Originally published as JCO Early Release 10.1200/JCO.2008.19.6162 on April 6 2009

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High Prevalence of Vitamin D Deficiency Despite Supplementation in Premenopausal Women With Breast Cancer Undergoing Adjuvant Chemotherapy

From the Department of Medicine, Division of Oncology, Columbia University, College of Physicians and Surgeons; Herbert Irving Comprehensive Cancer Center, Columbia University; and Department of Medicine, Division of Endocrinology, Columbia University, College of Physicians and Surgeons, New York, NY.

Corresponding author: Dawn L. Hershman, MD, MS, Columbia University, 161 Fort Washington Ave, 10-1068, New York, NY 10032; e-mail: dlh23{at}columbia.edu.

Purpose Vitamin D deficiency is associated with increased breast cancer risk and decreased breast cancer survival. The purpose of this study was to determine the prevalence of vitamin D deficiency, as measured by serum 25-hydroxyvitamin D (25-OHD), in premenopausal women at initiation of adjuvant chemotherapy for breast cancer and after 1 year of vitamin D supplementation.

Patients and Methods The study included 103 premenopausal women from the northeastern United States with stages I to III breast cancer who received adjuvant chemotherapy and participated in a 1-year zoledronate intervention trial. All patients were prescribed vitamin D₃ (cholecalciferol) 400 IU and calcium carbonate 1,000 mg daily. At baseline and at 6 and 12 months, bone mineral density (BMD) measurements were obtained and blood was collected and analyzed in batches for serum 25-OHD. Vitamin D deficiency was defined as serum 25-OHD less than 20 ng/mL, insufficiency as 20 to 29 ng/mL, and sufficiency as 30 ng/mL or greater.

Results At baseline, 74% of women were vitamin D deficient (median, 17 ng/mL). Vitamin D deficiency was slightly less common in white women (66%) compared with black (80%) and Hispanic (84%) women. After vitamin D supplementation for 1 year, less than 15% of white and Hispanic women, and no black women, achieved sufficient 25-OHD levels. Vitamin D levels did not correlate with baseline BMD and were not altered by chemotherapy or bisphosphonate use.

Conclusion Vitamin D deficiency is highly prevalent in women with breast cancer. The current recommended dietary allowance of vitamin D is too low to increase serum 25-OHD greater than 30 ng/mL. Optimal dosing for bone health and, possibly, improved survival has yet to be determined.

Supported in part by K07 Award No. CA95597 from the National Cancer Institute (D.L.H.); by an Advanced Clinical Research Award in Breast Cancer from the American Society of Clinical Oncology (D.L.H.); by K24 Award No. AR 052665 from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (E.S.); and by Novartis Pharmaceuticals Corp.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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