2,4, Brian Henderson19, Robert Hoover10, Anika Husing€ 7, Mattias Johansson14,20, Rudolf Kaaks7, Kay-Tee Khaw18, Laurence N. Kolonel21, Loic Le Marchand21, Jolanta Lissowska22, Eiliv Lund24, Marjorie L. McCullough15, Beata Peplonska23, Elio Riboli17, Carlotta Sacerdote25,26, María-JoseS anchez 27,28, Anne Tjønneland29, Dimitrios Trichopoulos2,30,31, Carla H. van Gils32, Meredith Yeager11, Peter Kraft2,3, David J. Hunter1,2,4, Regina G. Ziegler10, and Walter C. Willett1,2,4 Abstract Background: Dietary and circulating carotenoids have been inversely associated with breast cancer risk, but observed associations may be due to confounding. Single-nucleotide polymorphisms (SNPs) in b-carotene 15,150-monooxygenase 1 (BCMO1), a gene encoding the enzyme involved in the first step of synthesizing vitamin A from dietary carotenoids, have been associated with circulating carotenoid concentrations and may serve as unconfounded surrogates for those biomarkers. We determined associations between variants in BCMO1 and breast cancer risk in a large cohort consortium. Methods: We used unconditional logistic regression to test four SNPs in BCMO1 for associations with breast cancer risk in 9,226 cases and 10,420 controls from the National Cancer Institute Breast and Prostate Cancer Cohort Consortium (BPC3). We also tested weighted multi-SNP scores composed of the two SNPs with strong, confirmed associations with circulating carotenoid concentrations. Results: Neither the individual SNPs nor the weighted multi-SNP scores were associated with breast cancer risk [OR (95% confidence interval) comparing extreme quintiles of weighted multi-SNP scores ¼ 1.04 (0.94– 1.16) for b-carotene, 1.08 (0.98–1.20) for a-carotene, 1.04 (0.94–1.16) for b-cryptoxanthin, 0.95 (0.87–1.05) for lutein/zeaxanthin, and 0.92 (0.83–1.02) for retinol]. Furthermore, no associations were observed when stratifying by estrogen receptor status, but power was limited. Conclusions: Our results do not support an association between SNPs associated with circulating carotenoid concentrations and breast cancer risk. Impact: Future studies will need additional genetic surrogates and/or sample sizes at least three times larger to contribute evidence of a causal link between carotenoids and breast cancer. Cancer Epidemiol Biomarkers Prev; 22(5); 927–36. Ó2013 AACR. Authors' Affiliations: Department of 1Nutrition, 2Epidemiology, and 3Bio- Atlanta, Georgia; 16Division of Genetics and Epidemiology, Institute of statistics, Harvard School of Public Health; 4Channing Division of Network Cancer Research and Breakthrough Breast Cancer Research Centre; Medicine and 5Divisions of Preventive Medicine and Aging, Department of 17School of Public Health, Imperial College London, London; 18Clinical Medicine, Brigham and Women's Hospital; 6Department of Ambulatory Gerontology Unit, University of Cambridge, Cambridge, United Kingdom; Care and Prevention, Harvard Medical School, Boston, Massachusetts; 19Department of Preventive Medicine, Keck School of Medicine, University 7Division of Cancer Epidemiology and 8Genomic Epidemiology Group, of Southern California, Los Angeles, California; 20Department of Public German Cancer Research Center (DKFZ), Heidelberg, Germany; 9Division Health and Clinical Medicine, Nutritional Research, Umea University, of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville; Umea , Sweden; 21Epidemiology Program, University of Hawaii Cancer 10Division of Cancer Epidemiology and Genetics, National Cancer Institute, Center, Honolulu, Hawaii; 22Department of Cancer Epidemiology and Bethesda; 11Core Genotyping Facility, Frederick National Laboratory for Prevention, Cancer Center and M. Sklodowska-Curie Institute of Oncol- Cancer Research, Gaithersburg, Maryland; 12Institut National de la Santeet ogy, Warsaw; 23Nofer Institute of Occupational Medicine, Lodz, Poland; de la Recherche Medicale (INSERM), Centre for Research in Epidemiology 24Department of Community Medicine, University of Tromsø, Tromsø, and Population Health, Institut Gustave Roussy; 13Paris South University, Norway; 25Center for Cancer Prevention (CPO-Piemonte); 26Human Genet- Villejuif; 14International Agency for Research on Cancer (IARC), Lyon, ic Foundation (HuGeF), Torino, Italy; 27Escuela Andaluza de Salud Publica, 15 France; Epidemiology Research Program, American Cancer Society, Granada; 28CIBER de Epidemiología y Salud Publica, CIBERESP, Madrid, www.aacrjournals.org 927 Downloaded from cebp.aacrjournals.org on September 30, 2021. © 2013 American Association for Cancer Research. Published OnlineFirst March 20, 2013; DOI: 10.1158/1055-9965.EPI-13-0017 Hendrickson et al. Introduction noids are responsible for lower risk of breast cancer. Inverse associations with breast cancer for dietary (1) The distribution of genetic polymorphisms is unlikely to and circulating (2) carotenoids have been observed in be associated with behaviors (13), such as diet and other 2 pooled analyses of prospective studies. In particular, lifestyle factors that could confound association with die- higher dietary intakes of a-, b-carotene, and lutein/zea- tary and circulating carotenoids. When genetic variants xanthin have been associated with lower risk of estrogen alter the activity of an enzyme involved in nutrient metab- receptor-negative (ERÀ) breast cancer, and dietary b-cryp- olism, those variants can theoretically be used as proxies toxanthin has been inversely associated with overall breast for different exposure levels of that nutrient (14). Observed cancer risk (1). Several circulating carotenoids have been associations between the genetic variants and disease risk inversely associated with breast cancer risk with stronger can thus provide additional evidence of a causal associa- associations observed for a-andb-carotene and ERÀ breast tion between a given nutrient and disease risk. BCMO1 cancer (2). Together, these analyses suggest carotenoids Single-nucleotide polymorphisms (SNPs) in may reduce breast cancer risk, and a-andb-carotene may have been associated with circulating carotenoid levels À b be particularly protective against ER breast cancer. and -carotene conversion efficiency (10, 15, 16). The T The major carotenoids in the United States are a-, rs12934922 allele has been associated with both reduced b b-carotene, b-cryptoxanthin, lycopene, lutein, and zea- conversion of -carotene to retinyl palmitate as well as b G xanthin (3–5). a-, b-Carotene, and b-cryptoxanthin are higher fasting plasma -carotene (15). The rs6564851 known as provitamin A carotenoids as they can be con- allele was associated with increased circulating levels of a b verted into retinal, retinol, and other forms of vitamin A. - and -carotene and decreased levels of lycopene, lutein, The first step of this conversion is central cleavage by and zeaxanthin in a previous genome-wide association b-carotene 15,150-monooxygenase 1 (BCMO1; refs. 6–9). study (GWAS; ref. 10). This allele has also been reported to The resultant retinal, an active form of vitamin A, can be reduce BCMO1 activity (16). In the Nurses’ Health Study reduced to retinol and converted into retinyl esters, such (NHS), both alleles were significantly associated with as retinyl palmitate, for storage in the liver. For more higher plasma provitamin A carotenoid concentrations, T detailed description of the carotenoid pathway, the reader and the allele for each SNP was associated with higher is referred to Figure 3 in Ferrucci and colleagues (10). It is plasma lutein/zeaxanthin concentrations (17). It is possi- BCMO1 difficult to disentangle potential causal mechanisms ble that SNPs in can reduce conversion efficiency behind the observed associations between carotenoids to retinol, leading to higher provitamin A carotenoid and breast cancer. As the provitamin A carotenoids, exposure and theoretically lower retinol exposure. The including a- and b-carotene, can be converted to vitamin non-provitamin A carotenoids are not known substrates A, protective associations may be due to vitamin A or for BCMO1 (8, 9), and Hendrickson and colleagues did not BCMO1 possibly other metabolic products. Indeed, dietary vita- observe associations between SNPs and plasma min A has been weakly inversely associated with breast lycopene concentrations (17). However, they did observe BCMO1 cancer (11). However, given that more vitamin A activity an association between SNPs and plasma lutein/ comes from preformed vitamin A than from provitamin A zeaxanthin concentrations and hypothesized that the carotenoids in the western diet, the effect of provitamin observed association was due to either carotenoid inter- b b 0 0 A carotenoids on breast cancer risk through their vitamin actions, altered , -carotete-9 ,10 -oxygenase (BCDO2) A activity is probably low. expression or as yet unknown direct activity of BCMO1 Because fruits and vegetables are the primary source of on lutein
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