Originally published as JCO Early Release 10.1200/JCO.2009.23.8980 on July 20 2009

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Reply to R.T. Chlebowski

Columbia University Medical Center, New York, NY

We would like to thank Chlebowski¹ for elaborating on the uncertainty regarding the benefits of vitamin D in women with breast cancer. As was elegantly outlined in the editorial by Goodwin,² the number of articles related to vitamin D has increased substantially over the past 20 years, and uncertainty still exists regarding the risks associated with vitamin D deficiency, as well as the possible benefits associated with supplementation.³

We would like to clarify that the main objective of our study was to describe the prevalence of vitamin D deficiency (defined as serum 25-hydroxyvitamin D [25(OH)D] < 20 ng/mL) in a cohort of premenopausal women with newly diagnosed breast cancer. In doing that we found that not only was vitamin D deficiency present in over 70% of women at study entry, but also that standard supplementation with 400 U daily of vitamin D3 over 1 year only had a slight impact on the rate of vitamin D deficiency.

We recognize, and state as such, that given the current evidence, it would be premature to recommend vitamin D supplementation to all patients with breast cancer and that the optimal level of serum 25(OH)D in this patient population is still unknown. However, as we suggest, and as was reiterated by Goodwin,² it might be prudent to check levels and monitor supplementation rather than endorsing a fixed dose for all patients,⁴ given that many experts recommend repletion of vitamin D to sufficient levels.⁵

The increasing interest and biologic rationale justify continued research in the area of cancer prevention and treatment. Ongoing clinical trials may help clarify whether changing a woman's vitamin D status will alter her risk of breast cancer or, for those who develop breast cancer, whether it will alter the risk of breast cancer recurrence and improve survival.

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

The author(s) indicated no potential conflicts of interest.

REFERENCES

1. Chlebowski RT: Caution regarding 25-hydroxyvitamin D monitoring in women with breast cancer. J Clin Oncol 27:e72–e73, 2009.[Free Full Text]

2. Goodwin PJ: Vitamin D in cancer patients: Above all, do no harm. J Clin Oncol 27:2117–2119, 2009.[Free Full Text]

3. Cui Y, Rohan TE: Vitamin D, calcium, and breast cancer risk: A review. Cancer Epidemiol Biomarkers Prev 15:1427–1437, 2006.[Abstract/Free Full Text]

4. Crew KD, Shane E, Cremers S, McMahon DJ, et al: High prevalence of vitamin D deficiency despite supplementation in premenopausal women with breast cancer undergoing adjuvant chemotherapy. J Clin Oncol 27:2151–2156, 2009.[Abstract/Free Full Text]

5. Holick MF: Vitamin D deficiency. N Engl J Med 357:266–281, 2007.[Free Full Text]

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• Caution Regarding 25-Hydroxyvitamin D Monitoring in Women With Breast Cancer
  Rowan T. Chlebowski
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This Article Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Google Scholar Articles by Crew, K. Articles by Hershman, D. PubMed PubMed Citation Articles by Crew, K. Articles by Hershman, D. Related Articles Related Article Social Bookmarking                            What's this?