Vitamin D Tied to Breast Cancer Outcome-Study

CypressCynthia

My sister sent me this article today. My vitamin D level was low and is now being managed by an endocrinologist. Thought this was very interesting.

"Vitamin D Tied to Breast Cancer Outcome

SAN ANTONIO – Vitamin D levels may be part of the reason some women saw a benefit from adding a bone drug to standard breast cancer chemotherapy regimens, a researcher said.

Postmenopausal women with sufficient levels of the vitamin were significantly less likely to see their breast cancer recur in their bones when they combined chemotherapy with zoledronic acid (Zometa), according to Robert Coleman, MD, of the University of Sheffield in Sheffield, England.

On the other hand, markers of bone turnover had no impact on the risk, Coleman reported at the San Antonio Breast Cancer Symposium here.

The finding – based on an analysis of stored samples from participants in the large AZURE trial -- was "quite surprising," Coleman said.

The overall trial had found little benefit in adding the bone drug to chemotherapy, but in a prespecified analysis, postmenopausal women were shown to have a significantly lower risk of both recurrence in bone and distant recurrence to any tissue.

The question was why.

To help find out, Coleman and colleagues turned to stored blood samples given by 872 of the 3,360 participants before they began therapy. The subgroup included 606 premenopausal women and 266 who were postmenopausal.

Although the subgroup was not randomly selected, Coleman noted, its characteristics were similar to the overall cohort, and the results of treatment were similar – the postmenopausal women did better with the zoledronic acid.

The researchers looked at baseline levels of two markers of bone turnover – CTX and P1NP – as well as 25-hydroxyvitamin D (25-OHD) as a marker of bone and general health.

The 25-OHD level was deemed "insufficient" at or below 30 nanograms per milligrams of blood and "sufficient" above that. Strikingly, Coleman reported, only 10.3% of women in the subgroup had sufficient vitamin D.

On analysis, neither of the two bone turnover markers predicted outcomes, but "for vitamin D, there were quite surprising differences" in recurrence based on 25-OHD levels, Coleman said.

Specifically:
Low vitamin D predicted recurrence to bone. The hazard ratio was 0.11, with a 95% confidence interval from 0.02 to 0.76 (P=0.025).
And low vitamin D appeared to predict any distant recurrence, but the effect did not reach statistical significance. The hazard ratio was 0.56, with a 95% confidence interval from 0.31 to 1.01.


"Patients with a sufficient level of vitamin D had a better prognosis," Coleman said, but the results – although consistent with other data – still need validation.

Nevertheless, he said, clinicians "should be measuring vitamin D, replenishing it appropriately, (but) whether vitamin D as an intervention will change outcome, I don't know."

Patients starting the trial were given vitamin D supplements, noted Carol Lange, PhD, of the University of Minnesota in Minneapolis, who was not part of the study, but who moderated the session at which it was presented.

But those supplements were 10 times lower than recommended levels and probably had little effect, she told MedPage Today, suggesting that "their lifestyle and their vitamin D level could predict survival."

The study suggests "it's a really good idea" to keep vitamin D levels high, she said.

Vitamin D "is cheap, it's nontoxic, it's a vital hormone," she said, "and it can't hurt you."

Indeed, the study appears to be "demonstrating the importance of maintaining vitamin D levels in patients," commented Steven Isakoff, MD, PhD, of Massachusetts General Hospital in Boston, who was not part of the study.

There is "a lot of investigation aimed at understanding vitamin D metabolism – independent of bone health – impacting cancer outcomes," Isakoff told MedPage Today, but the picture is not yet clear."


http://www.medpagetoday.com/MeetingCoverage/SABCS/36398?utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=WC&xid=NL_DHE_2012-12-12&eun=g24143d0r&userid=24143&email=ppaddison@msn.com&mu_id=5023662

New Flower

You read my mind
Thank you for posting
My oncologist sent me email from San Antonio referring to this study to make sure I keep my levels up.
Everyone should find the specific dose. We started from 1000IU/per day which was not enough for me. In order to keep my vitamin D level between 50 -80 I need to take 4000IU per day. Everyone please make sure you have adjusted your dose to the seasonal conditions in your region. We do not have enough sunny days during winter

AngieD

New Flower said:

You read my mind
Thank you for posting
My oncologist sent me email from San Antonio referring to this study to make sure I keep my levels up.
Everyone should find the specific dose. We started from 1000IU/per day which was not enough for me. In order to keep my vitamin D level between 50 -80 I need to take 4000IU per day. Everyone please make sure you have adjusted your dose to the seasonal conditions in your region. We do not have enough sunny days during winter

I've been taking 1000 IU
I've been taking 1000 IU units of Vit D daily since I finished treatment the end of August. My MO ordered a level and it was normal at that time (end of summer.) I just had it re-checked when I had an annual visit with my PCP and it was low, so we are upping the dose to 1500 IU/day and will recheck. Just shows how seasonal it can be.
Angie

kacee999

VERY interesting...
I read elsewhere online about Vitamin D and cancer link. Oddly enough, for the past year I have been Vitamin D deficient and have been on 50,000 (something-or-others) a week. My doctor has now raised me to 100,000 a week.

abrub

kacee999 said:

VERY interesting...
I read elsewhere online about Vitamin D and cancer link. Oddly enough, for the past year I have been Vitamin D deficient and have been on 50,000 (something-or-others) a week. My doctor has now raised me to 100,000 a week.

The 50,000 iu vitamin D supplements you get by prescription are vitamin D2, which is not as well utilized. I, too, was taking 2 of those a week (100,000 iu) but we still couldn't get my D levels up. An integrative med specialist (MD) at Memorial Sloan Kettering put me on vitamin D3 (purchased over the counter) - 2 weeks at 20,000 iu/day, and then dropping to 8,000 iu/day until follow up at 4 weeks - brought me right up to normal within 4 weeks. I had been taking 100,000 iu/week of the prescription D2 for a year, and was still low. At 4 weeks she dropped me to 5,000 iu/day.

We've since learned that I require 10,000iu of D3/day to stay in the normal range.

My BIL could not tolerate the D2 - it made him sick. However, the D3 has been working for him to both raise his D levels to normal and be tolerable.

Note that D3 is from animal sources, there is no vegan D3. However, my BIL, who is vegan, accepts the importance of D-levels, and takes D3.

I would not go over 5,000 iu/day without a dr's supervision (perhaps 2,000 iu/day should be the max.) However, my 10,000iu/day is under medical supervision, and the need has been proven.

(Benefits have also been shown to be significant with colorectal cancers.)

Double Whammy

abrub said:

The 50,000 iu vitamin D supplements you get by prescription are vitamin D2, which is not as well utilized. I, too, was taking 2 of those a week (100,000 iu) but we still couldn't get my D levels up. An integrative med specialist (MD) at Memorial Sloan Kettering put me on vitamin D3 (purchased over the counter) - 2 weeks at 20,000 iu/day, and then dropping to 8,000 iu/day until follow up at 4 weeks - brought me right up to normal within 4 weeks. I had been taking 100,000 iu/week of the prescription D2 for a year, and was still low. At 4 weeks she dropped me to 5,000 iu/day.

We've since learned that I require 10,000iu of D3/day to stay in the normal range.

My BIL could not tolerate the D2 - it made him sick. However, the D3 has been working for him to both raise his D levels to normal and be tolerable.

Note that D3 is from animal sources, there is no vegan D3. However, my BIL, who is vegan, accepts the importance of D-levels, and takes D3.

I would not go over 5,000 iu/day without a dr's supervision (perhaps 2,000 iu/day should be the max.) However, my 10,000iu/day is under medical supervision, and the need has been proven.

(Benefits have also been shown to be significant with colorectal cancers.)

I'm confused
Just had my levels checked in July. I am once again insufficient (not deficient) at 24. I was very low at the time of dx and after tx I did the prescribed D and got up to 38 in Dec. 2010. Now 2 years later I'm down to 24 in spite of 2000 iu daily and to my surprise my oncologist said it was a little low but not concerning. Just saw my pcp yesterday and altho we didn't talk about it, she reviewed all my labs and didn't say anything about the D level. We did talk about my Dexascan results (ordered by oncologist) and it looks like I'll be taking a bisphosphonate soon.

I guess I'll ask about the D level when I see her at end of January. . .

abrub

Double Whammy said:

I'm confused
Just had my levels checked in July. I am once again insufficient (not deficient) at 24. I was very low at the time of dx and after tx I did the prescribed D and got up to 38 in Dec. 2010. Now 2 years later I'm down to 24 in spite of 2000 iu daily and to my surprise my oncologist said it was a little low but not concerning. Just saw my pcp yesterday and altho we didn't talk about it, she reviewed all my labs and didn't say anything about the D level. We did talk about my Dexascan results (ordered by oncologist) and it looks like I'll be taking a bisphosphonate soon.

I guess I'll ask about the D level when I see her at end of January. . .

You may want to wait on biphosphonates...
You may want to wait on biphosphonates if your dexa isn't too bad.

My dr at MSK pushed me to get my Vitamin D levels up, and then get my Dexa 6 months later - counts were improving. I had mild osteopenia, and that dr (my endocrinologist) wanted me to start biphosnphonates. My PCP and my Integrative med drs want me to wait, and at this point (2 years later) I am not in need.

As I mentioned, some people, myself included, do not absorb vitamin D2 - the prescription form (those 50,000iu capsules). (Side note - I also don't absorb from the sun, nor does anyone in my family. My sister, who is a farmer, and spends her days outside, and my other sister who lives in Hawaii are both also low in vitamin D, and require high dose supplements.) If you are low at 2,000iu of D3 a day, bump it up to 4,000 or 6,000, and get rechecked in 4-6 weeks. D3 affects your levels much more quickly than D2, which needs 3 months to change anything. Start the increased D3 now; have it rechecked when you see your dr in January, and if thinkgs are looking good, see if you can have another Dexa in 6 months.

CypressCynthia

Double Whammy said:

I'm confused
Just had my levels checked in July. I am once again insufficient (not deficient) at 24. I was very low at the time of dx and after tx I did the prescribed D and got up to 38 in Dec. 2010. Now 2 years later I'm down to 24 in spite of 2000 iu daily and to my surprise my oncologist said it was a little low but not concerning. Just saw my pcp yesterday and altho we didn't talk about it, she reviewed all my labs and didn't say anything about the D level. We did talk about my Dexascan results (ordered by oncologist) and it looks like I'll be taking a bisphosphonate soon.

I guess I'll ask about the D level when I see her at end of January. . .

That does seem a little low.
That does seem a little low. I would maybe discuss it with an endocrinologist. However, I have to say, the vitamin D stuff is controversial. As my GYN friend says, "If you tested women, 28 would have a low vitamin D level." Lol, I don't think there is any kind of consensus!

But, I would run it by an endocrinologist, because I personally would rather err on the side of caution.

At one point, my dosage was 5000 IU per day, but my level finally came up. I am now on 4000 IU per day and we may lower my dose again when I get checked in February. I let my endocrinologist handle it.