Colorectal (large intestinal) cancer affects the colon, or bowel, and rectum. It is one of the most common types of cancers in Western developed countries. Each year in the United States, more than 140,000 people are diagnosed with colorectal cancer and around 50,000 die from the disease.
Important risk factors for colorectal cancer include:
- Diets high in animal products
- Alcohol consumption
- Being overweight
Fresh fruits and vegetables and whole grains may lower disease risk.
Sunlight exposure and colorectal cancer risk
As early as 1980, colon cancer was credited as the first cancer to benefit from sunlight. Early U.S. studies noted high death rates in the Northeast. This area has limited sunshine. Low mortality rates were noted in the Southwest, which has more sunshine. Many studies since then have confirmed these findings for both colon and rectal cancer. Ultraviolet-B (UVB) light produces vitamin D. Researchers concluded that vitamin D provides the primary cancer benefit.
Vitamin D and colorectal cancer
Vitamin D levels
There are numerous studies of the link between vitamin D and colorectal cancer rates. Such studies generally find that rates drop rapidly as vitamin D levels rise above 5-10 ng/mL (12-25 nmol/L), then more slowly until levels of 40 ng/mL (100 nmol/L) are reached.
How vitamin D works
Vitamin D blocks the growth of cancer tumors. The active form of vitamin D, calcitriol, does most of the work. Calcitriol is made in the liver and in various organs affected by cancer. This form of vitamin D offers several benefits:
- Activates vitamin D receptors, which turn genes on and off
- Prevents cancer from starting (Calcitriol encourages cells to either adapt to their new organ or commit apoptosis [cell suicide].)
- Keeps surface layers of organs intact
- Limits blood supply to the tumor
- Reduces the spread of cancer
- Increases absorption of calcium from the intestines (Calcium may reduce the risk of colorectal cancer.)
Based on studies of colon and rectal cancer, vitamin D levels above 40 ng/mL (100 nmol/L) may reduce the risk of cancer. Taking 1000–4000 international units (IU) (25–100 mcg)/day of vitamin D may lower colorectal cancer risk.
Vitamin D and calcium
Studies have shown that taking both vitamin D and calcium provides additional cancer protection for many types of cancer. Calcium intake of more than 1000 mg/day from either diet or supplements is recommended.
Patients in one study took daily doses of 1100 IU (27.5 mcg) vitamin D and 1450 mg calcium. These patients had a 77% reduction in all-cancer rates between the ends of the first and fourth years of the study compared to those taking a placebo.
People with higher vitamin D levels at time of colorectal cancer diagnosis have better outcomes.
Harvard University studied patients with this cancer and vitamin D levels of about 25 ng/mL (63 nmol/L) or 31 ng/mL (78 nmol/L). Patients with higher vitamin D levels had half the death rates compared of those with lower vitamin D levels. A Japanese study found a similar effect for rectal cancer but not colon cancer.
Neither of these studies used vitamin D to treat colorectal cancer. However, vitamin D supplements may increase survival rates. Some cancer treatment centers are giving patients 5000 IU/day of vitamin D3 (cholecalciferol).
This evidence summary was written by:
William B. Grant, Ph.D.
Sunlight, Nutrition, and Health Research Center (SUNARC)
P.O. Box 641603
San Francisco, CA 94164-1603, USA
Complete bibliography of research used in this summary
The research we have cited in our summary is listed below, with links to PubMed abstracts and full-text for those who wish to explore further.
- Armstrong, B. Doll, R. Environmental factors and cancer incidence and mortality in different countries, with special reference to dietary practices. Int J Cancer. 1975 Apr 15; 15 (4): 617-31.
- Boscoe, F. P. Schymura, M. J. Solar ultraviolet-B exposure and cancer incidence and mortality in the United States, 1993-2002. BMC Cancer. 2006; 6264.
- Carroll, C. Cooper, K. Papaioannou, D. Hind, D. Pilgrim, H. Tappenden, P. Supplemental calcium in the chemoprevention of colorectal cancer: a systematic review and meta-analysis. Clin Ther. 2010 May; 32 (5): 789-803.
- Cross, H. S. Kallay, E. Regulation of the colonic vitamin D system for prevention of tumor progression: an update. Future Oncol. 2009 May; 5 (4): 493-507.
- Cross, H. S. Nittke, T. Peterlik, M. Modulation of vitamin D synthesis and catabolism in colorectal mucosa: a new target for cancer prevention. Anticancer Res. 2009 Sep; 29 (9): 3705-12.
- Devesa, S. S. Grauman, D. J. Blot, W. J. Pennello, G. A. Hoover, R. N. Fraumeni, J. F. Jr. Atlas of Cancer Mortality in the United States, 1950-1994. NIH Publication No. 99-4564. 1999 November 8, 2008;
- Fedirko, V. Bostick, R. M. Goodman, M. Flanders, W. D. Gross, M. D. Blood 25-hydroxyvitamin D3 concentrations and incident sporadic colorectal adenoma risk: a pooled case-control study. Am J Epidemiol. 2010 Sep 1; 172 (5): 489-500.
- Feskanich, D. Ma, J. Fuchs, C. S. Kirkner, G. J. Hankinson, S. E. Hollis, B. W. Giovannucci, E. L. Plasma vitamin D metabolites and risk of colorectal cancer in women. Cancer Epidemiol Biomarkers Prev. 2004 Sep; 13 (9): 1502-8.
- Fiscella, K. Winters, P. Tancredi, D. Franks, P. Racial Disparity in Blood Pressure: is Vitamin D a Factor?. Journal of general internal medicine. 2011 Apr 21;
- Freedman, D. M. Dosemeci, M. McGlynn, K. Sunlight and mortality from breast, ovarian, colon, prostate, and non-melanoma skin cancer: a composite death certificate based case-control study. Occup Environ Med. 2002 Apr; 59 (4): 257-62.
- Freedman, D. M. Looker, A. C. Chang, S. C. Graubard, B. I. Prospective study of serum vitamin D and cancer mortality in the United States. J Natl Cancer Inst. 2007 Nov 7; 99 (21): 1594-602.
- Gandini, S. Boniol, M. Haukka, J. Byrnes, G. Cox, B. Sneyd, M. J. Mullie, P. Autier, P. Meta-analysis of observational studies of serum 25-hydroxyvitamin D levels and colorectal, breast and prostate cancer and colorectal adenoma. Int J Cancer. 2010 May 6;
- Garland, C. Shekelle, R. B. Barrett-Connor, E. Criqui, M. H. Rossof, A. H. Paul, O. Dietary vitamin D and calcium and risk of colorectal cancer: a 19-year prospective study in men. Lancet. 1985 Feb 9; 1 (8424): 307-9.
- Garland, C. F. Comstock, G. W. Garland, F. C. Helsing, K. J. Shaw, E. K. Gorham, E. D. Serum 25-hydroxyvitamin D and colon cancer: eight-year prospective study. Lancet. 1989 Nov 18; 2 (8673): 1176-8.
- Garland, C. F. Garland, F. C. Do sunlight and vitamin D reduce the likelihood of colon cancer?. Int J Epidemiol. 1980 Sep; 9 (3): 227-31.
- Garland, C. F. Gorham, E. D. Mohr, S. B. Garland, F. C. Vitamin D for cancer prevention: global perspective. Ann Epidemiol. 2009 Jul; 19 (7): 468-83.
- Ginde, A. A. Liu, M. C. Camargo, C. A., Jr. Demographic differences and trends of vitamin D insufficiency in the US population, 1988-2004. Arch Intern Med. 2009 Mar 23; 169 (6): 626-32.
- Giovannucci, E. Epidemiology of vitamin D and colorectal cancer: casual or causal link?. J Steroid Biochem Mol Biol. 2010 Jul; 121 (1-2): 349-54.
- Giovannucci, E. Liu, Y. Rimm, E. B. Hollis, B. W. Fuchs, C. S. Stampfer, M. J. Willett, W. C. Prospective study of predictors of vitamin D status and cancer incidence and mortality in men. J Natl Cancer Inst. 2006 Apr 5; 98 (7): 451-9.
- Grant, W. B. An estimate of premature cancer mortality in the U.S. due to inadequate doses of solar ultraviolet-B radiation. Cancer. 2002 Mar 15; 94 (6): 1867-75.
- Grant, W. B. Lower vitamin-D production from solar ultraviolet-B irradiance may explain some differences in cancer survival rates. J Natl Med Assoc. 2006 Mar; 98 (3): 357-64.
- Grant, W. B. An ecologic study of cancer mortality rates in Spain with respect to indices of solar UVB irradiance and smoking. Int J Cancer. 2007 Mar 1; 120 (5): 1123-8.
- Grant, W. B. How strong is the evidence that solar ultraviolet B and vitamin D reduce the risk of cancer? An examination using Hill’s criteria for causality. Dermato-Endocrinology. 2009; 1 (1): 14-21.
- Grant, W. B. Relation between prediagnostic serum 25-hydroxyvitamin D level and incidence of breast, colorectal, and other cancers. J Photochem Photobiol B. 2010 May 12;
- Grant, W. B. Garland, C. F. A critical review of studies on vitamin D in relation to colorectal cancer. Nutr Cancer. 2004; 48 (2): 115-23.
- Grant, W. B. Garland, C. F. The association of solar ultraviolet B (UVB) with reducing risk of cancer: multifactorial ecologic analysis of geographic variation in age-adjusted cancer mortality rates. Anticancer Res. 2006 Jul-Aug; 26 (4A): 2687-99.
- IARC Vitamin D and Cancer. IARC Working Group Reports. 2008; 5465 pp.
- Jenab, M. et al Association between pre-diagnostic circulating vitamin D concentration and risk of colorectal cancer in European populations: a nested case-control study. BMJ. 2010; 340b5500.
- Ingraham, B. A. Bragdon, B. Nohe, A. Molecular basis of the potential of vitamin D to prevent cancer. Curr Med Res Opin. 2008 Jan; 24 (1): 139-49.
- Kuriki, K. Tajima, K. The increasing incidence of colorectal cancer and the preventive strategy in Japan. Asian Pac J Cancer Prev. 2006 Jul-Sep; 7 (3): 495-501.
- Kesse, E. Boutron-Ruault, M. C. Norat, T. Riboli, E. Clavel-Chapelon, F. Dietary calcium, phosphorus, vitamin D, dairy products and the risk of colorectal adenoma and cancer among French women of the E3N-EPIC prospective study. International journal of cancer. Journal international du cancer. 2005 Oct 20; 117 (1): 137-44.
- La Vecchia, C. Braga, C. Negri, E. Franceschi, S. Russo, A. Conti, E. Falcini, F. Giacosa, A. Montella, M. Decarli, A. Intake of selected micronutrients and risk of colorectal cancer. International journal of cancer. Journal international du cancer. 1997 Nov 14; 73 (4): 525-30.
- Lamprecht, S. A. Lipkin, M. Chemoprevention of colon cancer by calcium, vitamin D and folate: molecular mechanisms. Nat Rev Cancer. 2003 Aug; 3 (8): 601-14.
- Lappe, J. M. Travers-Gustafson, D. Davies, K. M. Recker, R. R. Heaney, R. P. Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial. Am J Clin Nutr. 2007 Jun; 85 (6): 1586-91.
- Liang, P. S. Chen, T. Y. Giovannucci, E. Cigarette smoking and colorectal cancer incidence and mortality: systematic review and meta-analysis. Int J Cancer. 2009 May 15; 124 (10): 2406-15.
- Ng, K. Meyerhardt, J. A. Wu, K. Feskanich, D. Hollis, B. W. Giovannucci, E. L. Fuchs, C. S. Circulating 25-hydroxyvitamin d levels and survival in patients with colorectal cancer. J Clin Oncol. 2008 Jun 20; 26 (18): 2984-91.
- Mezawa, H. Sugiura, T. Watanabe, M. Norizoe, C. Takahashi, D. Shimojima, A. Tamez, S. Tsutsumi, Y. Yanaga, K. Urashima, M. Serum vitamin D levels and survival of patients with colorectal cancer: post-hoc analysis of a prospective cohort study. BMC Cancer. 2010; 10347.
- Mizoue, T. Ecological study of solar radiation and cancer mortality in Japan. Health Phys. 2004 Nov; 87 (5): 532-8.
- Mizoue, T. Tanaka, K. Tsuji, I. Wakai, K. Nagata, C. Otani, T. Inoue, M. Tsugane, S. Alcohol drinking and colorectal cancer risk: an evaluation based on a systematic review of epidemiologic evidence among the Japanese population. Jpn J Clin Oncol. 2006 Sep; 36 (9): 582-97.
- Ng, K. Wolpin, B. M. Meyerhardt, J. A. Wu, K. Chan, A. T. Hollis, B. W. Giovannucci, E. L. Stampfer, M. J. Willett, W. C. Fuchs, C. S. Prospective study of predictors of vitamin D status and survival in patients with colorectal cancer. Br J Cancer. 2009 Sep 15; 101 (6): 916-23.
- Otani, T. Iwasaki, M. Sasazuki, S. Inoue, M. Tsugane, S. Plasma vitamin D and risk of colorectal cancer: the Japan Public Health Center-Based Prospective Study. Br J Cancer. 2007 Aug 6; 97 (3): 446-51.
- Peterlik, M. Cross, H. S. Vitamin D and calcium insufficiency-related chronic diseases: molecular and cellular pathophysiology. Eur J Clin Nutr. 2009 Sep 2;
- Peterlik, M. Grant, W. B. Cross, H. S. Calcium, vitamin D and cancer. Anticancer Res. 2009 Sep; 29 (9): 3687-98.
- Protiva, P. Cross, H. S. Hopkins, M. E. Kallay, E. Bises, G. Dreyhaupt, E. Augenlicht, L. Lipkin, M. Lesser, M. Livote, E. Holt, P. R. Chemoprevention of colorectal neoplasia by estrogen: potential role of vitamin D activity. Cancer Prev Res (Phila Pa). 2009 Jan; 2 (1): 43-51.
- Rheem, D. S. Baylink, D. J. Olafsson, S. Jackson, C. S. Walter, M. H. Prevention of colorectal cancer with vitamin D. Scand J Gastroenterol. 2010 Aug; 45 (7-8): 775-84.
- Takahashi, R. Mizoue, T. Otake, T. Fukumoto, J. Tajima, O. Tabata, S. Abe, H. Ohnaka, K. Kono, S. Circulating vitamin D and colorectal adenomas in Japanese men. Cancer Sci. 2010 Jul; 101 (7): 1695-700.
- Tangrea, J. Helzlsouer, K. Pietinen, P. Taylor, P. Hollis, B. Virtamo, J. Albanes, D. Serum levels of vitamin D metabolites and the subsequent risk of colon and rectal cancer in Finnish men. Cancer Causes Control. 1997 Jul; 8 (4): 615-25.
- Wactawski-Wende, J. Kotchen, J. M. Anderson, G. L. Assaf, A. R. Brunner, R. L. O’Sullivan, M. J. Margolis, K. L. Ockene, J. K. Phillips, L. Pottern, L. Prentice, R. L. Robbins, J. Rohan, T. E. Sarto, G. E. Sharma, S. Stefanick, M. L. Van Horn, L. Wallace, R. B. Whitlock, E. Bassford, T. Beresford, S. A. Black, H. R. Bonds, D. E. Brzyski, R. G. Caan, B. Chlebowski, R. T. Cochrane, B. Garland, C. Gass, M. Hays, J. Heiss, G. Hendrix, S. L. Howard, B. V. Hsia, J. Hubbell, F. A. Jackson, R. D. Johnson, K. C. Judd, H. Kooperberg, C. L. Kuller, L. H. LaCroix, A. Z. Lane, D. S. Langer, R. D. Lasser, N. L. Lewis, C. E. Limacher, M. C. Manson, J. E. Calcium plus vitamin D supplementation and the risk of colorectal cancer. N Engl J Med. 2006 Feb 16; 354 (7): 684-96.
- Wei, M. Y. Garland, C. F. Gorham, E. D. Mohr, S. B. Giovannucci, E. Vitamin D and prevention of colorectal adenoma: a meta-analysis. Cancer Epidemiol Biomarkers Prev. 2008 Nov; 17 (11): 2958-69.
- Woolcott, C. G. Wilkens, L. R. Nomura, A. M. Horst, R. L. Goodman, M. T. Murphy, S. P. Henderson, B. E. Kolonel, L. N. Le Marchand, L. Plasma 25-hydroxyvitamin D levels and the risk of colorectal cancer: the multiethnic cohort study. Cancer Epidemiol Biomarkers Prev. 2010 Jan; 19 (1): 130-4.
- Wu, K. Feskanich, D. Fuchs, C. S. Willett, W. C. Hollis, B. W. Giovannucci, E. L. A nested case control study of plasma 25-hydroxyvitamin D concentrations and risk of colorectal cancer. J Natl Cancer Inst. 2007 Jul 18; 99 (14): 1120-9.
- Yin, L. Grandi, N. Raum, E. Haug, U. Arndt, V. Brenner, H. Meta-analysis: longitudinal studies of serum vitamin D and colorectal cancer risk. Aliment Pharmacol Ther. 2009 Jul 1; 30 (2): 113-25.
- Lin, J. Zhang, S. M. Cook, N. R. Manson, J. E. Lee, I. M. Buring, J. E. Intakes of calcium and vitamin D and risk of colorectal cancer in women. American journal of epidemiology. 2005 Apr 15; 161 (8): 755-64.
- McCullough, M. L. Robertson, A. S. Rodriguez, C. Jacobs, E. J. Chao, A. Carolyn, J. Calle, E. E. Willett, W. C. Thun, M. J. Calcium, vitamin D, dairy products, and risk of colorectal cancer in the Cancer Prevention Study II Nutrition Cohort (United States). Cancer Causes Control. 2003 Feb; 14 (1): 1-12.
- Mizoue, T. Kimura, Y. Toyomura, K. Nagano, J. Kono, S. Mibu, R. Tanaka, M. Kakeji, Y. Maehara, Y. Okamura, T. Ikejiri, K. Futami, K. Yasunami, Y. Maekawa, T. Takenaka, K. Ichimiya, H. Imaizumi, N. Calcium, dairy foods, vitamin D, and colorectal cancer risk: the Fukuoka Colorectal Cancer Study. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology. 2008 Oct; 17 (10): 2800-7.
- Slattery, M. L. Neuhausen, S. L. Hoffman, M. Caan, B. Curtin, K. Ma, K. N. Samowitz, W. Dietary calcium, vitamin D, VDR genotypes and colorectal cancer. International journal of cancer. Journal international du cancer. 2004 Sep 20; 111 (5): 750-6.
- Ng, K. Sargent, D. J. Goldberg, R. M. Meyerhardt, J. A. Green, E. M. Pitot, H. C. Hollis, B. W. Pollak, M. N. Fuchs, C. S. Vitamin D status in patients with stage IV colorectal cancer: findings from Intergroup trial N9741. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2011 Apr 20; 29 (12): 1599-606.
- Yin, L. Grandi, N. Raum, E. Haug, U. Arndt, V. Brenner, H. Meta-analysis: Serum vitamin D and colorectal adenoma risk. Preventive medicine. 2011 Jun 13;