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Isabel Drake

Isabel Drake

Associate professor

Isabel Drake

Haem iron intake and risk of lung cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort


  • Heather A. Ward
  • Julia Whitman
  • David C. Muller
  • Mattias Johansson
  • Paula Jakszyn
  • Elisabete Weiderpass
  • Domenico Palli
  • Anouar Fanidi
  • Roel Vermeulen
  • Anne Tjønneland
  • Louise Hansen
  • Christina C. Dahm
  • Kim Overvad
  • Gianluca Severi
  • Marie Christine Boutron-Ruault
  • Aurélie Affret
  • Rudolf Kaaks
  • Renee Fortner
  • Heiner Boeing
  • Antonia Trichopoulou
  • Carlo La Vecchia
  • Anastasia Kotanidou
  • Franco Berrino
  • Vittorio Krogh
  • Rosario Tumino
  • Fulvio Ricceri
  • Salvatore Panico
  • H. Bas Bueno-de-Mesquita
  • Petra H. Peeters
  • Therese Haugdahl Nøst
  • Torkjel M. Sandanger
  • Jose Ramón Quirós
  • Antonio Agudo
  • Miguel Rodríguez-Barranco
  • Nerea Larrañaga
  • Jose Maria Huerta
  • Eva Ardanaz
  • Isabel Drake
  • Hans Brunnström
  • Mikael Johansson
  • Kjell Grankvist
  • Ruth C. Travis
  • Heinz Freisling
  • Magdalena Stepien
  • Melissa A. Merritt
  • Elio Riboli
  • Amanda J. Cross

Summary, in English

Background: Epidemiological studies suggest that haem iron, which is found predominantly in red meat and increases endogenous formation of carcinogenic N-nitroso compounds, may be positively associated with lung cancer. The objective was to examine the relationship between haem iron intake and lung cancer risk using detailed smoking history data and serum cotinine to control for potential confounding. Methods: In the European Prospective Investigation into Cancer and Nutrition (EPIC), 416,746 individuals from 10 countries completed demographic and dietary questionnaires at recruitment. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for incident lung cancer (n = 3731) risk relative to haem iron, non-haem iron, and total dietary iron intake. A corresponding analysis was conducted among a nested subset of 800 lung cancer cases and 1489 matched controls for whom serum cotinine was available. Results: Haem iron was associated with lung cancer risk, including after adjustment for details of smoking history (time since quitting, number of cigarettes per day): as a continuous variable (HR per 0.3 mg/1000 kcal 1.03, 95% CI 1.00–1.07), and in the highest versus lowest quintile (HR 1.16, 95% CI 1.02–1.32; trend across quintiles: P = 0.035). In contrast, non-haem iron intake was related inversely with lung cancer risk; however, this association attenuated after adjustment for smoking history. Additional adjustment for serum cotinine did not considerably alter the associations detected in the nested case–control subset. Conclusions: Greater haem iron intake may be modestly associated with lung cancer risk.


  • Diabetes - Cardiovascular Disease
  • EpiHealth: Epidemiology for Health
  • EXODIAB: Excellence of Diabetes Research in Sweden
  • Improved diagnostics and prognostics of lung cancer and metastases to the lungs
  • Tumor microenvironment
  • BioCARE: Biomarkers in Cancer Medicine improving Health Care, Education and Innovation

Publishing year







European Journal of Clinical Nutrition





Document type

Journal article


Nature Publishing Group


  • Nutrition and Dietetics
  • Cancer and Oncology



Research group

  • Diabetes - Cardiovascular Disease
  • Improved diagnostics and prognostics of lung cancer and metastases to the lungs


  • ISSN: 0954-3007