Breast Cancer outcomes much better if higher vitamin D levels – Nov 2016

Association of Serum Level of Vitamin D at Diagnosis With Breast Cancer Survival - A Case-Cohort Analysis in the Pathways Study

JAMA Oncol. Published online Nov 10, 2016. doi:10.1001/jamaoncol.2016.4188
Song Yao, PhD1; Marilyn L. Kwan, PhD2; Isaac J. Ergas, MPH2; et al Janise M. Roh, MSW, MPH2; Ting-Yuan David Cheng, PhD1; Chi-Chen Hong, PhD1; Susan E. McCann, PhD1; Li Tang, PhD1; Warren Davis, PhD1; Song Liu, PhD3; Charles P. Quesenberry Jr, PhD2; Marion M. Lee, PhD4; Christine B. Ambrosone, PhD1; Lawrence H. Kushi, ScD2

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28% better overall survival if > 25 ng

42% Better Invasive disease–free survival if > 25 ng

Key Points

• Question What is the association of serum vitamin D levels at the time of diagnosis with breast cancer survival?
• Findings In this cohort study of 1666 women with breast cancer, higher serum 25-hydroxyvitamin D levels were independently associated with better outcomes, including overall survival. Compared with women with the lowest third of 25-hydroxyvitamin D levels, those with the highest third had reduced hazards of all-cause death after full adjustment, and the associations were stronger in premenopausal women.
• Meaning This study provides compelling observational evidence of vitamin D’s benefits for breast cancer progression and mortality.

Abstract
Importance There are long-standing interests in the potential benefits of vitamin D for preventing breast cancer recurrence and mortality, yet data from prospective cohort studies are limited.

Objective To investigate a serum biomarker of vitamin D status, 25-hydroxyvitamin D (25OHD) measured at the time of breast cancer diagnosis, to determine the association with prognosis.

Design, Setting, and Participants The Pathways Study is a prospective cohort study of breast cancer survivors established in 2006. Enrollment was completed in 2013; follow-up is ongoing. The cohort was established in Kaiser Permanente Northern California, a large integrated health care delivery system in northern California. Women with a diagnosis of incident invasive breast cancer were typically consented and enrolled within 2 months of diagnosis. The overall enrollment rate was 46% (4505 of 9820). Participants are followed for health outcomes and comorbidities at 12, 24, 48, 72, and 96 months after baseline interview. A case-cohort design was used for efficiency assay of 25OHD, selecting 1666 cohort members with serum samples and ensuring representation in the subcohort of races and clinical subtypes. The data analysis was performed from January 5, 2014, to March 15, 2015.

Main Outcomes and Measures Primary outcomes are breast cancer recurrence, second primary cancer, and death.

Results Mean (SD) age was 58.7 (12.4) years. Serum 25OHD concentrations were lower in women with advanced-stage tumors, and the lowest in premenopausal women with triple-negative cancer. Levels were also inversely associated with hazards of disease progression and death. Compared with the lowest tertile, women with the highest tertile of 25OHD levels had superior overall survival (OS). This association remained after adjustment for clinical prognostic factors (hazard ratio [HR], 0.72; 95% CI, 0.54-0.98). Among premenopausal women, the association with OS was stronger, and there were also associations with breast cancer–specific survival and invasive disease–free survival (OS: HR, 0.45; 95% CI, 0.21-0.96; breast cancer–specific survival: HR, 0.37; 95% CI, 0.15-0.93; invasive disease–free survival: HR, 0.58; 95% CI, 0.34-1.01; all after full adjustment).

Conclusions and Relevance Serum 25OHD levels were independently associated with breast cancer prognostic characteristics and patient prognosis, most prominently among premenopausal women. Our findings from a large, well-characterized prospective cohort provide compelling observational evidence on associations of vitamin D with lower risk of breast cancer morbidity and mortality.