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Elevated vitamin B12 levels and cancer risk in UK primary care: a THIN database cohort study

Arendt, JF; Sorensen, HT; Horsfall, LJ; Petersen, I; (2019) Elevated vitamin B12 levels and cancer risk in UK primary care: a THIN database cohort study. Cancer Epidemiology, Biomarkers and Prevention 10.1158/1055-9965.EPI-17-1136. (In press).

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Abstract

BACKGROUND: Elevated vitamin B12 levels (B12) are associated with increased short-term cancer risk. However, the implications for early cancer detection in primary care have not been assessed. METHODS: Individuals with plasma B12 measurements were sampled from The Health Improvement Network primary care database, United Kingdom. Persons with low B12 levels were excluded together with persons with cancer or B12 treatment before date of B12 measurement. Incident cancer was the outcome of interest and was identified through Read codes. Individuals were disaggregated according to plasma B12 levels (unit: pmol/L): 150-600 (reference range values), 601-800, 801-1000, and >1000. RESULTS: Among the 757,185 persons who met the inclusion criteria, we identified 33,367 incident cancers during 2,874,059 years of follow-up. We found a higher one-year cancer risk among the 25,783 (3.4%) persons with elevated B12 levels compared to those with normal B12 levels. After multivariable adjustment for lifestyle factors and social deprivation, persons with B12 >1000 pmol/L had a one-year incidence rate ratio of 4.72 (95% confidence interval: 3.99-5.58). The association showed a non-linear dose-response pattern and it remained robust in stratified analyses, including when reducing the risk of confounding by indication in sub-analyses. The risks were particularly elevated for liver cancer, pancreas cancer and myeloid malignancies among persons with elevated B12 levels. CONCLUSIONS: Elevated plasma B12 levels were associated with a higher one-year cancer risk than normal B12 levels among persons seen in UK primary care, suggesting that some cancers may affect B12 metabolism. IMPACT: Elevated B12 may mark occult cancer.

Type: Article
Title: Elevated vitamin B12 levels and cancer risk in UK primary care: a THIN database cohort study
Location: United States
DOI: 10.1158/1055-9965.EPI-17-1136
Publisher version: http://doi.org/10.1158/1055-9965.EPI-17-1136
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute of Epidemiology and Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute of Epidemiology and Health > Primary Care and Population Health
URI: http://discovery.ucl.ac.uk/id/eprint/10066927
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