Folic acid fortification is still an urgent, global health priority, says Emory epidemiologist Godfrey P. Oakley, Jr., MD, following an article in the British Medical Journal that asks if folate supplements in pregnancy increase breast cancer risk. The results, Dr. Oakley says, are most likely a "statistical fluke."
The preliminary data from the study were reported by British scientists and are being published in the December 11 issue of the BMJ. Dr. Andy Ness and research teams from the University of Bristol and University of Aberdeen (United Kingdom) followed up on 2,928 pregnant women who were enrolled in a trial of folate supplementation in the sixties. The women randomized to folate supplements had a statistically insignificant increase in deaths from breast cancer.
A commentary written by Dr. Oakley and Jack S. Mandel, PhD, MPH, Chair of Epidemiology, Rollins School of Public Health, Emory University, also appears in the BMJ. The commentary argues that the report shouldn't deter mandatory folic acid fortification of wheat and flour around the world.
The Emory authors write, "The randomized controlled trial sought to evaluate the effect of antenatal folate consumption and pregnancy outcomes, not breast cancer. There were only 31 breast cancer deaths and the confidence intervals were wide and include one. We believe that the most likely explanation for the reported association is chance."
Dr. Ness stresses that the findings could be due to chance and will serve to help further studies to determine the link, if any, between folate supplementation and increased breast cancer risk.
Dr. Oakley adds, "The current evidence favors the idea that folic acid will prevent breast cancer, not cause it."
One of the most important messages, Dr. Oakley says, is that the United Kingdom and other nations should immediately require mandatory folic acid fortification of flour.
"Folic acid fortification is likely to prevent each year in each country more deaths from heart attacks and strokes than the number of deaths that occur from vehicular crashes. In addition, fortification will prevent serious birth defects and folate deficiency in the elderly."
In addition, Dr. Oakley says, "All women of reproductive age should continue to consume 400 micrograms of synthetic folic acid from multivitamins or breakfast cereals."