Research table: Carotenoids and breast cancer risk

This summary table contains detailed information about research studies. Summary tables are a useful way to look at the science behind many breast cancer guidelines and recommendations. However, to get the most out of the tables, it’s important to understand some key concepts. Learn how to read a research table.

Introduction: Carotenoids are natural orange-red food pigments found in foods such as carrots, sweet potatoes, squash and melons. Many carotenoids, such as beta-carotene, are antioxidants and can be converted into vitamin A in the body.

Researchers can study carotenoids by measuring levels of carotenoids in the blood or through a person’s diet.

Blood levels of carotenoids

A pooled analysis of data from 8 studies found women with higher blood levels of carotenoids had a reduced risk of breast cancer compared to women with lower levels [1].

Dietary intake of carotenoids

Most studies have found no link between eating a diet high in foods that contain carotenoids and overall breast cancer risk.

However, carotenoids appear to be linked to a lower risk of certain breast cancers.

A pooled analysis of data from more than a million women found a diet high in carotenoids was linked to a lower risk of estrogen receptor-negative breast cancers, but not estrogen receptor-positive breast cancers [2].

Learn more about carotenoids and breast cancer risk.

Note of caution on carotenoid supplements

Eating too much of certain carotenoids may have some health risks. A few studies have found taking a daily supplement of the carotenoid beta-carotene is linked to an increased risk of lung cancer and early death in smokers [3-5].

In general, fruits and vegetables are the best sources of carotenoids (rather than supplements) and are part of a healthy diet.   

Learn about the strengths and weaknesses of different types of studies.  

See how this risk factor compares with other risk factors for breast cancer.

Study selection criteria: For blood level studies: Prospective cohort studies with at least 150 breast cancer cases, nested case-control studies with at least 300 breast cancer cases and pooled analyses.

For dietary intake studies: Prospective cohort studies and nested case-control studies with at least 400 breast cancer cases and meta-analyses.

Table note: Relative risk above 1 indicates increased risk. Relative risk below 1 indicates decreased risk.  

Blood Levels of Carotenoids
Study	Study Population (number of participants)		Follow-up  (years)	Relative Risk of Breast Cancer in Women with Higher Blood Levels of Beta-Carotene Compared to Women with Lower Levels, RR (95% CI)
Prospective cohort studies
Women’s Health Initiative [6]	5,450 (153 cases)		8	0.78 (0.49-1.24)
Nested case-control studies
	Cases	Controls
Nurses’ Health Study [7]	2,188	2,188	20	0.72 (0.59-0.88)*
EPIC [8]	1,502	1,502	up to 13	Estrogen receptor-positive breast cancers: 1.02 (0.66-1.57) Estrogen receptor-negative breast cancers: 0.41 (0.26-0.65)
Women’s Health Study [9]	508	508	10	1.36 (0.79-2.33)
Cancer Prevention Study II Nutrition Cohort [10]	496	496	up to 9	0.95 (0.64-1.41)
E3N Cohort [11]	366	720	7	0.85 (0.53-1.35)
Shanghai Women’s Health Study [12]	365	726	8	1.47 (0.92-2.35)
Pooled and meta-analyses
Eliassen et al. [1]	3,055	3,956	Various	Overall breast cancer: 0.83 (0.70-0.98) Estrogen receptor-negative breast cancer: 0.52 (0.36-0.77)
Aune et al. [13]	12 studies (3,609 cases)		Various	0.82 (0.65-1.04)

* Highest vs. lowest level of total blood carotenoids also reduced breast cancer risk, with RR of 0.77 (0.63-0.94).    

 

Dietary Intake of Carotenoids
Study	Study Population (number of participants)			Follow-up (years)	Relative Risk of Breast Cancer in Women with a High Intake of Beta-Carotene Compared to Women with a Low Intake, RR (95% CI)
Prospective cohort studies
EPIC [14]	288,776 (6,478 cases)			9	Among premenopausal women: 1.04 (0.85-1.27) Among postmenopausal women: 0.93 (0.82-1.04)
Women’s Health Initiative Observational Study [15]	84,805 (2,879 cases)			8	0.86 (0.75-0.99)
Nurses’ Health Study [16]	83,234 (2,697 cases)			14	0.83 (0.66-1.04)†
Swedish Mammography Cohort [17-18]	59,036 (1,271 cases)			10	1.01 (0.84-1.22)
Diet, Cancer and Health [19]	26,224 (1,072 cases)			11	0.91 (0.75-1.11)
Iowa Women’s Health Study [20]	34,387 (879 cases)			6	1.17 (0.87-1.56)
Nurses’ Health Study II [21]	90,655 (714 cases)			8	0.96 (0.75-1.22)
Nested case-control studies
	Cases	Controls
Canadian National Breast Screening Study [22]	1,452	5,239		10	1.01 (0.70-1.33)
Netherlands Cohort Study [23]	650	1,066		4	1.01 (0.72-1.42)
Pooled and meta-analyses
Zhang et al. [2]	1,028,438 (33,380 cases)			7-26	Overall breast cancer: 1.00 (0.97-1.04) Estrogen receptor-negative breast cancers: 0.86 (0.78-0.94)
Aune et al. [13]	10 cohort and nested case-control studies (18,191 cases)				0.93 (0.88-0.98)
AMBER Consortium [24]	3 cohort studies (3,564 cases)‡				Estrogen receptor-positive breast cancers: 0.95 (0.79-1.14) Estrogen receptor-negative breast cancers: 1.07 (0.82-1.40)
Hu et al. [25]	7 cohort studies				0.94 (0.88-1.00)

† Premenopausal women only  

‡ All women in the studies are Black.

References

1. Eliassen AH, Hendrickson SJ, Brinton LA, et al. Circulating carotenoids and risk of breast cancer: pooled analysis of eight prospective studies. J Natl Cancer Inst. 104(24):1905-16, 2012.
2. Zhang X, Spiegelman D, Baglietto L, et al. Carotenoid intakes and risk of breast cancer defined by estrogen receptor and progesterone receptor status: a pooled analysis of 18 prospective cohort studies. Am J Clin Nutr. 95(3):713-25, 2012.
3. The Alpha-Tocopherol, Beta Carotene Cancer Prevention Study Group. The effect of vitamin E and beta carotene on the incidence of lung cancer and other cancers in male smokers. N Engl J Med. 330:1029 –35, 1994.
4. Omenn GS, Goodman G, Thornquist M, et al. Chemoprevention of lung cancer: the beta-Carotene and Retinol Efficacy Trial (CARET) in high-risk smokers and asbestos-exposed workers. IARC Sci Publ: 67-85, 1996.
5. Druesne-Pecollo N, Latino-Martel P, Norat T, et al. Beta-carotene supplementation and cancer risk: a systematic review and metaanalysis of randomized controlled trials. Int J Cancer. 127(1):172-84, 2010.
6. Kabat GC, Kim M, Adams-Campbell LL, et al. for the Women’s Health Initiative Investigators. Longitudinal study of serum carotenoid, retinol, and tocopherol concentrations in relation to breast cancer risk among postmenopausal women. Am J Clin Nutr. 90(1):162-9, 2009.
7. Eliassen AH, Liao X, Rosner B, Tamimi RM, Tworoger SS, Hankinson SE. Plasma carotenoids and risk of breast cancer over 20 y of follow-up. Am J Clin Nutr. 101(6):1197-205, 2015. 
8. Bakker MF, Peeters PH, Klaasen VM, et al. Plasma carotenoids, vitamin C, tocopherols, and retinol and the risk of breast cancer in the European Prospective Investigation into Cancer and Nutrition cohort. Am J Clin Nutr. 103(2):454-64, 2016.
9. Sesso HD, Buring JE, Zhang SM, et al. Dietary and plasma lycopene and the risk of breast cancer. Cancer Epidemiol Biomarkers Prev. 14(5):1074-81, 2005.
10. Wang Y, Gapstur SM, Gaudet MM, Furtado JD, Campos H, McCullough ML. Plasma carotenoids and breast cancer risk in the Cancer Prevention Study II Nutrition Cohort. Cancer Causes Control. 26(9):1233-44, 2015.
11. Maillard V, Kuriki K, Lefebvre B, et al. Serum carotenoid, tocopherol and retinol concentrations and breast cancer risk in the E3N-EPIC study. Int J Cancer. 127(5):1188-96, 2010.
12. Dorjgochoo T, Gao YT, Chow WH, et al. Plasma carotenoids, tocopherols, retinol and breast cancer risk: results from the Shanghai Women Health Study (SWHS). Breast Cancer Res Treat. 117(2):381-9, 2009.
13. Aune D, Chan DS, Vieira AR, et al. Dietary compared with blood concentrations of carotenoids and breast cancer risk: a systematic review and meta-analysis of prospective studies. Am J Clin Nutr. 96(2):356-73, 2012.
14. Nagel G, Linseisen J, van Gils CH, et al. Dietary beta-carotene, vitamin C and E intake and breast cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC). Breast Cancer Res Treat. 119(3):753-65, 2010.
15. Cui Y, Shikany JM, Liu S, Shagufta Y, Rohan TE. Selected antioxidants and risk of hormone receptor-defined invasive breast cancers among postmenopausal women in the Women’s Health Initiative Observational Study. Am J Clin Nutr. 87(4):1009-18, 2008.
16. Zhang S, Hunter DJ, Forman MR, et al. Dietary carotenoids and vitamins A, C and E, and risk of breast cancer. J Natl Cancer Inst. 91(6):547-56, 1999.
17. Michels KB, Holmberg L, Bergkvist L, et al. Dietary antioxidant vitamins, retinol, and breast cancer incidence in a cohort of Swedish women. Int J Cancer. 91(4):563-7, 2001.
18. Larsson SC, Bergkvist L, Wolk A. Dietary carotenoids and risk of hormone receptor-defined breast cancer in a prospective cohort of Swedish women. Eur J Cancer. 46(6):1079-85, 2010.
19. Roswall N, Olsen A, Christensen J, Dragsted LO, Overvad K, Tjønneland A. Micronutrient intake and breast cancer characteristics among postmenopausal women. Eur J Cancer Prev. 19(5):360-5, 2010.
20. Kushi LH, Fee RM, Sellers TA, et al. Intake of vitamins A, C, and E and postmenopausal breast cancer. The Iowa Women’s Health Study. Am J Epidemiol. 144(2):165-74, 1996.
21. Cho E, Spiegelman D, Hunter DJ, Chen WY, Zhang SM, Colditz GA, Willett WC. Premenopausal intakes of vitamins A, C, and E, folate, and carotenoids, and risk of breast cancer. Cancer Epidemiol Biomarkers Prev. 12(8):713-20, 2003.
22. Terry P, Jain M, Miller AB, Howe GR, Rohan TE. Dietary carotenoids and risk of breast cancer. Am J Clin Nutr. 76(4);883-8, 2002.
23. Verhoeven DT, Assen N, Goldbohm RA, et al. Vitamins C and E, retinol, beta-carotene and dietary fibre in relation to breast cancer risk: a prospective cohort study. Br J Cancer. 75(1):149-55, 1997.
24. Bitsie KR, Cheng TD, McCann SE, et al. Dietary vitamin A and breast cancer risk in Black women: the African American Breast Cancer Epidemiology and Risk (AMBER) Consortium. J Nutr. 151(12):3725-3737, 2021.
25. Hu F, Wang Yi B, Zhang W, et a. Carotenoids and breast cancer risk: a meta-analysis and meta-regression.Breast Cancer Res Treat. 131(1):239-53, 2012.

Updated 11/08/23