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Vitamin
D Levels Linked to Breast-Cancer Prognosis
Women who are vitamin D deficient when they are diagnosed with breast cancer are more likely to have their disease spread and are more likely to die than women who have adequate vitamin D levels, new Canadian research says. The study found that women who were vitamin D deficient were 94 per cent more likely to have their cancer metastasize (spread) and 73 per cent more likely to die. The research was led by Dr. Pamela Goodwin, a breast cancer researcher at Mount Sinai Hospital in Toronto. The study analyzed blood samples and disease outcome from more than 500 women diagnosed with breast cancer between 1989 and 1995. Women were followed up for an average of 11 years. The study found that when they were diagnosed with breast cancer:
The study also found that 69 per cent of women deficient in vitamin D had their disease metastasize, while 74 per cent were still alive 10 years later. Yet among those with adequate vitamin D levels, 83 per cent of women did not have their cancer spread and 85 per cent were still alive after 10 years. Dr. Reinhold Veith of Mount Sinai Hospital, said that vitamin D is a crucial part of normal cell function. "Vitamin D is a basic that cells need to function properly. If you take that away they don't behave properly and are at greater risk of becoming cancerous." Previous studies have linked low levels of vitamin D with an increased risk of developing breast cancer. Because breast cancer tumours have vitamin D receptors, the vitamin can slow the growth rate of cancer cells and make them less aggressive, the researchers said. Time to test your Vitamin D levels? Goodwin said that it is too early to tell all women with breast cancer to increase their vitamin D intake. However, women may want to have their blood levels of vitamin D measured and, if they are low, supplement to bring them up to the acceptable level of 72 nanomoles per litre. However, if her findings are confirmed in a second study, the next step will be to test how raising vitamin D levels in breast cancer patients might affect their prognosis. "I think it would be very worthwhile to see if improving those vitamin D levels will lead to improved breast cancer outcomes," Goodwin said. "Can we really reduce the risk of recurrence in half by increasing vitamin D levels into the clinically adequate range? That would be very interesting question and a very important question to answer." People get most of their vitamin D from sunlight. After being exposed to the sun, the skin produces vitamin D, which is then converted to its active form by the kidney. Vitamin D is also easy to get from nutritional supplements. Daily recommendations for vitamin D intake vary, but the average recommendation is 1,000 international units (IU). Every 1,000 IU of vitamin D translates to a 25 nanomole per litre increase of vitamin D in the blood. Carole Baggerly is one breast cancer patient who swears by vitamin D. She was diagnosed with breast cancer more than three years ago, and had a mastectomy followed by both radiation and chemotherapy. The 65-year-old San Diego resident had her vitamin D level measured two years after her diagnosis, and found it to be very low. Her doctors told her she had osteoporosis, which is also linked to low vitamin D levels. Baggerly started taking 5,000 international units (IU) of vitamin D per day for her bones and to improve her chances of staying cancer-free. "To be able to reduce this with nothing more than vitamin D, as opposed to having to take some of these very toxic, other drugs, I think is extremely exciting and should be very exciting to every woman," Baggerly said. She now runs a website, www.grassrootshealth.org, where she extols the virtues of vitamin D. "It's so easy, it's simple, it's cheap, it's almost risk free, and if people knew about it they would be healthy," Baggerly said. With a report from CTV's medical correspondent Avis Favaro and senior producer Elizabeth St. Philip. Abstract:Vitamin D (Vit D) deficiency is common at breast cancer (BC) diagnosis and is associated with a significantly higher risk of distant recurrence and death in a prospective cohort study of T1-3, N0-1, M0 BC. Author Block: P. J. Goodwin, M. Ennis, K. I. Pritchard, J. Koo, N. Hood; Samuel Lunenfeld Research Institute, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; St. Michael's Hospital, Toronto, ON, Canada Background: Vit D acts through a nuclear transcription factor to regulate many aspects of cellular growth and differentiation. Low levels have been associated with increased BC risk. We examined Vit D levels and prognostic effects in an existing BC cohort. Methods: 512 consecutive women with newly diagnosed BC were enroled at 3 U of Toronto hospitals between 1989 and 1995. A blood specimen obtained at diagnosis was stored at -80¡ãC. The Block questionnaire was used to measure diet intake. Clinical and pathology data were obtained from medical and pathology records. 25-OH Vit D was measured by radioimmunoassay. Women were followed prospectively to 2006. Results: Mean age was 50.4¡À9.7 yrs. 288 women had T1 tumors, 164 T2 and 24 T3/4. 356 tumors were N0. 342 were estrogen receptor (ER) positive. 73 tumors were grade 1, 202 grade 2 and 173 grade 3. 199 women received adjuvant chemotherapy (CXT) and 200 received tamoxifen. 116 women (22.7%) had distant recurrences and 106 (20.7%) died during a median follow-up of 11.6 yrs. Mean 25-OH Vit D was 58.1¡À23.4 nmol/L. Vit D levels were deficient (<50 nmol/L) in 192 (37.5%), insufficient (50-72 nmol/L) in 197 (38.5%) and adequate (>72 nmol/L) in 123 (24.0%). Low Vit D levels were associated with premenopausal status, high body mass index (BMI), high insulin and high tumor grade (all p¡Ü0.03). Low Vit D levels were associated with low dietary intake of retinol, Vitamin E, grains and alcohol (all p<0.02). Vit D was marginally lower when drawn in winter (Oct-Mar) vs summer (Apr-Sept) months (56.7 vs 59.5 nmol/L, p=0.07). Distant disease-free survival (DDFS) was significantly worse in women with deficient (vs adequate) Vit D levels (HR 1.94, 95% CI 1.16-3.24, p=0.02) as was overall survival (OS) (HR 1.73, 95% CI 1.05-2.86, p=0.02). Vit D associations with DDFS were independent of age, BMI, insulin, T and N stage, ER and grade (all HR ¡Ý1.55 Q1 vs Q4, all p ¡Ü 0.04); they were not significantly modified by ER, adjuvant CXT or tamoxifen. Vit D associations with OS were attenuated by grade and were absent in ER negative BC. Conclusions: Vit D deficiency is common at BC diagnosis and is associated with poor prognosis. Taking
Vitamin D Revolution to the Next Step The problem is, leading vitamin D researchers are already loaded with reams of scientific studies, and it's about time to aim this information at the public as well as health professionals, who are eager to learn of this discovery. The challenge is, how to get accurate and authoritative information into eager hands? Public uncertainty is high. People have heard about recent vitamin D discoveries, but they want to obtain assurance and instruction from their doctors before embarking upon a regimen to increase vitamin D levels. This may sound a bit silly, since vitamin D is obtained freely from skin exposure to midday UV-B sun rays. At a brief glance, it doesn't appear the public needs instruction how to get out in the sun. But since the dermatology community made the public phobic over sun exposure, fearing more skin cancer, and medical textbooks mistakenly warn the public away from higher-dose vitamin D supplements, the public is a bit confused. Can vitamin D pills be taken with medicines? Can I overdose? Can I take vitamin D pills if I'm out in the sun all day? These are some of the questions. Even doctors were trained to be cautious in prescribing vitamin D, so they need first-hand instruction on safety and applications of vitamin D therapy. Enter Carole Baggerly, founder of Grassroots Health, a non-profit organization that wants to carry the torch for vitamin D. The trigger for her role as a sparkplug for the unfolding vitamin D revolution was her own ordeal --- breast cancer. After undergoing breast removal, chemo and radiation therapy, treatment she thinks is barbaric, Carole kept saying to herself, "there has to be a better way. But what?" It took another unwelcome disease diagnosis for Carole Baggerly to find it. Her doctor informed her she had osteoporosis. Carole asked why. Why me? Her doctor said, maybe it's due to a low vitamin D level. Tests confirmed she was deficient (about 20 nanograms per milliliter in blood serum) for adequate bone health. Just about then, Dr. Cedric Garland of the University of California, San Diego, had published authoritative data showing the risk for breast cancer could be reduced by 50% with adequate levels of vitamin D (48 nanograms per milliliter). Carole reached the same freezing point the public now has -- she didn't know what to do. She sought out a world expert, Dr. Anthony Norman at University of California, Riverside. She asked Dr. Norman, "is the research on vitamin D true?" A two-and-a-half hour lecture later, Carole was beginning to be convinced. But she needed to hear more. She attended a scientific workshop on Vitamin D and Cancer at the National Cancer Institute in Washington, DC. It was there that Carole literally jumped out of her turtle shell as an attendee of the workshop to become a change agent for vitamin D. Panel experts concluded more research needed to be done. To the contrary, Carole felt it was also time to get word out to the public, that cancer is too life-threatening of a disease to wait for more research when vitamin D therapy is safe and economical. She was appalled at the lack of urgency shown by many attendees at the conference. Before she left Washington DC, a dozen or so people came to her and said something must be done. Then, with her husband in tow, they both motorhomed to visit all the leading vitamin D researchers in the country and interview them firsthand. The list included Drs. Robert Heaney and Joan Lappe at Creighton University in Omaha, Reinhold Vieth PhD of Toronto University, Dr. John Cannell, founder of The Vitamin D Council in Atascadero, California, William Grant of the Sunlight, Nutrition and Health Research Center in San Francisco, Cedric Garland Dr. P.H. at University of California, San Diego, Bruce Hollis PhD from the Medical University of South Carolina, Anthony Norman, PhD, University of California, Riverside, and Walter Willet, MD, Dr. P.H. and Edward Giovannucci, MD, ScD. of the Harvard School of Public Health, and Michael Holick MD, PhD of Boston University Medical Center. Carole mulled over how to become a change agent without much of a budget. She started by urging vitamin D researchers to develop a consensus statement over dosage. They came up with a recommended range of vitamin D blood concentration -- 40-60 nanograms per milliliter sample of blood serum. She then founded GrassrootsHealth, a non-profit corporation, to sponsor teaching seminars across the country about vitamin D for health professionals. Next, Carole began attending medical association meetings, to prod them to produce policy statements regarding vitamin D. Work is now going on within the American Medical Association, the American Public Health Association, the American College of Physicians and the American College of Preventive Medicine. Carole's latest developments are a set of community health projects on Chronic Diseases and Health Disparities. Carole's prior experience in the computer industry has also led her to the observation that 'there's a better way' for getting the public involved in health. The first seminar, free for health professionals, is fully subscribed. Over 150 health professionals have registered, some from foreign countries. Dr. Cedric Garland, when he heard the seminar registration was standing room only, said "I never thought this would happen in my lifetime." Carole even has the Black Nurses Association volunteering their time as volunteers at the conference, invigorated by a presentation Carole made for their group. Black American health professionals need to lead the way, especially since Black Americans need far more sunshine to produce adequate levels of vitamin D compared to Caucasians. Carole is utilizing skills she learned as a business woman in the computer software industry. Her desk at home serves as the world headquarters for GrassrootsHealth. The internet expands her reach to the world. She says it's the biggest health development presented to humankind since clean water. She thinks of the fact that Edward Mellanby discovered vitamin D in 1922. The question arises in her mind and others, why didn't this message get out to the public sooner? Carole ended her interview with a touching story. Preliminary studies show vitamin D may be a godsend for young children stricken with autism. She sent a note to a pediatrician friend about that. Three days later her note was passed on by the doctor to a third party, a mom with an autistic child. That mom began taking her autistic child outdoors to get more midday sun, with noticeable improvement in behavior. The vitamin D revolution trudges forward, one person at a time. For more information about vitamin D, and to see how you can help in this revolution, visit www.grassrootshealth.org Contact: Carole Baggerly, founder and director Black Nurses Association Leads Disease Prevention Effort with Vitamin D “The San Diego Black Nurses Association looked at their major health priorities, namely reducing healthcare disparities in the areas of diabetes, hypertension, cardiovascular disease, breast cancer, prostate cancer and influenza and listened to Carole Baggerly, Director of GrassrootsHealth, do a presentation on the disease prevention capabilities of vitamin D and the group said ‘we’re your volunteer spokespeople!’” reported Syvera Hardy, Director of Public Relations for the Nurses Association. “Anything that can have a potential reduction in the incidence of these chronic diseases of 50% or more is critical to our community. We want to help get the word out to the public about the need to solve the vitamin D deficiency situation. It’s urgent and its solution is inexpensive, easy and safe!” The group has signed up as volunteers to assist in the ‘Diagnosis & Treatment of Vitamin D Deficiency’ Seminar, a UCSD School of Medicine Accredited CME seminar on April 9th, sponsored by GrassrootsHealth. “We designed the seminar to address the need of the healthcare professionals to know how to treat the deficiency that they keep reading about in the news media”, said Ms. Baggerly. “We have spent a year traveling the country, speaking with the researchers, trying to see what the message needed to be and came to the conclusion that everyone was interested in ‘getting on with it!’, i.e., knowledgeably solving the deficiency problem. One hundred fifty people are currently signed up for the seminar and they’re coming from all over the country including Puerto Rico, Finland and the UK as well! All are coming for a 5 hour seminar. We had hoped for 30-50 attendees and were totally surprised when so many people signed up.” The featured presenters are all experienced researchers and/or practitioners using vitamin D with their patients. Cedric F. Garland, Dr. P.H., Moores UCSD Cancer Center, said “I didn’t think this call to action would happen in my lifetime! Now, we can get on with preventing cancer!” Dr. Garland is one of the world’s leading researchers on the impact of vitamin D and cancer. “It is not unlikely that the higher mortality rate amongst blacks from cancer is due to a vitamin D deficiency,” says Dr. Garland. “Low vitamin D occurs in approximately 42.4% of African American women vs 4.2% Caucasian women according to an NHANES III study of women of child-bearing age, 1988-94” according to Bruce Hollis, PhD, another one of the seminar’s speakers. Based on work that Dr. Hollis is doing at the Medical University of South Carolina, “essentially 100% of women of color are vitamin D insufficient during pregnancy. Low vitamin D is a risk factor for a diverse range of disorders from type 1 diabetes to cancer.” According to Ms. Hardy, fifteen of the members of the San Diego Black Nurses Association are attending the seminar so they can be better informed about how to take this message to their community. “We will be taking this information to our National Conference in August, that’s for sure!” says Ms. Hardy. GrassrootsHealth will be working with the nurses’ group to provide vitamin D expertise and resources for their promotion efforts. More information about the seminar is at http://www.grassrootshealth.org/seminar.htm. For Information contact: Carole Baggerly Cedric F. Garland, Dr. P.H., F.A.C.E. Syvera Hardy, RN Bruce W. Hollis, PhD Vitamin
D Consensus Letter TO WHOM IT MAY CONCERN Scientists' Letter on Vitamin D for Cancer and other Disease Prevention We are aware
of substantial scientific evidence supporting the role of vitamin
D in prevention of cancer. It has been reasonably established that
adequate serum vitamin D metabolite levels are associated with
substantially lower incidence rates of several types of cancer,
including those of the breast, colon, and ovary, and other sites. Higher vitamin D status can be achieved in part by increased oral intake of vitamin D3. The appropriate intake of vitamin D3 for cancer risk reduction depends on the individual's age, race, lifestyle, and latitude of residence. New evidence indicates that the intake should be 1000-2000 IU per day. Intake of 2000 IU/day is the current upper limit of the National Academy of Sciences, Institute of Medicine, Food and Nutrition Board. New evidence also indicates that the upper limit should be raised substantially. The levels that are needed to prevent a substantial proportion of cancer would also be effective in substantially reducing risk of fractures, Type I childhood diabetes and multiple sclerosis. Greater oral intakes of vitamin D3 may be needed in the aged and in individuals who spend little time outdoors, because of reduced cutaneous synthesis. Choice of a larger dose may be based on the individual's wintertime serum 25(OH)D level. For those choosing to have serum 25-hydroxyvitamin D tested, a target serum level should be chosen in consultation with a health care provider, based on the characteristics of the individual. An approximate guide-line for health care providers who choose to measure serum 25-hydroxyvitamin D in their patients would to aim for 40-60 ng/ml, unless there are specific contraindications. Contraindications are extremely rare, and are well known to physicians. No intervention is free of all risk, including this one. Patients should be advised of this, and advised in detail of risks that may be specific to the individual. Any risks of vitamin D inadequacy considerably exceed any risks of taking 2000 IU/day of vitamin D3, which the NAS-IOM regards as having no adverse health effect. A substantially higher level of support for research on the role of vitamin D for the prevention of cancer is urgently needed. However, delays in taking reasonable preventive action on cancer by ensuring nearly universal oral intake of vitamin D3 in the range of 1000-2000 IU/day is costing thousands of lives unnecessarily each year that are lost due to fractures, cancer, diabetes, multiple sclerosis, and other diseases for which vitamin D deficiency plays a major role. Signed: Cedric F. Garland,
Dr.P.H., F.A.C.E. Frank C. Garland,
Ph.D. Edward Giovannucci,
M.D., Sc.D Edward D. Gorham,
M.P.H., Ph.D. William B. Grant,
Ph.D. John Hathcock Robert P. Heaney,
M.D. Michael F. Holick,
Ph.D., M.D. Bruce W. Hollis,
Ph.D. Joan M. Lappe,
Ph.D., R.N., F.A.A.N. Anthony W. Norman,
Ph.D. Reinhold Vieth
Ph.D., F.C.A.C.B. Vitamin
D Dramatically Cuts Cancer Risk: Study A landmark new study is raising the tantalizing spectre that a simple and cheap vitamin supplement may offer a highly effective way of preventing cancer. The research, published in the online edition of the American Journal of Clinical Nutrition, finds that a combination of vitamin D3 and calcium has a substantially marked effect on reducing cancer incidence. The four-year study out of Creighton University in Nebraska found that women who regularly took vitamin D3 had a 60 per cent reduction in cancer infections compared to a group taking placebos. The study followed 1,179 healthy, women 55 years and older from rural eastern Nebraska between 2000 and 2005. Participants were randomly assigned to receive 1400-1500 mg of calcium alone, or supplemental calcium plus 1,100 IU vitamin D3, or placebo. The researchers studied only vitamin D3, which comes from animal sources and seems to be more active than vitamin D2, which is derived from plant sources. Among the 288 women taking placebo, 20 developed breast, colon, lung or another form of cancer. Among the 445 women taking just calcium, 17 developed cancer. But among the largest group -- the 446 women taking vitamin D daily -- just 13 developed cancer. " What we found is that a vitamin D supplement decreased the cancer incidence in postmenopausal women by about 60 per cent," lead investigator Joan Lappe, an associate professor of both medicine and nursing at Creighton University, told CTV News. On the premise that some of the women who did develop cancer may have entered the study with undiagnosed cancers, researchers then eliminated the first-year results and looked at the last three years of the study. When they did that, the results became even more dramatic with the calcium/vitamin D3 group showing a startling 77 per cent cancer-risk reduction. " The findings are very exciting. They confirm what a number of vitamin D proponents have suspected for some time but that, until now, have not been substantiated through clinical trial," said Lappe. " Vitamin D is a critical tool in fighting cancer as well as many other diseases." While the study was open to all ethnic groups, all participants were Caucasian, she noted. Lappe said further studies are needed to determine whether the results apply to different ethnic groups, to men, and to women of all ages. This is not the first time that researchers have noted the health benefits of vitamin D. In February, two studies found that the vitamin was linked to lower rates of breast cancer and colorectal cancer. The "sunshine vitamin," as it's sometimes called, has also been shown to kill some cancer cells in laboratory experiments. " There's
a lot of evidence out there that populations in first world countries
are deficient in vitamin D and if you give them more, we can prevent
cancers and other diseases that have been reported to be prevented
with vitamin D," said Lappe. " The vitamin
D story is what I call a 'no-lose' proposition. Take it. You can
only win," he told CTV News. Because of the growing body of evidence about vitamin D, for the first time, the Canadian Cancer Society is recommending a specific amount of supplementation for Canadians to consider taking. The Society is now recommending that:
" The evidence is still growing in this area, but we want to give guidance to Canadians about this emerging area of cancer prevention based on what we know now," said Heather Logan, director of Cancer Control Policy with the Canadian Cancer Society. " We're recommending 1,000 IUs daily because the current evidence suggests this amount will help reduce cancer risk with the least potential for harm," said Logan. " As we find out more we will update our recommendation." Logan cautions Canadians about relying too much on getting vitamin D through exposure to sunlight. "It's not a good idea to rely solely on the sun to obtain vitamin D," said Logan. "For some people, it's possible that just a few minutes of unprotected sun exposure every day could increase skin cancer risk." The Cancer Society is not changing its SunSense guidelines, as skin cancer is the most frequently diagnosed cancer in Canada. The Society recommends that people reduce their exposure to the sun, particularly between 11 a.m. and 4 p.m. when the sun's rays are the strongest. And use a sunscreen with a sun protection factor (SPF) 15 or higher and SPF 30 if you work outdoors or if you will be outside for most of the day. With a report from CTV medical specialist Avis Favaro and medical producer Elizabeth St. Philip |