Calcium plus vitamin D supplementation and the risk of breast cancer

Rowan T. Chlebowski, Karen C. Johnson, Charles Kooperberg, Mary Pettinger, Jean Wactawski-Wende, Thomas E. Rohan, Jacques Rossouw, Dorothy Lane, Mary Jo O'Sullivan, Shagufta Yasmeen, Robert A. Hiatt, James M. Shikany, Mara Vitolins, Janu Khandekar, F. Allan Hubbell

Research output: Contribution to journalArticle

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Abstract

Background: Although some observational studies have associated higher calcium intake and especially higher vitamin D intake and 25-hydroxyvitamin D levels with lower breast cancer risk, no randomized trial has evaluated these relationships. Methods: Postmenopausal women (N = 36 282) who were enrolled in a Women's Health Initiative clinical trial were randomly assigned to 1000 mg of elemental calcium with 400 IU of vitamin D3 daily or placebo for a mean of 7.0 years to determine the effects of supplement use on incidence of hip fracture. Mammograms and breast exams were serially conducted. Invasive breast cancer was a secondary outcome. Baseline serum 25-hydroxyvitamin D levels were assessed in a nested case-control study of 1067 case patients and 1067 control subjects. A Cox proportional hazards model was used to estimate the risk of breast cancer associated with random assignment to calcium with vitamin D 3. Associations between 25-hydroxyvitamin D serum levels and total vitamin D intake, body mass index (BMI), recreational physical activity, and breast cancer risks were evaluated using logistic regression models. Statistical tests were two-sided. Results: Invasive breast cancer incidence was similar in the two groups (528 supplement vs 546 placebo; hazard ratio = 0.96; 95% confidence interval = 0.85 to 1.09). In the nested case-control study, no effect of supplement group assignment on breast cancer risk was seen. Baseline 25-hydroxyvitamin D levels were modestly correlated with total vitamin D intake (diet and supplements) (r = 0.19, P <. 001) and were higher among women with lower BMI and higher recreational physical activity (both P <. 001). Baseline 25-hydroxyvitamin D levels were not associated with breast cancer risk in analyses that were adjusted for BMI and physical activity (Ptrend =. 20). Conclusions: Calcium and vitamin D supplementation did not reduce invasive breast cancer incidence in postmenopausal women. In addition, 25-hydroxyvitamin D levels were not associated with subsequent breast cancer risk. These findings do not support a relationship between total vitamin D intake and 25-hydroxyvitamin D levels with breast cancer risk.

Original languageEnglish (US)
Pages (from-to)1581-1591
Number of pages11
JournalJournal of the National Cancer Institute
Volume100
Issue number22
DOIs
StatePublished - Nov 2008

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Vitamin D
Breast Neoplasms
Calcium
Body Mass Index
Cholecalciferol
Exercise
Case-Control Studies
Incidence
Logistic Models
Placebos
Hip Fractures
Women's Health
25-hydroxyvitamin D
Serum
Proportional Hazards Models
Observational Studies
Breast
Clinical Trials
Confidence Intervals
Diet

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Chlebowski, R. T., Johnson, K. C., Kooperberg, C., Pettinger, M., Wactawski-Wende, J., Rohan, T. E., ... Hubbell, F. A. (2008). Calcium plus vitamin D supplementation and the risk of breast cancer. Journal of the National Cancer Institute, 100(22), 1581-1591. https://doi.org/10.1093/jnci/djn360

Calcium plus vitamin D supplementation and the risk of breast cancer. / Chlebowski, Rowan T.; Johnson, Karen C.; Kooperberg, Charles; Pettinger, Mary; Wactawski-Wende, Jean; Rohan, Thomas E.; Rossouw, Jacques; Lane, Dorothy; O'Sullivan, Mary Jo; Yasmeen, Shagufta; Hiatt, Robert A.; Shikany, James M.; Vitolins, Mara; Khandekar, Janu; Hubbell, F. Allan.

In: Journal of the National Cancer Institute, Vol. 100, No. 22, 11.2008, p. 1581-1591.

Research output: Contribution to journalArticle

Chlebowski, RT, Johnson, KC, Kooperberg, C, Pettinger, M, Wactawski-Wende, J, Rohan, TE, Rossouw, J, Lane, D, O'Sullivan, MJ, Yasmeen, S, Hiatt, RA, Shikany, JM, Vitolins, M, Khandekar, J & Hubbell, FA 2008, 'Calcium plus vitamin D supplementation and the risk of breast cancer', Journal of the National Cancer Institute, vol. 100, no. 22, pp. 1581-1591. https://doi.org/10.1093/jnci/djn360
Chlebowski RT, Johnson KC, Kooperberg C, Pettinger M, Wactawski-Wende J, Rohan TE et al. Calcium plus vitamin D supplementation and the risk of breast cancer. Journal of the National Cancer Institute. 2008 Nov;100(22):1581-1591. https://doi.org/10.1093/jnci/djn360
Chlebowski, Rowan T. ; Johnson, Karen C. ; Kooperberg, Charles ; Pettinger, Mary ; Wactawski-Wende, Jean ; Rohan, Thomas E. ; Rossouw, Jacques ; Lane, Dorothy ; O'Sullivan, Mary Jo ; Yasmeen, Shagufta ; Hiatt, Robert A. ; Shikany, James M. ; Vitolins, Mara ; Khandekar, Janu ; Hubbell, F. Allan. / Calcium plus vitamin D supplementation and the risk of breast cancer. In: Journal of the National Cancer Institute. 2008 ; Vol. 100, No. 22. pp. 1581-1591.
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AU - Chlebowski, Rowan T.

AU - Johnson, Karen C.

AU - Kooperberg, Charles

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AU - Wactawski-Wende, Jean

AU - Rohan, Thomas E.

AU - Rossouw, Jacques

AU - Lane, Dorothy

AU - O'Sullivan, Mary Jo

AU - Yasmeen, Shagufta

AU - Hiatt, Robert A.

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AU - Hubbell, F. Allan

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