Ovarian cancerVitamin D levels

A study of prediagnostic serum 25(OH)D in New York and Sweden did not find statistically significant correlations with incidence of ovarian cancer1.  Interestingly, in a comparison of high levels to low levels, the odds ratio was elevated in the U.S. but reduced in Sweden.

However, a study in Finland found a nearly statistically significant reduced risk of ovarian cancer for those with serum 25(OH)D levels >57.8 nmol/L (23.1 ng/mL) compared to <31.5 nmol/L (12.6 ng/mL): the adjusted odds ratio (OR) for those followed between 3 and 13 years after serum draw was 0.43 (95% confidence interval, 0.18-1.05).  When those were included whose blood draw was between 1 and 13 years before diagnosis, the OR dropped to 0.57 (95% CI, 0.26-1.24)2.  A previous study by the same group failed to find a beneficial effect of 25(OH)D level3, which was explained as being due to having a lower mean serum 25(OH)D level, 35.0 nmol/L in the former study vs. 39.2 nmol/L in the latter study.

Having the right amount of vitamin D may prevent ovarian cancer.
Low levels of vitamin D are associated with higher risk of ovarian cancer.

One review of the evidence for a role of vitamin D in reducing the risk of ovarian cancer concluded: “Approximately half of the ecologic and case-control studies reported reductions in incidence or mortality with increasing geographic latitude, solar radiation levels, or dietary/supplement consumption of vitamin D, whereas the other half reported null associations. The cohort studies reported no overall risk reduction with increasing dietary/supplement consumption of vitamin D or with plasma levels of vitamin D prior to diagnosis, although vitamin D intakes were relatively low in all studies.”4.

A recent analysis of pooled case-control data of prediagnostic serum 25(OH)D found no trend or odds ratio (risk) for quintiles from <25 nmol/L to >100 nmol/L and no statistically significant variation from unity for any quintile5.  As this finding diverges from the findings in ecological studies, the question arises why the difference.  One likely cause is that a one time measurement of serum 25(OH)D several years prior to cancer diagnosis is not representative of serum 25(OH)D levels during the time when they would be most effective in fighting cancer. The period could be decades6 or a few years7. That study had a mean follow-up period of 6.63 years. Recent studies indicate that serum 25(OH)D levels change significantly with time89.

A meta-analysis of prediagnostic serum 25(OH)D levels and incidence of ovarian cancer including the recent pooled study10 found an insignificant reduced risk of ovarian cancer: relative risk = 0.83 (95% confidence interval, 0.63-1.08, p trend = 0.1711. As all of the included studies were nested case-control with a several year follow-up period after serum draw, serum 25(OH)D levels may have changed enough to reduce the value of the serum level12.

There has been one case-control study of ovarian cancer incidence with respect to oral vitamin D intake, conducted in Mexico. The odds ratio for high vs. low serum 25(H)D levels was OR = 0.43 (0.23–0.80); p = 0.0113.

Page last edited: 22 August 2011

References

  1. Arslan AA, Clendenen TV, Koenig KL, Hultdin J, Enquist K, Agren A, et al. Circulating vitamin D and risk of epithelial ovarian cancer. J Oncol. 2009;
  2. Toriola, A. T. Surcel, H. M. Calypse, A. Grankvist, K. Luostarinen, T. Lukanova, A. Pukkala, E. Lehtinen, M. Independent and joint effects of serum 25-hydroxyvitamin D and calcium on ovarian cancer risk: A prospective nested case-control study. Eur J Cancer. 2010 Jun 18;
  3. Toriola AT, Surcel HM, Agborsangaya C, Grankvist K, Tuohimaa P, Toniolo P, et al. Serum 25-hydroxyvitamin D and the risk of ovarian cancer. Eur J Cancer. 2010; 46 (2): 364-9.
  4. Cook, L. S. Neilson, H. K. Lorenzetti, D. L. Lee, R. C. A systematic literature review of vitamin D and ovarian cancer. Am J Obstet Gynecol. 2010 Jul; 203 (1): 70 e1-8.
  5. Zheng W, Danforth KN, Tworoger SS, Goodman MT, Arslan AA, Patel AV, et al Circulating 25-hydroxyvitamin D and risk of epithelial ovarian cancer: Cohort Consortium Vitamin D Pooling Project of Rarer Cancers. Am J Epidemiol. 2010 June 18 [Epub ahead of print]; 172 (1): 70-80.
  6. Tuohimaa P, Pukkala E, Scelo G, Olsen JH, Brewster DH, Hemminki K, et al Does solar exposure, as indicated by the non-melanoma skin cancers, protect from solid cancers: Vitamin D as a possible explanation. Eur J Cancer. 2007 May; 29 (43): 1701-1712.
  7. Lappe JM, Travers-Gustafson D, Davies KM, Recker RR, Heaney RP. Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial. Am J Clin Nutr. 2007; 85 (6): 1586-91.
  8. Hofmann JN, Yu K, Horst RL, Hayes RB, Purdue MP Long-term variation in serum 25-hydroxyvitamin D concentration among participants in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. Cancer Epidemiol Biomarkers Prev. 2010; 19 (4): 927-31.
  9. Jorde R, Sneve M, Hutchinson M, Emaus N, Figenschau Y, Grimnes G. Tracking of serum 25-hydroxyvitamin D levels during 14 years in a population-based study and during 12 months in an intervention study. Am J Epidemiol. 2010; 171 (8): 903-908.
  10. Zheng, S. Vuitton, L. Sheyhidin, I. Vuitton, D. A. Zhang, Y. Lu, X. Northwestern China: a place to learn more on oesophageal cancer. Part one: behavioural and environmental risk factors. Eur J Gastroenterol Hepatol. 2010 Aug; 22 (8): 917-25.
  11. Yin, L. Grandi, N. Raum, E. Haug, U. Arndt, V. Brenner, H. Meta-analysis: Circulating vitamin D and ovarian cancer risk. Gynecologic oncology. 2011 May 1; 121 (2): 369-75.
  12. Grant, W. B. Effect of interval between serum draw and follow-up period on relative risk of cancer incidence with respect to 25-hydroxyvitamin D level; implications for meta-analyses and setting vitamin D guidelines. Dermato-endocrinology. 2011; 3 (3):
  13. Salazar-Martinez, E. Lazcano-Ponce, E. C. Gonzalez Lira-Lira, G. Escudero-De los Rios, P. Hernandez-Avila, M. Nutritional determinants of epithelial ovarian cancer risk: a case-control study in Mexico. Oncology. 2002; 63 (2): 151-7.