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Associations of serum 25-hydroxyvitamin D with overall and breast cancer–specific mortality in a multiethnic cohort of breast cancer survivors

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Abstract

Purpose

Despite limited evidence on the association of vitamin D with outcomes in breast cancer survivors, some clinicians advise breast cancer patients to use vitamin D supplements. More evidence is needed to inform these recommendations.

Methods

In the Health, Eating, Activity, and Lifestyle study, we examined associations of post-treatment serum concentrations of 25-hydroxyvitamin D (25(OH)D) on overall and breast cancer–specific mortality in 585 breast cancer survivors from western Washington State, New Mexico, and Los Angeles County. 25(OH)D was measured in stored blood collected 2 years post-enrollment. Outcomes were ascertained from the Surveillance, Epidemiology, and End Results registries and medical records. Cox proportional hazards models were fit to assess associations of serum 25(OH)D with overall and breast cancer–specific mortality.

Results

After a median follow-up of 9.2 years; 110 women died, including 48 from breast cancer. Standard cut points classified 211 (31.6 %) women as serum 25(OH)D deficient (<20 ng/mL), 189 (32.2 %) as insufficient (20–30 ng/mL), and 185 (36.2 %) as sufficient (>30 ng/mL). Compared to women with deficient 25(OH)D, those in the sufficient ranges had a decreased risk of overall mortality (age-adjusted HR = 0.58; 95 % CI 0.36–0.96); however, multivariate adjustments attenuated the association (HR = 0.90; 95 % CI 0.50–1.61). No association was found between serum 25(OH)D and breast cancer–specific mortality (sufficient: HR = 1.21; 95 % CI 0.52–2.80) in multivariate models.

Conclusion

In this breast cancer cohort, higher serum 25(OH)D may be associated with improved survival, but results were not statistically significant and must be interpreted with caution. The potential prognostic effect of vitamin D from diet, supplements, or both should be evaluated in future larger studies with additional endpoints from breast cancer patients.

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Acknowledgments

The authors would like to thank the HEAL participants for their ongoing dedication to this study. This study was supported through National Cancer Institute contracts NO1-CN-75036-20, NO1-CN-05228, NO1-PC-67010, U54-CA116847 and training grant R25-CA094880. A portion of this work was conducted through support by the National Institutes of Health grant MO1-RR-0037, and University of New Mexico grant, NCRR MO1-RR-0997. Data collection for the Women’s CARE Study at the University of Southern California was supported by contract N01-HD-3-3175 from the National Institute of Child Health and Human Development and patient identification was supported in part by contract 050Q-8709-S1528 from the California Department of Health Services.

Conflict of interest

No potential conflicts of interest were disclosed.

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Authors and Affiliations

  1. Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Adriana Villaseñor, Anne McTiernan & Marian L. Neuhouser

  2. University of Washington, Seattle, WA, USA

    Adriana Villaseñor, Anne McTiernan & Marian L. Neuhouser

  3. Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA

    Rachel Ballard-Barbash & Anita Ambs

  4. Division of Population Sciences, City of Hope National Medical Center, Duarte, CA, USA

    Leslie Bernstein

  5. Department of Epidemiology and Population Health, University of Louisville, Louisville, KY, USA

    Kathy Baumgartner & Richard Baumgartner

  6. National Center for Tumor Diseases and German Cancer Research Center, Heidelberg, Germany

    Cornelia M. Ulrich

  7. Pediatric Nutritional Sciences, Medical University of South Carolina, Charleston, SC, USA

    Bruce W. Hollis

  8. Moores UCSD Cancer Center, University of California, San Diego, 3855 Health Sciences Drive., #0901, La Jolla, CA, 92109-0901, USA

    Adriana Villaseñor

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  1. Adriana Villaseñor
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Correspondence to Adriana Villaseñor.

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Villaseñor, A., Ballard-Barbash, R., Ambs, A. et al. Associations of serum 25-hydroxyvitamin D with overall and breast cancer–specific mortality in a multiethnic cohort of breast cancer survivors. Cancer Causes Control 24, 759–767 (2013). https://doi.org/10.1007/s10552-013-0158-4

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  • DOI: https://doi.org/10.1007/s10552-013-0158-4

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