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New meta-analysis on vitamin D levels, menopause and risk of breast cancer

Posted on: July 27, 2013   by  John Cannell, MD

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In 2008, breast cancer caused more than 458,000 deaths worldwide (13.7% of cancer deaths in women). Survival rates in the Western world are high; for example, 84% of women in England diagnosed with breast cancer survive for at least 5 years. In developing countries, survival rates are much poorer although the incidence rates in many developing countries are much lower than in the US.

The USA has the highest incidence of breast cancer in the world. In twelve world regions, the incidence rates per 100,000 women are as follows: in Eastern Asia, 18; South Central Asia, 22; sub-Saharan Africa, 22; South-Eastern Asia, 26; North Africa and Western Asia, 28; South and Central America, 42; Eastern Europe, 49; Southern Europe, 56; Northern Europe, 73; Oceania, 74; Western Europe, 78; and in North America, 90. As you see, the rates in The US are more than four times higher than in other areas of the world, although one wonders about proper reporting from the developing world.

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15 Responses to New meta-analysis on vitamin D levels, menopause and risk of breast cancer

  1. Rita and Misty

    Dr. Cannell,

    From your above article: “Recently researchers at Harvard led by Scott Bauer working under the supervision of Professor Eric Ding found in their study that higher vitamin D levels have no protective effect in premenopausal breast cancer…”

    I’m extremely confused here, as in January of this year (2013), I know that the University of California, San Diego School of Medicine published the results of a recent study that shows a link between low vitamin D serum levels and premenopausal breast cancer.

    According this THIS study, premenopausal women with low vitamin D serum levels are at a greatly increased risk for breast cancer.

    http://health.ucsd.edu/news/releases/Pages/2013-01-24-breast-cancer-linked-to-vitamin-d-levels.aspx

    So, I ask you:

    WHAT’S UP WITH THIS?

  2. Rita and Misty

    I think it is only fair that women know about BOTH studies. And, if we are to speak of a negative study, it needs ALSO to be mentioned in the same article that there have recently been studies indicating a POSITIVE effect of vitamin d upon premenopausal breast cancer numbers.

    How can any woman make an informed decision without having all the necessary information for her review?

    Also, from your above article:

    “They had no data on women with levels greater than 42 ng/ml, but the curve was flat from 37 to 42 ng/ml.”

    Perhaps 42 ng/ml is simply too low a 25(OH)D level?

    What would the results have been if an optimal 25(OH)D level of (at least) 50 ng/ml had been utilized?

    I venture to say that Harvard’s results would have been quite different if 50 ng/ml had been the target number.

  3. Rita and Misty

    Additionally from your above article:

    “To clarify the extent of benefit of vitamin D in preventing breast cancer (if any benefit at all), there is a trial underway called the VITAL study at Harvard, which is studying cancer rates in people supplanted with an extra 2,000 IU/day of D3. However, their results are not due until 2017. ”

    1. 2,000 iu d3/daily is like spitting in the ocean (sorry for the graphic description, but I’d like to get my point across to you in politely strong words).

    2. If we all wait until 2017, how many women will die needlessly? (and I know you know that I ask a valid question).

    3. It’s already been proven that low levels of vitamin d are linked to more aggressive breast cancer: http://www.webmd.com/breast-cancer/news/20110429/low-vitamin-d-linked-to-aggressive-breast-cancer

  4. Rita and Misty

    I apologize to the readership for being so upset regarding this particle post. However, it concerns me, because if a woman visiting this site for the very first time, reads this article and knows nothing about previous research regarding vitamin d and breast cancer, she might have the impression that there is no connection between vitamin d levels and breast cancer.

    How sad would this be? Is this the “take away” message we would want a new reader to get?

    Let’s remember that back in 2011, Dr. Cedric Garland and colleagues estimated that a serum level of 50 ng/ml is associated with 50 percent lower risk of breast cancer.

    I think THIS is what we would want a new reader to realize….

  5. Rita and Misty

    To quote:

    Dr. John Jacob Cannell (February 11, 2013):

    “In other words, to date, apparently all the studies show that breast cancer survivors with high vitamin D levels live longer; someone should do a meta-analysis.

    Breast cancer survivors can either do nothing but wait for more studies, risking being vitamin D deficient, or take enough vitamin D (5,000 IU/day) to obtain natural levels (around 50 ng/ml) while waiting for more studies. The choice is yours.”

    https://www.vitamindcouncil.org/blog/vitamin-d-levels-and-breast-cancer-survival/

  6. Dr William Grant

    The problem with the Bauer et al. study is that they used data from prospective studies, not case-control studies. The difference between the two types of studies is that in prospective studies, serum 25(OH)D levels are determined from blood draw at time of enrollment but the cancer occurs many years later, while in case-control studies, serum 25(OH)D levels are determined at time of cancer diagnosis. There are about six case-control studies of breast cancer incidence rates with respect to serum 25(OH)D. They consistently show that incidence rates are lower for higher serum 25(OH)D levels out to about 40 ng/ml. Breast cancer can develop extremely fast, which is why breast cancer incidence rates are highest in spring and fall: in summer, vitamin D reduces risk, in winter, melatonin reduces risk.

    See these two open access papers to see the problem with prospective studies:
    Grant WB. Effect of interval between serum draw and follow-up period on relative risk of cancer incidence with respect to 25-hydroxyvitamin D level; implications for meta-analyses and setting vitamin D guidelines. Dermatoendocrinol. 2011;3(3):199-204.
    Grant WB. Effect of follow-up time on the relation between prediagnostic serum 25-hydroxyitamin D and all-cause mortality rate. Dermatoendocrinol. 2012;4(2):198-202.
    They can be found through searching pubmed.gov

    also, for my meta-analysis of case-control studies of breast cancer-25(OH)D relation
    Grant WB. A review of the evidence regarding the solar ultraviolet-B–vitamin D–cancer hypothesis. Standardy Medyczne/Pediatria. 2012;9:610-9.
    http://www.vitamindwiki.com/A+review+of+the+evidence+regarding+the+solar+ultraviolet-B-vitamin+D-cancer+hypothesis+-+Oct+2012

  7. Rita and Misty

    Thanks, Dr. Grant~~I thought I was writing to myself here… 🙂

    I appreciate your reply.

    And, please ladies, keep your 25(OH)D level at optimal, range being 50 ng/ml–80 ng/ml.

    Be well,
    Rita

  8. Dr William Grant

    Well, it is early Sunday morning

  9. Rita and Misty

    Only on the west coast (and I still think your clocks off). 🙂

  10. IAW

    To: Rita
    You said “I apologize to the readership for being so upset regarding this particle post. However, it concerns me, because if a woman visiting this site for the very first time reads this article and knows nothing about previous research regarding vitamin d and breast cancer, she might have the impression that there is no connection between vitamin d levels and breast cancer.” Absolutely no apology is necessary! I for one whole heartedly agree with you.
    You also said “And, if we are to speak of a negative study, it needs ALSO to be mentioned in the same article that there have recently been studies indicating a POSITIVE effect of vitamin d upon premenopausal breast cancer numbers.” I also agree!
    Thanks to Dr. William Grant for the “science/studies lesson”!

  11. Rita and Misty

    IAW~~

    I always appreciate your support! Thank you!!

    And, Bill Grant did provide an excellent response, thank you as well!!!..BTW–I am SORRY, Dr. Grant, for waking you up so early this morning! I hope you were able to get some additional rest.

    IAW, I think, though, that John Cannell was being tongue-in-cheek with today’s article. And, Dr. Cannell, perhaps I did respond from my emotional side. But, as you know, I have a very dear friend who is a premenopausal breast cancer survivor. This is an extremely painful, and emotional topic for me, John. And it upsets me that any woman might put her health in jeopardy by not keeping her 25(OH)D level at optimal. I think you will agree with me on this??

    IAW, I take heart in Dr. Cannell’s conclusions from February of this year, and look to the below statements as being John’s true thoughts on this subject.

    Dr. Cannell and Dr. Grant, both of you are great, and we must continue to push forward. We haven’t won yet. Only a win is acceptable (imo).

    Dr. John Jacob Cannell (February 11, 2013):

    “In other words, to date, apparently all the studies show that breast cancer survivors with high vitamin D levels live longer; someone should do a meta-analysis.

    Breast cancer survivors can either do nothing but wait for more studies, risking being vitamin D deficient, or take enough vitamin D (5,000 IU/day) to obtain natural levels (around 50 ng/ml) while waiting for more studies. The choice is yours.”

    https://www.vitamindcouncil.org/blog/vitamin-d-levels-and-breast-cancer-survival/

  12. Rita and Misty

    I understand that the mission of the Vitamin D Council is one of educating the public. However, I encourage the Vitamin D Council to consider its role to include educating policy makers. This is where true change will occur.

    Certainly grassroots, door-to-door, person-to-person, outreach is always needed–BUT ISN’T ENOUGH.

    Real, lasting and forceful change will only occur at the policy level. And such change requires Change Management, just like any business….and this is a business.

    We are in the business of saving lives….

    “The history of the role of vitamin D in human health is rich and much of that history is yet to be written not only by scientists, but by policy makers with the vision and leadership necessary to bridge the gap between research and policy.”

    http://www.ncbi.nlm.nih.gov/pubmed/19185802

  13. rcbaker200@comcast.net

    I’d like to point out that the studies that show a marked reduction of vitamin D with a level of 47 ng or so have gotten very little if any publicity in the lay press. The studies that seem to make the press are those that use ridiculously low doses of vitamin D and as a result have little if any effect.
    We’re familiar with policy makers who have admirable motivations. However educating policy makers is a very problematic issue. Some policy makers have an agenda and different motivations and goals.

  14. Rita and Misty

    @rcbaker200@comcast.net,

    I understand how we in the Vitamin d community may become exhausted at trying to effect change. It is hard work, and when we bump up against policy makers that have their own agendas and different motivations and goals, it is frustrating, for sure.

    It is then that we must remember our agenda, motivations and goals.

    We must become crystal clear in what we want, or we won’t get it.

    We still must unite, support, direct and push forward. Or, in five years, we will ALL still be here on our little BLOG chatting away with ourselves…preaching to our little, tiny choir…

    It that what we want? It’s not what I want.

    All change is difficult, but possible.

    We must identify the stakeholders and begin to establish ties based on trust and loyalty.

    Average people, policy makers, researchers and physicians alike will all need to be convinced by charismatic leadership.

    Again, I ask you, has anyone used the “six degrees of separation” to go at a round of golf?

    Much good can occur on the golf course….

    (I hope someone is reading me).

    Best,
    Rita

  15. Rita and Misty

    Establishing friendship, trust and loyalty is the only way to call in your chits.

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