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A 2014 mouse study found that NAC and vitamin E accelerated lung tumor progression and reduced survival.41 A 2015 melanoma mouse study found that NAC increased lymph node metastases in mice with malignant melanoma.42 A 2019 mouse study reported that NAC protected against emphysema-related lung damage but also induced lung adenocarcinoma in some mice.43 And a 2021 hepatocellular carcinoma study found that antioxidant supplements including NAC promoted tumor formation, growth, and drug resistance in experimental models by reducing intracellular ROS.3 Newer human data add another layer of complexity

Some GPs may incorrectly believe that only patients with a definite diagnosis of PA, those with a positive intrinsic factor antibody test, require treatment for life so seem to be using this as their treatment exclusion criteria

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