| This summary table contains detailed information about research studies. Summary tables offer an informative look at the science behind many breast cancer guidelines and recommendations. However, they should be viewed with some caution. In order to read and interpret research tables successfully, it is important to understand some key concepts. Learn how to read a research table. |
Introduction: A possible link between vitamin D and breast cancer is under study. Most of the vitamin D a person gets comes from the sun and a small amount comes from diet.
Studies measuring vitamin D through sunlight exposure and diet
Findings from studies on vitamin D exposure (through diet alone or diet plus sunlight) and breast cancer risk are mixed.
Studying vitamin D with measures of sunlight exposure and diet presents some challenges. It is difficult to measure sunlight exposure. And, because so many foods that contain vitamin D also contain calcium, it is hard to tease out the effects of vitamin D alone.
Studies measuring blood levels of vitamin D
Blood levels of vitamin D are a good marker of vitamin D exposure. By studying blood levels of vitamin D, researchers avoid the measurement issues with sunlight exposure and diet.
At this time, only a few large studies (listed in the table below) have looked at possible links between blood levels of vitamin D and breast cancer risk and findings have been mixed.
Read our perspective on the vitamin D and breast cancer risk.
Learn more about vitamin D and breast cancer risk.
Learn more about vitamin D.
Learn about the strengths and weaknesses of different types of studies.
See how this risk factor compares with other risk factors for breast cancer.
Study selection criteria: For studies with measures of sunlight exposure and dietary intake of vitamin D: Prospective cohort studies, nested case-control studies and meta-analyses with at least 200 breast cancer cases. For studies of blood levels of vitamin D: Prospective cohort studies and nested case-control studies with at least 100 breast cancer cases.
Table note: Relative risk above 1 indicates increased risk. Relative risk below 1 indicates decreased risk.
Sunlight Exposure and Dietary Intake of Vitamin D
|
Study
|
Study Population
(number of participants)
|
Follow-up
(years)
|
Measure(s) of
Vitamin D
|
Relative Risk of Breast Cancer
in Women with a High Exposure
to Vitamin D Compared to
Women with Low Exposure,
RR (95% CI)
|
Randomized controlled trials
|
Women’s Health Initiative [1]
|
36,282
(1,074 cases)
|
7
|
Supplement
intake
|
Postmenopausal women:
0.96 (0.85-1.09)*
|
Prospective cohort studies
|
Nurses' Health Study [2]
|
88,691
(3,482 cases)
|
16
|
Dietary and
supplement
intake
|
Premenopausal women:
0.72 (0.55-0.94)
Postmenopausal women:
0.94 (0.80-1.10)
|
French E3N Cohort [3]
|
67,721
(2,871 cases)
|
10.4
|
Dietary
intake
|
Premenopausal women:
1.03 (0.85-1.25)
Postmenopausal women:
0.92 (0.83-1.02)
|
| |
|
|
Sun exposure:
High vs. low
level of sun exposure
in place of residence
|
Premenopausal women:
0.85 (0.67-1.08)
Postmenopausal women:
0.92 (0.82-0.98)
|
Cancer Prevention Study II Nutrition Cohort [4]
|
68,567
(2,855 cases)
|
8-9
|
Dietary and
supplement
intake
|
Postmenopausal women:
0.95 (0.81-1.13)
|
Iowa Women’s Health Study [5]
|
34,321
(2,440 cases)
|
18
|
Dietary and
supplement
intake
|
Postmenopausal women:
0.89 (0.77-1.03)
|
Women’s Health Study [6]
|
31,487
(1,019 cases)
|
10
|
Dietary and
supplement
intake
|
Premenopausal women:
0.65 (0.42-1.00)
Postmenopausal women:
1.30 (0.97-1.73)
|
Norwegian Women and Cancer Study [7]
|
41,811
(948 cases)
|
8.5
|
Dietary and
supplement
intake
|
Pre- and postmenopausal women:
1.07 (0.87-1.32)
|
| |
|
|
Sun exposure:
More than one
sunburn per year
vs. none
|
Pre- and postmenopausal women:
0.95 (0.75-1.21)†
|
VITAL Cohort [8]
|
35,016
(880 cases)
|
6
|
Supplement
intake
|
Postmenopausal women:
0.68 (0.50-0.92)
|
Women’s Lifestyle and Health Cohort Study [9]
|
41,889
(840 cases)
|
12.9
|
Dietary
intake
|
Pre- and postmenopausal women:
0.9 (0.8-1.1)
|
| |
|
|
Sun exposure:
2 or more
sunburns per year
vs. none
|
Pre- and postmenopausal women:
1.1 (0.9-1.4)‡
|
Meta-analyses
|
Chen et al. [10]
|
11 studies
|
Various
|
Dietary and
supplement
intake
|
Pre- and postmenopausal women:
0.91 (0.83-1.00)
|
Gissel et al. [11]
|
6 studies
|
Various
|
Dietary and
supplement
intake
|
Pre- and postmenopausal women:
0.98 (0.93-1.03)
|
* Breast cancer risk among women randomized to take a supplement containing vitamin D and calcium versus women randomized to a placebo.
† Average number of sunburns per year. Sun exposure as measured by weeks per year spent on sunbathing vacations and tanning bed use was also not related to breast cancer risk.
‡ Sunburns from ages 10 to 19 years. Sunburns during other ages were also not shown to be related to breast cancer risk. Sun exposure as measured by weeks per year spent on sunbathing vacations and tanning bed use was also not related to breast cancer risk.
Blood Levels of Vitamin D
|
Study
|
Study Population
(number of participants)
|
Follow-up
(years)
|
Relative Risk of Breast Cancer
in Women with Higher Blood Levels
of Vitamin D (25-hydroxyvitamin D)
Compared to Women with Lower Levels,
RR (95% CI)
|
Nested case-control studies
|
| |
Cases
|
Controls
|
|
|
Women’s Health Initiative [1]
|
1,067
|
1,067
|
7
|
Postmenopausal women:
NS
|
Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial [12]
|
1,005
|
1,005
|
4-12
|
Postmenopausal women:
1.04 (0.75-1.45)
|
Malmo Diet and Cancer Study [13]
|
764
|
764
|
10-15
|
Pre- and postmenopausal women:
0.93 (0.66-1.33)
|
Nurses' Health Study [14]
|
701
|
724
|
6-7
|
Pre- and postmenopausal women:
0.73 (0.49-1.07)
|
French E3N Cohort [15]
|
636
|
1,272
|
10
|
Pre- and postmenopausal women:
0.73 (0.55-0.96)
|
Nurses' Health Study II [16]
|
613
|
1,218
|
8-11
|
Pre- and postmenopausal women:
1.29 (0.92-1.81)
|
Cancer Prevention Study-II [17]
|
516
|
516
|
4-7
|
Postmenopausal women:
1.09 (0.70-1.68)
|
Meta-analyses
|
| Mohr et al. [18] |
5 nested case-control studies
|
Pre- and postmenopausal women:
0.87 (0.77-0.99)
|
| Gandini et al. [19] |
5 prospective studies
|
Pre- and postmenopausal women:
0.97 (0.92-1.03)§
|
| Chen et al. [10] |
7 studies
|
Pre- and postmenopausal women:
0.55 (0.38-0.80)
|
U.S. Preventive Services Task Force [20]
|
4 nested case-control studies
|
Pre- and postmenopausal women:
0.99 (0.97-1.01)
|
§ Results for a 10 ng/ml increase in blood vitamin D levels.
References
- Chlebowski RT, Johnson KC, Kooperberg C, et al. for the Women's Health Initiative Investigators. Calcium plus vitamin D supplementation and the risk of breast cancer. J Natl Cancer Inst. 100(22):1581-91, 2008.
- Shin MH, Holmes MD, Hankinson SE, Wu K, Colditz GA, Willett WC. Intake of dairy products, calcium, and vitamin d and risk of breast cancer. J Natl Cancer Inst. 94(17):1301-11, 2002.
- Engel P, Fagherazzi G, Mesrine S, Boutron-Ruault MC, Clavel-Chapelon F. Joint effects of dietary vitamin D and sun exposure on breast cancer risk: results from the French E3N cohort. Cancer Epidemiol Biomarkers Prev. 20(1):187-98, 2011.
- McCullough ML, Rodriguez C, Diver WR, et al. Dairy, calcium, and vitamin D intake and postmenopausal breast cancer risk in the Cancer Prevention Study II Nutrition Cohort. Cancer Epidemiol Biomarkers Prev. 14(12):2898-904, 2005.
- Robien K, Cutler GJ, Lazovich D. Vitamin D intake and breast cancer risk in postmenopausal women: the Iowa Women's Health Study. Cancer Causes Control. 18(7):775-82, 2007.
- Lin J, Manson JE, Lee IM, Cook NR, Buring JE, Zhang SM. Intakes of calcium and vitamin D and breast cancer risk in women. Arch Intern Med. 167(10):1050-9, 2007.
- Edvardsen K, Veierød MB, Brustad M, Braaten T, Engelsen O, Lund E. Vitamin D-effective solar UV radiation, dietary vitamin D and breast cancer risk. Int J Cancer. 128(6):1425-33, 2011.
- Brasky TM, Lampe JW, Potter JD, Patterson RE, White E. Specialty supplements and breast cancer risk in the VITamins And Lifestyle (VITAL) Cohort. Cancer Epidemiol Biomarkers Prev. 19(7):1696-708, 2010.
- Kuper H, Yang L, Sandin S, Lof M, Adami HO, Weiderpass E. Prospective study of solar exposure, dietary vitamin D intake, and risk of breast cancer among middle-aged women. Cancer Epidemiol Biomarkers Prev. 18(9):2558-61, 2009.
- Chen P, Hu P, Xie D, Qin Y, Wang F, Wang H. Meta-analysis of vitamin D, calcium and the prevention of breast cancer. Breast Cancer Res Treat. 121(2):469-77, 2010.
- Gissel T, Rejnmark L, Mosekilde L, Vestergaard P. Intake of vitamin D and risk of breast cancer--a meta-analysis. J Steroid Biochem Mol Biol. 111(3-5):195-9, 2008.
- Freedman DM, Chang SC, Falk RT, et al. Serum levels of vitamin D metabolites and breast cancer risk in the prostate, lung, colorectal, and ovarian cancer screening trial. Cancer Epidemiol Biomarkers Prev. 17(4):889-94, 2008.
- Almquist M, Bondeson AG, Bondeson L, Malm J, Manjer J. Serum levels of vitamin D, PTH and calcium and breast cancer risk-a prospective nested case-control study. Int J Cancer. 127(9):2159-68, 2010.
- Bertone-Johnson ER, Chen WY, Holick MF, et al. Plasma 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D and risk of breast cancer. Cancer Epidemiol Biomarkers Prev. 14(8):1991-7, 2005.
- Engel P, Fagherazzi G, Boutten A, et al. Serum 25(OH) vitamin D and risk of breast cancer: a nested case-control study from the French E3N cohort. Cancer Epidemiol Biomarkers Prev. 19(9):2341-50, 2010.
- Eliassen AH, Spiegelman D, Hollis BW, Horst RL, Willett WC, Hankinson SE. Plasma 25-hydroxyvitamin D and risk of breast cancer in the Nurses' Health Study II. Breast Cancer Res. 13(3):R50, 2011.
- McCullough ML, Stevens VL, Patel R, et al. Serum 25-hydroxyvitamin D concentrations and postmenopausal breast cancer risk: a nested case control study in the Cancer Prevention Study-II Nutrition Cohort. Breast Cancer Res. 11(4):R64, 2009.
- Mohr SB, Gorham ED, Alcaraz JE, et al. Serum 25-hydroxyvitamin D and prevention of breast cancer: pooled analysis. Anticancer Res. 31(9):2939-48, 2011.
- Gandini S, Boniol M, Haukka J, et al. Meta-analysis of observational studies of serum 25-hydroxyvitamin D levels and colorectal, breast and prostate cancer and colorectal adenoma. Int J Cancer. 128(6):1414-24, 2011.
- Chung M, Lee J, Terasawa T, Lau J, Trikalinos TA. Vitamin D with or without calcium supplementation for prevention of cancer and fractures: an updated meta-analysis for the U.S. Preventive Services Task Force. Ann Intern Med. 155(12):827-38, 2011.
Updated 08/13/12
