British Journal of Nutrition

Systematic Review with Meta-Analysis

Calcium supplements and cancer risk: a meta-analysis of randomised controlled trials

Sarah M. Bristowa1, Mark J. Bollanda1 c1, Graeme S. MacLennana2, Alison Avenella2, Andrew Greya1, Greg D. Gamblea1 and Ian R. Reida1

a1 Bone Research Group, Department of Medicine, University of Auckland, Private Bag 92 019, Auckland 1142, New Zealand

a2 Health Services Research Unit, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK


Some evidence suggests that Ca and vitamin D supplements affect cancer risk; however, it is uncertain whether the effects are due to Ca, vitamin D or the combination. We investigated the effect of Ca supplements without co-administered vitamin D on cancer risk. Medline, Embase and the Cochrane Central Register of Controlled Trials, reference lists of meta-analyses and two clinical trial registries were searched for randomised, placebo-controlled trials of Ca supplements ( ≥ 500 mg/d), with ≥ 100 participants and duration >1 year. The lead authors of eligible trials supplied data on cancer outcomes. Trial-level data were analysed using random-effects meta-analyses and patient-level data using Cox proportional hazards models. A total of sixteen trials were eligible, six had no data available, ten provided trial-level data (n 10 496, mean duration 3·9 years), and of these, four provided patient-level data (n 7221, median duration 3·5 years). In the meta-analysis of trial-level data, allocation to Ca did not alter the risk of total cancer (relative risk 0·95, 95 % CI 0·76, 1·18, P= 0·63), colorectal cancer (relative risk 1·38, 95 % CI 0·89, 2·15, P= 0·15), breast cancer (relative risk 1·01, 95 % CI 0·64, 1·59, P= 0·97) or cancer-related mortality (relative risk 0·96, 95 % CI 0·74, 1·24, P= 0·75), but reduced the risk of prostate cancer (relative risk 0·54, 95 % CI 0·30, 0·96, P= 0·03), although there were few events. The meta-analysis of patient-level data showed similar results, with no effect of Ca on the risk of total cancer (hazard ratio 1·07, 95 % CI 0·89, 1·28, P= 0·50). Ca supplements without co-administered vitamin D did not alter total cancer risk over 4 years, although the meta-analysis lacked power to detect very small effects, or those with a longer latency.

(Received September 06 2012)

(Revised March 06 2013)

(Accepted March 07 2013)

(Online publication April 19 2013)

Key Words:

  • Calcium supplements;
  • Cancer;
  • Meta-analysis;
  • Randomised trials


c1 Corresponding author: M. J. Bolland, fax +64 9 373 7677, email


  Abbreviations: RECORD, Randomised Evaluation of Calcium Or Vitamin D; WHI, Women's Health Initiative