Folic acid / folate (cancer-prevention context — context-dependent risk/benefit)
Детермінований перегляд YAML-сутності з джерельної бази. Клінічний авторитет лишається за вказаними source ID та статусом клінічного sign-off.
| ID | DRUG-FOLATE-PREVENTION |
|---|---|
| Тип | Препарат |
| Синоніми | FolacinFolate / folic acid preventionFolic acidFolicinFolinic acid (leucovorin — separate entity for chemo rescue)L-methylfolate (5-MTHF)Vitamin B9various OTC supplementsФолієва кислота / фолати (контекст профілактики раку — суперечлива користь) |
| Статус | переглянуто 2026-05-18 | очікує клінічного підпису |
| Хвороби | Не вказано |
| Джерела | SRC-USPSTF-CRC-2021 SRC-WCRF-AICR-CUP-2018 |
Дані про препарат
| Клас | Water-soluble B-vitamin — one-carbon metabolism cofactor |
|---|---|
| Механізм дії | Folate (tetrahydrofolate, THF) is the active cofactor for one-carbon transfer reactions in DNA synthesis (thymidylate synthesis from dUMP to dTMP), purine biosynthesis, and methionine cycle / S-adenosyl- methionine (SAM) generation for DNA methylation. Folic acid is the synthetic / fortified form; 5-MTHF is the dominant circulating form. Cancer-prevention rationale (LOW INTAKE → RISK): chronic folate deficiency disrupts DNA methylation and impairs dTMP synthesis (→ uracil misincorporation, double-strand breaks); ecological and observational data link low folate intake / status to increased colorectal cancer risk and possibly breast, pancreatic, esophageal. CONTROVERSY: HIGH INTAKE in patients with EXISTING adenomas or preneoplastic lesions may PROMOTE progression — the "dual-effect" hypothesis (Mason 2007). RCT evidence in CRC chemoprevention (Aspirin/Folate Polyp Prevention Study — Col... |
| Типове дозування | Periconceptional NTD prevention (NOT cancer chemoprevention): 400-800 µg PO daily, start ≥1 month before conception through first trimester (4 mg/d if prior NTD-affected pregnancy or on valproate / carbamazepine). Methotrexate rescue (NOT cancer chemoprevention): 1 mg PO daily (for chronic low-dose MTX in rheumatology); leucovorin is used for high-dose MTX in oncology — separate entity. Cancer-PREVENTION dosing: NO accepted dose. Population-level CRC observational signal is for adequate dietary folate intake (DFE 400 µg/d equivalents); SUPRA-PHYSIOLOGICAL DOSES (e.g., 1 mg/d folic acid supplements) lacking benefit and potentially harmful in patients with established adenomas (Cole JAMA 2007... |
| Зареєстровано в Україні | True |
| Відшкодовується НСЗУ | False |
| Остання перевірка для України | 2026-05-18 |
Нотатки
STUB — v0.2 chemoprevention-workstream authoring (batch 2); pending two-Clinical-Co-Lead signoff per CHARTER §6.1 dev-mode. FOLATE- CANCER ASSOCIATION IS COMPLEX. (1) LOW DIETARY FOLATE → modest INCREASED CRC risk in long-term cohorts (and possibly breast, pancreatic, esophageal). (2) PERICONCEPTIONAL FOLIC ACID SUPPLEMENTATION for NTD prevention is unequivocal benefit — NOT a chemoprevention indication, but every authoring should preserve this distinction. (3) HIGH-DOSE FOLATE in patients with EXISTING adenomas may PROMOTE progression (Mason 2007 dual-effect hypothesis; Cole JAMA 2007 Aspirin/Folate Polyp Prevention Study — folic acid 1 mg/d in prior- adenoma patients did NOT reduce recurrence, with non-significant signals of more advanced lesions and more non-colorectal cancers). CURRENT GUIDELINES: WCRF-AICR 2018 — do NOT recommend high-dose folate supplementation for cancer prevention; encourage adequate dietary intake. USPSTF / NCCN — no chemoprevention recommendation for high-dose folate. ENGINE should NOT auto-recommend folate supplementation for cancer prevention. Patients with prior adenomas + already on chronic >1 mg/d folate (e.g., for NTD prophylaxis or MTX rescue) req...
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