Study: High vitamin D levels at breast cancer diagnosis may be associated with a better prognosis
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This study is about:
Whether women’s vitamin D blood levels at the time of diagnosis are related to their health outcomes.
Why is this study important?
Vitamin D is important for bone health and is also implicated in other bodily processes. Some research suggests that vitamin D is involved in breast cancer, but its role is not well understood. Researchers in this study wanted to know if there is a link between the level of vitamin D in a woman’s blood at the time of her breast cancer diagnosis and her prognosis (how well she does after the diagnosis), including measurements of breast cancer and survival.
- Women with the highest levels of vitamin D (slightly higher than the recommended level) in their blood had better overall survival than women with lower vitamin D levels.
- Lower vitamin D levels were associated with a more advanced breast cancer at diagnosis.
What does this mean for me?
This study suggests that women who have high vitamin D levels (slightly higher than the level recommended by the National Institute of Health) have better overall survival compared to women with lower levels. These findings agree with several other studies of vitamin D levels and breast cancer survival outcomes. But much more work needs to be done before these findings can be applied to preventing breast cancer or recurrence. This study’s results do not mean that increasing vitamin D consumption after a breast cancer diagnosis will improve patient survival; it just means that patients who had better survival were seen to have higher vitamin D levels. The researchers do not know if better survival is directly related to vitamin D.
Ultimately, vitamin D is very important for all women. It helps calcium absorption in the gut, keeps bones strong, and also aids in some functions of immune function, cell growth, and reduction of inflammation. Vitamin D deficiencies result in diseases that cause weak bones and contribute to , so it is important to maintain adequate levels of vitamin D in our bodies whether or not it affects cancer risk or prognosis. Women concerned about their vitamin D levels should consult with their health care provider who can order blood tests to check their vitamin D levels and advise them if dietary changes or supplements are necessary.
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Yao S, Kwan ML, Ergas IJ, et al. “Association of Serum Level of Vitamin D at Diagnosis with Breast Cancer Survival A Case-Cohort Analysis in the Pathways Study.” JAMA Oncology. Published online first on November 10, 2016.
National Institutes of Health, Office of Dietary Supplements. “Vitamin D.”
This article is relevant for:
Women at average risk for breast cancer and newly diagnosed women
This article is also relevant for:
people with breast cancer
people with ER/PR + cancer
healthy people with average cancer risk
people with Her2-positive cancer
people with a genetic mutation linked to cancer risk
people with triple negative breast cancer
people newly diagnosed with cancer
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IN DEPTH REVIEW OF RESEARCH
Previous studies have tried to determine whether there are potential associations between vitamin D levels in the blood and breast cancer risk, but have concluded with mixed results: some say there is an association while others say there is not. But fewer studies have looked at whether there is an association between vitamin D blood levels at the time of diagnosis and breast cancer prognosis; studies that did involve this relationship assessed overall survival, but not deaths from breast cancer. As vitamin D deficiencies have known effects beyond any role in breast cancer, lower overall survival in women with low blood levels of vitamin D may be due to causes unrelated to their breast cancer.
Song Yao and colleagues from the Department of Cancer Prevention and Control at the Rosewell Park Cancer Institute performed a study (meaning they designed the study and collected the data themselves rather than looking back on information collected by others or relying on patients’ recollections). They looked at the association between blood vitamin D levels at the time of diagnosis and breast cancer prognosis.
Researchers of this study wanted to know:
Does a woman’s amount of vitamin D in her blood indicate how well she will do after a breast cancer diagnosis?
Population(s) looked at in the study:
This study (called the Pathways Study) included 1,666 women who were diagnosed with invasive breast cancer. This population was established at Kaiser Permanente Northern California and was designed to specifically study factors that are associated with breast cancer recurrence and survival. The women’s vitamin D levels were measured shortly after diagnosis and were then followed for up to 96 months after they were enrolled in the study in which researchers tracked participants’ health outcomes.
Vitamin D has several forms in the blood. In this study, the researchers measured a form called 25-hydroxyvitamin D, which according to the National Institutes of Health () is the best indicator of a person’s overall vitamin D status.
The states that a vitamin D level of 20 ng/mL or greater is considered adequate for bone and overall health. For this study, the researchers divided the women into three groups based on their vitamin D blood levels:
- Group 1 had low vitamin D levels: below 16.75 ng/mL
- Group 2 had vitamin D levels just over or under the recommended levels: 16.75-25.09 ng/mL
- Group 3 had high vitamin levels: 25.10 ng/mL or greater
- Women with the highest level of vitamin D (slightly higher than the recommended vitamin D levels) in their blood had better overall survival than women with lower vitamin D levels.
- This association was greatest in premenopausal women.
- Premenopausal women with the highest vitamin D levels were less likely to die from breast cancer within the period of the study than women with lower vitamin D levels..
- Premenopausal women with the highest vitamin D levels had greater invasive disease-free survival, which included recurrences and secondary cancer diagnoses, than women with lower vitamin D levels.
- Lower vitamin D levels were associated with a more advanced of breast cancer at diagnosis.
It is important to understand that the link identified in this study between high vitamin D levels in the blood and better breast cancer survival after diagnosis does not necessarily mean that vitamin D directly caused the better prognosis or that having higher levels of vitamin D in the blood prevents breast cancer diagnosis or recurrence. Other factors that were not measured by the study may have played a role in the women’s improved survival.
This study suggests that women who are diagnosed with breast cancer and have high levels of vitamin D have a better prognosis than women with lower levels of vitamin D. More work needs to be done to further understand how this can help women with breast cancer in the clinic. In the meantime, women should maintain a healthy vitamin D level, which benefits their overall health.
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National Comprehensive Cancer Network (NCCN) guidelines on survivorship include the following recommendations on dietary supplement use:
- Taking dietary supplements is not recommended for most cancer survivors unless a patient has a known nutritional deficit, an inadequate diet or other indication (for example, ).
- Little data exist to support the use of vitamins or other dietary supplements for cancer prevention, control or recurrence.
- Taking vitamin supplements does not replace the need for a healthy diet. Patients should try to get nutrients from the foods they eat and the beverages they drink.
- Providers should ask about supplement use at regular intervals, about a patient’s reasons for using supplements and the ingredients in those supplements.
- Survivors of certain cancers are at risk of vitamin deficiencies based on cancer treatment (e.g., gastric cancer patients who have had a gastrectomy may be at risk of vitamin B12 and iron deficiencies).
- NCCN recommends calcium and vitamin D supplements for people who have been prescribed denosumab or a bisphosphonate to treat bone or .
- Patients taking multiple supplements and those in need of nutritional support should be referred to a registered dietitian or nutritionist, preferably one who is trained in supporting oncology patients.
- Should I have my vitamin D levels monitored?
- If I am vitamin D deficient, what can I do?
- What are measures I can take to reduce my breast cancer risk?
- Should I be taking any other supplements?
- Can you refer me to a nutritionist?
- clinicaltrials.gov/show/NCT03596073. Calcipotriene is a form of vitamin D. It works by slowing down the growth of skin cells and has been approved for treating a skin condition called psoriasis. Researchers want to find out how topical calcipotriene ointment affects people who have breast cancer, and what impact that may have on those who are at risk of developing breast cancer in the future.
The following are studies focused on nutrition for people diagnosed with breast cancer.
- NCT05259410: Time Restricted Eating During Chemotherapy for Breast Cancer. This study will look at whether intermittent fasting during treatment will improve treatment related outcomes, patient related outcomes, and limit treatment related weight gain.
- NCT04000880: AMPLIFY: An Online Weight Loss Study Specifically for Cancer Survivors. AMPLIFY is a nation-wide, web-based diet and exercise study recruiting overweight survivors of breast, , ovarian, renal, colorectal, endometrial cancer and multiple myeloma in people age 50 and older who are interested in becoming more active, eating better and losing weight.
- NCT04298086: A Study of the Body's Response to Exercise and a Plant-Based Diet in Overweight Postmenopausal Women With Breast Cancer. This study is looking to find out what effects exercise and a plant-based diet have on aromatase levels in postmenopausal women who are overweight and being treated with an aromatase inhibitor for their HR+ breast cancer.
- NCT04365569 Evaluating the Effectiveness of an Individualized Nutrition and Physical Activity Counseling Program. This pilot study looks at whether a tailored in-person and telephone-based nutrition and exercise counseling program can help breast cancer patients improve weight and fitness and thus improve cancer outcomes.
- NCT03824145: Every Day Counts: A Lifestyle Program for Women With Breast Cancer (EDC). This study will examine diet and activity, body composition, blood and quality of life in breast cancer patients. The study will recruit 176 women with MBC in Milwaukee (n=88) and Chicago (n=88).
Who covered this study?
Medical News Today
Vitamin D may increase survival for breast cancer patients This article rates 4.0 out of 5 stars
New York Times
Vitamin D linked to longer breast cancer survival This article rates 3.5 out of 5 stars
Breast cancer treatment: High levels of vitamin D linked to better prognosis This article rates 3.0 out of 5 stars