Links with breast cancer have been cited by those opposed to the widespread introduction of folate to food supplies as well as concerns over bowel cancer and anaemia in the elderly. Fortification is being considered because of the B vitamin's ability to prevent neural tube defects. Additional research The American Journal of Clinical Nutrition study concluded that a range of B vitamins, including folate, B6 and B12, neither added to nor reduced the risk of developing breast cancer. However the researchers observed that, "positive associations of folate status with risk of developing pre-menopausal breast cancer and ER-positive or PR-positive tumours are unexpected." They called for "additional research…to elucidate the role of folate in breast cancer development." The study evaluated 848 women with breast cancer who were matched with a control group of 848 women with no breast cancer chosen from more than 28,345 women in a Women's Health Study. The women were all 45-years-old and had no history of cancer and cardiovascular disease at the start of the study. Each woman provided blood samples for measurement of folate, vitamin B6 and vitamin B12 levels. Preliminary findings Pamela Mason, spokesperson for the Health Supplements Information Service (HSIS), said the study demonstrated no link between breast cancer and supplements use. "What is important is that this study showed no overall link between breast cancer and blood levels of folate, vitamin B6 and vitamin B12. Higher blood levels of these essential B vitamins were not associated with increased risk of breast cancer," she said. "There was no association of breast cancer with use of supplements. It is also noteworthy that the women who developed breast cancer were more likely than the control subjects to have had benign breast disease in the past and to be current smokers." Mason added: "The study did show an association - albeit marginal - between higher blood folate levels and a risk of pre-menopausal breast cancer and oestrogen receptor positive or progesterone receptor positive breast tumours. The risk of breast cancer seems to be influenced by the hormone receptor status in the cells of the breast, but the influence of folic acid on these hormonal receptors is by no means clear from this study. The associations were only marginal and these findings are preliminary." Prevention not treatment She noted folic acid supplements were not intended to be taken to prevent or treat cancer. "This study does not address the issue of health maintenance. Moreover, previous studies have shown that high blood folate levels are associated with reduced risk of breast cancer. My worry with these types of studies is that women will be alarmed and dissuaded from taking this essential nutrient, which is vital for the health of their unborn babies." Folic acid has been shown to prevent neural tube defects such as spina bifida in foetal and infant development, a factor that has led some countries like the US to introduce mandatory fortification. According to HSIS, nine out of ten women consume too little folic acid. The UK Food Standards Agency (FSA) is considering fortifying bread and/or flour with folic acid as is Food Standards Australian and New Zealand (FSANZ). The FSA said numbers consuming too little folate in the UK could be reduced from 13.3m to 5.6m if mandatory fortification were introduced.