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Sun exposure and esophageal cancer: Does vitamin D help?

Posted on: March 16, 2013   by  John Cannell, MD

Sun exposure and esophageal cancer: Does vitamin D help?


Esophageal cancer is a relatively rare form of cancer, but some areas of the world have a markedly higher incidence than others: such as Belgium, China, Iran, Iceland, India, Japan, and the United Kingdom. The American Cancer Society estimates that just over 15 thousand cases of esophageal cancer are diagnosed in the United States every year.

In the United States, squamous cell carcinoma of the esophagus usually affects African Americans. The incidence of esophageal adenocarcinoma has been rising relatively rapidly over the last four decades. Humans cannot be evolving quickly enough for genetics to explain this rapid change. Instead, this indicates that environmental or behavioral factors have important roles in the etiology of the cancer. Such general evidence might make one ask, does vitamin D have a role?

Recently, Dr Joel Rubenstein of the University of Michigan Medical School wrote an editorial opining that while the vitamin D hypothesis is attractive, vitamin D should not be used to prevent esophageal cancer.

Rubenstein JH. Editorial: shedding some light on the etiology of adenocarcinomas of the esophagus and gastric cardia. Am J Gastroenterol. 2012 Dec;107(12):1814-6.

He pointed out that an ecological analysis found that counties in the United States with lower UVR exposure had greater incidences and mortality of esophageal cancer. However, ecological analyses are prone to biases called the “ecological fallacy,” because individual level data may differ from the population level data.

An example was the finding that suicide rates were more common in areas of Prussia that had higher proportions of Protestants. This in turn was interpreted as supporting the hypothesis that Catholicism prevents suicide. However, it may have been that all of the suicides in the heavily Protestant areas were committed by Catholics, and so the conclusion that Protestantism is associated with suicide would not be true, an example of the “ecological fallacy.”

A study in the same edition of the journal used residential location to examine the association between exposure to UV radiation and the frequency of cancer of the esophagus, finding a substantial inverse association between mean daily UVR exposure and adenocarcinomas of the esophagus (OR = 0.66).

Tran B, Lucas R, Kimlin M, Whiteman D, Neale R.  Association between ambient ultraviolet radiation and risk of esophageal cancer. Am J Gastroenterol. 2012 Dec;107(12):1803-13.

In contrast to an ecological study, the study reported by Tran et al. is not an ecological analysis, as the data on both the outcomes and the exposures were at the individual, rather than the population level. However, says Dr Rubenstein, there may have been measurement error.

Dr Rubenstein concludes,

“There is no evidence to support the use of (vitamin D) supplementation. The negative association with UVR exposure (found by Tran et al.) may be due to unmeasured confounders. Perhaps there are other environmental factors related to UVR exposure that explain the association (such as soil fungi, toxins from local flora, availability of micronutrients in locally grown produce, fall-out from  twentieth century nuclear weapons testing, etc.). Despite observational data suggesting protective effects, in most trials to date of vitamin or micronutrient supplementation for prevention of a number of different types of cancer, there has been no decrease in incidence or mortality, and in fact some have reported worse outcomes in the group randomized to supplementation.”

He is right; fallout from nuclear testing notwithstanding, the evidence does not support the use of vitamin D supplements to prevent esophageal cancer. However, the evidence is overwhelming that vitamin D supplements prevent vitamin D deficiency and such deficiency puts one at risk for a breathtaking array of diseases, one of which may or may not be esophageal cancer.

1 Response to Sun exposure and esophageal cancer: Does vitamin D help?

  1. Rita and Misty

    Dear Readers,

    If I may quote two points from Dr Cannell’s excellent article:

    1. “In the United States, squamous cell carcinoma of the esophagus usually affects African Americans.”

    2. “However, the evidence is overwhelming that vitamin D supplements prevent vitamin D deficiency and such deficiency puts one at risk for a breathtaking array of diseases, one of which may or may not be esophageal cancer.”

    Let’s just take a moment to seriously ponder these two points…

    I’ve said it before, and I’ll say it again…and I will continue to say it until we end this pandemic:

    Because of our indoor lifestyles, Vitamin D deficiency is at epidemic proportions in the United States…actually worldwide. And it is worse among those with darker skin pigmentation, as melanin factors greatly into Vitamin D production.

    The sunlight needs for people with darker skin pigmentation, living at higher latitudes, are immense and are not being met. A lighter pigmented person standing in full sun can produce a day’s bodily requirement of Vitamin D in about 15 minutes. In stark contrast, a person with darker skin pigmentation, standing in the same spot, will need approximately 6 times more sun exposure to produce the same amount of vitamin D. The following link will provide you with a thorough explanation:


    Furthermore, current research indicates that Vitamin D improves the antibacterial, antiviral and anti-parasitic functioning of the immune system, and people with low vitamin D levels in their blood are more likely to die from cancer, heart disease, stroke and many other diseases. According to reports by the United States Center for Disease Control and Prevention, African American suffer greatly from chronic diseases such as cancer, heart disease, fibromyalgia, lupus, and obesity which can be effectively controlled or prevented with vitamin D supplementation.

    Unfortunately, many African Americans do not know about the health enhancing properties of vitamin D so their health continues to deteriorate.

    Despite the alarming health situation for Blacks, conventional medical practitioners do not seem to be informing Black people that they may need to take at least 5,000 IU of vitamin D3, in supplement form, every day; and that Black children should also be given adequate amounts of vitamin D3 on a daily basis, because food and drinks do not supply adequate amounts of vitamin D.

    Instead, all of us continue to be overloaded with prescription medications that treat the symptoms of illnesses while the causative factors are left unaddressed.

    Vitamin D deficiency is a huge and serious public health issue…the irony of it all ist that it is also one of these easiest (easiest) public health issues to resolve.

    Test and supplement to reach and maintain 50 ng/ml — 80 ng/ml.

    I am always (always) amazed at the ignorance among the intelligent. It astounds me.

    To sunnier days,

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