Originally published as JCO Early Release 10.1200/JCO.2008.20.0725 on May 18 2009

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Prognostic Effects of 25-Hydroxyvitamin D Levels in Early Breast Cancer

From the Departments of Medicine and Surgery, Division of Clinical Epidemiology, Samuel Lunenfeld Research Institute, Mount Sinai Hospital; Sunnybrook Health Sciences Center–Odette Cancer Center; St Michael's Hospital; University of Toronto, Toronto; and Applied Statistician, Markham, Ontario, Canada.

Corresponding author: Pamela J. Goodwin, MD, Mount Sinai Hospital, 1284-600 University Ave, Toronto, Ontario M5G 1X4, Canada; e-mail: pgoodwin{at}mtsinai.on.ca.

Purpose Vitamin D has been linked to breast cancer risk, but prognostic effects are unknown. Such effects are biologically plausible given the presence of vitamin D receptors in breast cancer cells, which act as nuclear transcription factors to regulate gene activity.

Patients and Methods The study was conducted in a prospective inception cohort of 512 women with early breast cancer diagnosed 1989 to 1996. Vitamin D levels were measured in stored blood. Clinical, pathologic, and dietary data were accessed to examine prognostic effects of vitamin D.

Results Mean age was 50.4 years, mean vitamin D was 58.1 ± 23.4 nmol/L. Vitamin D levels were deficient (< 50 nmol/L) in 37.5% of patients, insufficient (50 to 72 nmol/L) in 38.5% of patients, and sufficient (> 72 nmol/L) in 24.0% of patients. There was little variation in mean vitamin D levels between summer and winter months. Mean follow-up was 11.6 years; 116 women had distant recurrences, and 106 women died. Women with deficient vitamin D levels had an increased risk of distant recurrence (hazard ratio [HR] = 1.94; 95% CI, 1.16 to 3.25) and death (HR = 1.73; 95% CI, 1.05 to 2.86) compared with those with sufficient levels. The association remained after individual adjustment for key tumor and treatment related factors but was attenuated in multivariate analyses (HR = 1.71; 95% CI, 1.02 to 2.86 for distant recurrence; HR = 1.60; 95% CI, 0.96 to 2.64 for death).

Conclusion Vitamin D deficiency may be associated with poor outcomes in breast cancer.

Supported by the Breast Cancer Research Foundation and the Canadian Breast Cancer Research Alliance.

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

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