Prognostic Effects of 25-Hydroxyvitamin D Levels in Early Breast Cancer

• Published in: Journal of clinical oncology Vol. 27; no. 23; pp. 3757 - 3763
• Main Authors: GOODWIN, Pamela J, ENNIS, Marguerite, PRITCHARD, Kathleen I, KOO, Jarley, HOOD, Nicky
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Society of Clinical Oncology 10.08.2009
• Subjects: Adult; Aged; Biological and medical sciences; Body Mass Index; Breast Neoplasms - blood; Breast Neoplasms - metabolism; Breast Neoplasms - pathology; Disease-Free Survival; Female; Gynecology. Andrology. Obstetrics; Humans; Kaplan-Meier Estimate; Mammary gland diseases; Medical sciences; Middle Aged; Multivariate Analysis; Neoplasm Staging; Predictive Value of Tests; Prognosis; Prospective Studies; Surveys and Questionnaires; Tumors; Vitamin D - analogs & derivatives; Vitamin D - blood; Vitamin D Deficiency - blood; Vitamin D Deficiency - complications; Vitamin D Deficiency - metabolism; Mammary gland diseases; Breast disease; Cancerology; Prognosis; Vitamin D; Steroid hormone; Calcitriol; Cholecalciferol(25-hydroxy); Early; Breast cancer; Malignant tumor; Cancer
• ISSN: 0732-183X; 1527-7755
• DOI: 10.1200/JCO.2008.20.0725

Vitamin D has been linked to breast cancer risk, but prognostic effects are unknown. Such effects are biologically plausible given the presence of vitamin D receptors in breast cancer cells, which act as nuclear transcription factors to regulate gene activity. The study was conducted in a prospective inception cohort of 512 women with early breast cancer diagnosed 1989 to 1996. Vitamin D levels were measured in stored blood. Clinical, pathologic, and dietary data were accessed to examine prognostic effects of vitamin D. Mean age was 50.4 years, mean vitamin D was 58.1 +/- 23.4 nmol/L. Vitamin D levels were deficient (< 50 nmol/L) in 37.5% of patients, insufficient (50 to 72 nmol/L) in 38.5% of patients, and sufficient (> 72 nmol/L) in 24.0% of patients. There was little variation in mean vitamin D levels between summer and winter months. Mean follow-up was 11.6 years; 116 women had distant recurrences, and 106 women died. Women with deficient vitamin D levels had an increased risk of distant recurrence (hazard ratio [HR] = 1.94; 95% CI, 1.16 to 3.25) and death (HR = 1.73; 95% CI, 1.05 to 2.86) compared with those with sufficient levels. The association remained after individual adjustment for key tumor and treatment related factors but was attenuated in multivariate analyses (HR = 1.71; 95% CI, 1.02 to 2.86 for distant recurrence; HR = 1.60; 95% CI, 0.96 to 2.64 for death). Vitamin D deficiency may be associated with poor outcomes in breast cancer.