Two new vitamin D studies using a sophisticated form of analysis called meta-analysis, in which data from multiple reports is combined, have revealed new prescriptions for possibly preventing up to half of the cases of breast cancer and two-thirds of the cases of colorectal cancer in the United States. The work was conducted by a core team of cancer prevention specialists at the Moores Cancer Center at University of California, San Diego (UCSD), and colleagues from both coasts.
The breast cancer study, published online in the current issue of the Journal of Steroid Biochemistry and Molecular Biology, pooled dose-response data from two earlier studies - the Harvard Nurses Health Study and the St. George's Hospital Study - and found that individuals with the highest blood levels of 25-hydroxyvitamin D, or 25(OH)D, had the lowest risk of breast cancer.
The researchers divided the 1,760 records of individuals in the two studies into five equal groups, from the lowest blood levels of 25(OH)D (less than 13 nanograms per milliliter, or 13 ng/ml) to the highest (approximately 52 ng/ml). The data also included whether or not the individual had developed cancer.
"The data were very clear, showing that individuals in the group with the lowest blood levels had the highest rates of breast cancer, and the breast cancer rates dropped as the blood levels of 25-hydroxyvitamin D increased," said study co-author Cedric Garland, Dr.P.H. "The serum level associated with a 50 percent reduction in risk could be maintained by taking 2,000 international units of vitamin D3 daily plus, when the weather permits, spending 10 to 15 minutes a day in the sun."
The colorectal cancer study, published online February 6 in the American Journal of Preventive Medicine, is a meta-analysis of five studies that explored the association of blood levels of 25(OH)D with risk of colon cancer. All of the studies involved blood collected and tested for 25 (OH)D levels from healthy volunteer donors who were then followed for up to 25 years for development of colorectal cancer.
As with the breast cancer study, the dose-response data on a total of 1,448 individuals were put into order by serum 25(OH)D level and then divided into five equal groups, from the lowest blood levels to the highest.
"Through this meta-analysis we found that raising the serum level of 25-hydroxyvitamin D to 34 ng/ml would reduce the incidence rates of colorectal cancer by half," said co-author Edward D. Gorham, Ph.D. "We project a two-thirds reduction in incidence with serum levels of 46ng/ml, which corresponds to a daily intake of 2,000 IU of vitamin D3. This would be best achieved with a combination of diet, supplements and 10 to 15 minutes per day in the sun."
Vitamin D3 is available through diet, supplements and exposure of the skin to sunlight, or ultraviolet B (UVB). In the paper, the researchers underscored the importance of limiting sun exposure such that the skin does not change color (tan) or burn. For a typical fair-skinned Caucasian individual, adequate vitamin D could be photosynthesized safely by spending 10 to 15 minutes in the noontime sun on a clear day with 50 percent of skin area exposed to the sun. Darker skinned individuals may require more time in the sun, such as 25 minutes. For people with photosensitivity disorders, or anyone with a personal or family history of nonmelanoma skin cancer, any amount of extra sun exposure would be inadvisable.
A larger daily dose of vitamin D could reduce the incidence of colorectal cancer with minimal risk, according to a new review that pools results from five studies.
The analysis found that maintaining a specific target blood level of vitamin D was associated with a 50 percent lower risk of colorectal cancer than that seen in people with consistently lower blood levels.
Previous studies had shown that lower blood levels of vitamin D did not protect against colorectal cancer, according to lead author Edward Gorham, Ph.D., a research epidemiologist with the Naval Health Research Center in San Diego. However, a meta-analysis pools the data from several studies, thus increasing the strength of the results.
The study is being published in the March issue of the American Journal of Preventive Medicine.
The five studies looked at serum collected from healthy volunteers who were then followed for periods ranging from two years to 25 years. There were 535 cases in the pooled analysis and 913 controls, or 1,448 total participants.
The researchers found that a blood serum vitamin D level of 33 nanograms per milliliter or higher was associated with a 50 percent lower risk of colorectal cancer than that seen with blood levels of 12 nanograms per milliliter or lower.
Vitamin D levels in the body are a factor of both diet and sun exposure. Exposing the skin to the sun lets the body synthesize vitamin D, which is why mortality due to colorectal cancer may be higher in geographic areas that get less sunshine.
The amount of dietary vitamin D needed to reach the serum levels that appear to be protective against colorectal cancer — 1,000 to 2,000 international units a day — would not pose any risk, according to Gorham: “The Institute of Medicine has set a ‘No Adverse Effect Level’ of 2,000 IU per day for vitamin D intake, so this recommendation would be safe for most people.”
There is no official recommended dietary allowance for vitamin D, but an adequate dietary intake per day for most adults is currently considered to be 200 to 400 IU.
Small amounts of sun exposure would also help people boost their vitamin D levels. Fifteen to 20 minutes per day without sunscreen is enough for the body to synthesize 10,000 IU of vitamin D with minimal risk of sunburn or skin cancer, Gorham said.
“The results are pretty straightforward,” said Karen Glanz, Ph.D., director of Emory University’s Prevention Research Center at the Rollins School of Public Health. However, changing behavior on the basis of this study may be premature, she said. The analysis found an association between vitamin D levels and lowered risk, not a definite link, Glanz said, but adding vitamin D to the diet or taking a supplement would probably not do much harm and there could be a benefit.
The meta-analysis on colorectal cancer includes data from the Women's Health Initiative, which had shown in 2006 that a low dose of vitamin D did not protect against colorectal cancer within seven years of follow-up. However, the researchers wrote, the meta-analysis indicates that a higher dose may reduce its incidence.
"Meta-analysis is an important tool for revealing trends that may not be apparent in a single study," said co-author Sharif B. Mohr, M.P.H. "Pooling of independent but similar studies increases precision, and therefore the confidence level of the findings."
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