***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: In a prospect i ve study of about 22,000 men attending a screening centre , serum sample s were collected and stored . The concentration of vitamin E ( alpha-tocopherol ) was measured in the stored serum sample s from 271 men subsequently notified as having cancer and from 533 unaffected controls , matched for age , smoking history and duration of storage of the serum sample s. The mean vitamin E level of the cancer subjects was not significantly different from that of their matched controls . The mean level in the cancer  subjects who were diagnosed as having cancer before the elapse of one year from the date of blood collection was , however , significantly lower than the mean concentration of their matched controls ( 10.0 and 11.5 mgl-1 respectively , P = 0.003 ) . For subjects whose cancers were diagnosed one or more years after blood collection the difference was not statistically significant either for all cancers or for cancers of six sites considered separately , viz . lung , colon and rectum , stomach , bladder , central nervous system and skin . The most likely explanation for these results is that the low vitamin E levels observed in these subjects were a metabolic consequence , rather than a precursor , of the cancer . This would explain , at least in part , the overall inverse association between serum vitamin E  and risk of cancer observed in the published epidemiological studies on serum vitamin E and cancer This population -based case-control study examined the association between selected nutrients , foods , and diet behaviors and  bladder cancer . Bladder cancer cases ( n = 262 ) were identified from the Surveillance , Epidemiology , and End Results Program cancer registry for western Washington , and controls ( n = 405 ) were identified through r and om digit dialing . Cases were diagnosed between January 1987 and June 1990 , and eligible subjects were Caucasian , aged 45 - 65 years , and residents of King , Pierce , or Snohomish counties . Subjects completed a self-administered , 71-item food frequency question naire and a structured telephone interview . Analyses were conducted by logistic regression analysis and included adjustment for age , sex , smoking ( current , former , never ) , and county . Odds ratios and their 95 % confidence intervals for highest versus lowest level of intake were examined . An inverse association was found between the risk of bladder cancer and dietary retinol  ( odds ratio ( OR ) across quartiles : 1.00 , 1.09 , 0.97 , and 0.52 ; 95 % CI 0.29 - 0.97 ; trend p value = 0.03 ) and dietary vitamin C ( OR across quartiles : 1.00 , 0.96 , 0.67 , and 0.50 ; 95 % CI 0.28 - 0.88 ; trend p value = 0.009 ) , adjusted for calories . The use of multivitamin supplements daily over the 10-year period ending 2 years before diagnosis versus no use was associated with a decreased risk of bladder cancer ( OR = 0.39 ; 95 % CI 0.24 - 0.63 ) as was use of supplemental vitamin C ( OR for > 502 mg/day over the 10 years vs. none = 0.40 ; 95 % CI 0.21 - 0.76 ) . Increased intake of fruit was associated with a decreased risk of bladder cancer ( OR across quartiles : 1.00 , 1.24 , 0.72 , and 0.53 ; 95 % CI 0.30 - 0.93 ; trend p value = 0.01 , adjusted for calories ) , while increased use of fried foods was associated with an increased risk of bladder cancer ( OR across quartiles : 1.00 , 1.51 , 1.81 , and 2.24 ; 95 % CI 1.25 - 4.03 ; trend p value = 0.006 ) . This study provides modest evidence that certain nutrients , foods , and supplementation may affect the incidence of bladder cancer Data derived from laboratory investigations suggest that a number of dietary variables may contribute to bladder carcinogenesis . Although bladder cancer is the fourth leading cause of cancer in men in the United States , dietary studies are few . The authors examined the relations between intakes of macro- and micronutrients and the  risk of bladder cancer among men in the prospect i ve Health Professionals Follow-Up Study . Each participant completed a 131-item food frequency question naire in 1986 and in 1990 , from which nutrient intakes were calculated . During 12 years of follow-up , 320 cases of bladder cancer were diagnosed . No association was observed for total caloric or macronutrient intake and bladder cancer risk . Similarly , we found no relation for dietary intake of potassium , sodium , calcium , magnesium , phosphorus , iron , or water-soluble vitamins and bladder cancer risk . Total vitamin E intake and vitamin E supplements  were inversely associated with risk . In addition , a dose-response relation was observed for duration of vitamin E supplement use . A suggestive inverse association was seen with dose of vitamin C supplement use . More studies are needed to determine the role of vitamins E and C supplement intake in bladder carcinogenesis PURPOSE Urothelial carcinoma has the highest lifetime treatment cost of any cancer , making it an ideal target for preventative therapies . Previous work has suggested that certain vitamin and mineral supplements may reduce the risk of urothelial  carcinoma . We used the prospect i ve VITamins And Lifestyle cohort to examine the association of all commonly taken vitamin and mineral supplements as well as 6 common anti-inflammatory supplements with incident urothelial carcinoma in a United States population . MATERIAL S AND METHODS A total of 77,050 eligible VITAL participants completed a detailed question naire at baseline on supplement use and cancer risk factors . After 6 years of followup 330 incident urothelial carcinoma cases in the cohort were identified via linkage to the Seattle-Puget Sound SEER cancer registry . We analyzed use of supplemental vitamins ( multivitamins , beta-carotene , retinol , folic acid , and vitamins B1 , B3 , B6 , B12 , C , D and E ) , minerals ( calcium , iron , magnesium , zinc and selenium ) and anti-inflammatory supplements ( glucosamine , chondroitin , saw palmetto , ginkgo biloba , fish oil and garlic ) . For each supplement the hazard ratios ( risk ratios ) for urothelial carcinoma comparing each category of users to nonusers , and 95 % CIs , were determined using Cox proportional hazards regression , adjusted for potential confounders . RESULTS None of the vitamin , mineral or anti-inflammatory supplements was significantly associated with urothelial carcinoma risk in age adjusted or multivariate models . CONCLUSIONS The results of this study do not support the use of commonly taken vitamin or mineral supplements or 6 common anti-inflammatory supplements for the chemoprevention of urothelial carcinoma We examined the relation between dietary fruit and vegetables , carotenoids and vitamin intakes and the  risk of bladder cancer among male smokers in a prospect i ve cohort study . Over a median of 11 years , we followed 27 111 male smokers aged 50–69 years who were initially enrolled in the Alpha-Tocopherol Beta-Carotene Cancer Prevention Study . During this period , 344 men developed bladder cancer . All of these men had completed a 276-food item dietary question naire at baseline . Cox proportional hazards models were used to estimate the relative risks and 95 % confidence intervals and to simultaneously adjust for age , smoking history , energy intake and intervention group . Consumption of fruits and vegetables was not associated with the risk of bladder cancer ( relative risk=1.28 ; 95 % confidence intervals CI : 0.89–1.84 , for highest vs lowest quintile ) . Similarly , no associations were observed for groups of fruits or vegetables ( berries and cruciferous vegetables ) , or for specific fruits and vegetables . Dietary intakes of alpha-carotene , beta-carotene , lycopene , lutein/zeaxanthin , beta-cryptoxanthin , vitamins A , E , and C , and folate were not related to the risk of bladder cancer . These findings suggest that fruit and vegetable intakes are not likely to be associated with bladder cancer risk . However , these results may not be generalisable to non-smokers BACKGROUND Previous epidemiologic studies of fruit and vegetable intake and bladder cancer risk have yielded inconsistent results , especially with regard to the types of fruits and vegetables consumed . We examined total fruit and vegetable intake  , as well as intakes of subtypes of fruits and vegetables , in relation to bladder cancer risk in a large male prospect i ve cohort study . METHODS Two hundred fifty-two cases of incident bladder cancer were diagnosed from 1986 through January 31 , 1996 , among 47,909 men enrolled in the Health Professionals Follow-up Study . Each participant in this cohort completed a 131-item food-frequency question naire in 1986 and subsequently in 1990 and 1994 . We used logistic regression analyses to examine  fruit and vegetable intake in relation to bladder cancer risk , after adjusting for age , history of cigarette smoking , current smoking status , geographic region , total fluid intake , and caloric intake . RESULTS We observed a weak , inverse association that was not statistically significant between total fruit and vegetable intake and bladder cancer risk . Intake of cruciferous vegetables was inversely associated with risk ( relative risk = 0.49 ; 95 % confidence interval = 0.32 - 0.75 , for the highest category of cruciferous vegetable intake compared with the lowest ) , but intakes of yellow or green leafy vegetables or carotenoid-rich vegetables were not associated with risk . Individual cruciferous vegetables , except for coleslaw , were all inversely related to bladder cancer risk , but only the associations for broccoli and cabbage were statistically significant . CONCLUSIONS Data from this study indicate that high cruciferous vegetable consumption may reduce bladder cancer risk , but other vegetables and fruits may not confer appreciable benefits against this cancer Objective : To examine the relation between fruits and vegetables , carotenoids , folate , and vitamins A , C , E and the  risk of bladder cancer  in a prospect i ve study of women Methods : A total of 237 incident bladder cancer cases were documented during 20 years of follow-up among 88,796 women enrolled in the Nurses ’ Health Study . Dietary intake was assessed by food-frequency question naires every two to four years and incident diagnosis of bladder cancer was ascertained every two years . Cox proportional hazard models were used to estimate incidence rate ratios ( RR ) and 95 % confidence intervals ( CI ) for bladder cancer risk , adjusting for age , pack-years of smoking , current smoking , and total caloric intake . Results : Consumption of total fruits and vegetables was not associated with bladder cancer risk ( RR = 1.08 , 95 % CI = 0.70–1.65 , for > 5.5 compared to < 2.5 servings per day ) . Similarly , dietary intakes of carotenoids , folate , and vitamins A , C , E , were not related to bladder cancer risk . No association was observed between supplemental intake of multivitamins , vitamins A , C , E and bladder cancer risk . Conclusions : We did not observe any association for fruit and vegetable consumption or vitamin intake and bladder cancer risk among women A multi-centre case-control study on bladder cancer and diet was carried out in 5 regions of Spain . We report results on 432 male cases and 792 matched controls .  Usual dietary habits were investigated by means of an interview-based dietary history question naire .  Bladder-cancer cases were selected from the registers of 12 hospitals located in the study areas . Each case was matched by sex , age and area of residence to 2 controls , one identified in the same hospital and one drawn from population lists . Descriptive analyses indicated that the average dietary pattern was typical of Mediterranean population s : a high P/S ratio , high intake of fish , fruits and vegetables and moderate or low intake of meat and dairy products .  Relative risks for specific foods and nutrients were adjusted for tobacco smoking and energy intake . Subjects in the highest quarter of intake of saturated fat had a significantly increased risk of bladder cancer ( RR for highest quarter = 2.25 ; 95 % CI = 1.42 to 3.55 ) . Moderate increases in risk for high intake of mono-unsaturated fats and calcium , and a slight decrease for iron were also found , but these disappeared after adjustment for saturated fat . Intake of vitamin E was related to slightly reduced risk ( RR for highest quarter = 0.72 ; 95 % CI = 0.48 to 1.09 ) which was not modified by adjustment for fat . No association was found with intake of retinol or carotene . These results , along with those of previous studies , suggest that saturated fat intake may influence the occurrence of bladder cancer A case-control study of diet and bladder cancer was conducted during 1979 - 1982 in Edmonton , Calgary , Toronto , and Kingston , Canada . A 
    Output:
    
Although some of the summary effects were non-significant , subgroup analyses showed that these inverse relationships were not modified by study design , sex , geographical regions and source of vitamins intake for vitamin E intake .
Our results indicated that high intake of vitamin E could reduce bladder cancer risk .
However , the inverse association between vitamin C and bladder cancer seemed to be limited .