Albumin, bilirubin, uric acid and cancer risk: results from a prospective population-based study

BACKGROUND: It has long been proposed that albumin, bilirubin and uric acid may inhibit cancer development due to their anti-oxidative properties. However, there is a lack of population-based studies on blood levels of these molecules and cancer risk. METHODS: Associations between pre-diagnostic serum albumin, bilirubin and uric acid and the risks of common cancers as well as cancer death in the EPIC-Heidelberg cohort were evaluated by multivariable Cox regression analyses. A case–cohort sample including a random subcohort (n=2739) and all incident cases of breast (n=627), prostate (n=554), colorectal (n=256), and lung cancer (n=195) as well as cancer death (n=761) that occurred between baseline (1994–1998) and 2009 was used. RESULTS: Albumin levels were inversely associated with breast cancer risk (hazard ratio(Quartile 4 vs Quartile 1) (95% CI): 0.71 (0.51, 0.99), P(linear trend)=0.004) and overall cancer mortality (HR(Q4 vs Q1) (95% CI): 0.64 (0.48, 0.86), P(linear trend)<0.001) after multivariable adjustment. Uric acid levels were also inversely associated with breast cancer risk (HR(Q4 vs Q1) (95% CI): 0.72 (0.53, 0.99), P(linear trend)=0.043) and cancer mortality (HR(Q4 vs Q1) (95% CI): 0.75 (0.58, 0.98), P(linear trend)=0.09). There were no significant associations between albumin or uric acid and prostate, lung and colorectal cancer. Serum bilirubin was not associated with any cancer end point. CONCLUSIONS: The present findings indicate that higher levels of albumin and uric acid are related to lower risks of breast cancer and cancer mortality. Further studies are needed to assess whether the observed associations are causal.