Study: High vitamin D levels at breast cancer diagnosis may be associated with a better prognosis


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Vitamin D is most known for its role in maintaining bone health but vitamin D has additional roles in keeping us healthy. In this study, researchers found that breast cancer patients who had the highest amounts of vitamin D in their blood (slightly over the recommended levels) had better health outcomes, including overall survival, than women with lower amounts of vitamin D. This finding adds to the growing evidence for the role of vitamin D in cancer, but it does not change how breast cancer is prevented or treated. (1/10/17)

Contents

At a glance Clinical trials
Findings     In-depth            
Guidelines Limitations
Questions for your doctor Resources and references


STUDY AT A GLANCE

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 stage and survival.

Study findings: 

  1. 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.
  2. Lower vitamin D levels were associated with a more advanced breast cancer stage 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 osteoporosis, 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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Expert Guidelines

Dietary supplements

The National Comprehensive Cancer Network (NCCN) has guidelines on survivorship that include the following recommendations on supplement use:

  • Supplement use is not recommended for most survivors, except in instances of documented nutritional deficiencies, inadequate diet, or other indications (eg., osteoporosis).
  • Little data exist to support the use of vitamins or other dietary supplements for the purposes of cancer control, recurrence, or prevention. 
  • Taking vitamin supplements does not replace the need for a healthy diet. All efforts should be made to obtain nutrients from food and beverages.
  • Providers should assess supplement use at regular intervals. Ask about reasons for supplement use and supplement ingredients. 
  • Survivors of certain cancers (eg., gastrointestinal cancers) may be at risk for vitamin deficiencies based on their cancer treatment. Deficiencies should be asessed and addressed as needed. 

The American Institute for Cancer Research (AICR) is an organization that translates research on diet and cancer risk into practical information for the public. AICR recommends that people try to meet their nutritional needs through a healthy diet. They do not discourage people from taking a multivitamin supplement, but they warn people not to rely on supplements alone to protect from cancer. 

The American Cancer Society recommends speaking with your oncologist before taking any supplements. 

Questions To Ask Your Health Care Provider

  • 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?

Open Clinical Trials

  • NCT03596073: Topical Calcipotriene Treatment for Breast Cancer Immunoprevention. Calcipotriene is a form of vitamin D. It works by slowing down the growth of skin cells and has been FDA 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. 

IN DEPTH REVIEW OF RESEARCH

Study background:

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 prospective 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 (NIH) is the best indicator of a person’s overall vitamin D status.

The NIH 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

Study findings: 

  1. 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.
  2. 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..
  3. 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.
  4. Lower vitamin D levels were associated with a more advanced stage of breast cancer at diagnosis.

Limitations:

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.  

Conclusions:

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.

Posted 1/10/17

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