Vit D and Breast Tumor Size

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SABCS: Vitamin D Level Linked to Breast Tumor Size www.medpagetoday.com/MeetingCoverage/SABCS/30191?utm_source=WC & utm_medium=email & utm_campaign=Meeting_Roundup_SABCS By a Fiore, Staff Writer, MedPage Today

December 13, 2011

Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston and Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

SAN ANTONIO -- Women who have higher levels of vitamin D when they're diagnosed with breast cancer appear to have smaller tumors, researchers said here.In a retrospective study, lower vitamin D levels were significantly associated with larger tumor size (P=0.0063), Barbara Brouwers, PhD, of the University of Leuven in Belgium, reported during a poster session at the San Breast Cancer Symposium here.

"Lower vitamin D levels were correlated with much bigger tumors," she told MedPage Today. "We also saw that higher vitamin D levels were associated with better outcomes, but it wasn't significant."

Brouwers explained that many studies have shown that vitamin D status is important in many chronic illnesses, and some have even shown low vitamin D levels to be a risk factor for breast cancer, as well as a predictor of outcomes.

Yet it's difficult to interpret its specific role given the many confounding factors known to influence serum concentrations, such as dietary intake, seasonal variation, and weight.

Also, genetic variants regarding vitamin D metabolism could influence risk, she added.

So to assess the potential associations between vitamin D status and genetic variability on breast tumor characteristics and outcomes, Brouwers and colleagues looked at data from a cohort of 1,800 early breast cancer patients treated at their clinic between 2003 and 2010.

Data on serum 25-hydroxy vitamin D3 levels was collected at diagnosis for all patients, and they were followed for a mean of four years.

The researchers found that lower vitamin D levels were significantly associated with larger tumor size; each 0.4 ng/mL decrease in levels was linked with a 1-cm increase in tumor size (P=0.0063).

There were no associations, however, between vitamin D levels and other characteristics such as lymph node invasion, ER or HER2 status, or tumor grade.

Patients with lower vitamin D levels at diagnosis tended to have a higher risk of breast-cancer related death, though the finding wasn't significant, Brouwers said.

In multivariate analyses, however, the relationship became of borderline significance, as the risk of death from breast cancer fell 27% per 10 ng/mL increase in serum vitamin D levels at diagnosis, they reported.

For patients who were clearly vitamin D deficient -- having a level below 30 ng/mL at diagnosis -- there was a significant increase in the risk of relapse after three years, Brouwers and colleagues found.

On the other hand, patients who weren't deficient had a lower risk of relapse at three and six years (HR 0.47, 95% CI 0.27 to 0.83, P=0.0094, and HR 0.22, 95% CI 0.07 to 0.65, P=0.0065, respectively).

With regard to vitamin D genetic variants, Brouwers and colleagues found that certain genotypes had effects on vitamin D levels, but there were no further associations with survival or tumor characteristics such as size, number of positive lymph nodes, and age at diagnosis.

Brouwers told MedPage Today that the anti-inflammatory effects of vitamin D are the likely mediator of the relationship between higher levels and smaller tumor size, though more research is needed to clarify the exact mechanisms.

She and colleagues called for further research to determine whether vitamin D supplementation would have beneficial effects on breast cancer prevention or should be incorporated into standard breast cancer treatments.

Action Points

This study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal. This study found that higher vitamin D levels at diagnosis of breast cancer were correlated with smaller tumor sizes. There was a trend toward improved outcomes in the patients with higher vitamin D levels, but the difference was not statistically significant.

Primary source: San Breast Cancer SymposiumSource reference: Hatse S, et al "Vitamin D status in newly diagnosed breast cancer patients inversely correlates with tumor size and moderately correlates with outcome" SABCS 2011; Abstract P5-05-01.

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