1
|
Bahador M, Saeedi Nejad M, Dabiri S, Larizadeh MH, Soofiabadi MF. Investigating the level of vitamin D receptor gene expression in two tumoral and healthy breast tissues in breast cancer patients and its association with prognostic factors. J Egypt Natl Canc Inst 2024; 36:12. [PMID: 38616231 DOI: 10.1186/s43046-024-00215-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 03/06/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Breast cancer is one of the most common cancers known among women. This study aimed to investigate the level of vitamin D receptor gene expression in two tumoral and healthy breast tissues in breast cancer patients and its association with prognostic factors. METHODS This descriptive cross-sectional study was conducted in 2022 on 50 patients with high suspicion of breast cancer who were candidates for mastectomy and lumpectomy in a learning hospital. From the patients, two tissue samples were prepared, and there was a total of 100 samples. The samples were subjected to H/E staining and evaluated by a pathologist. The presence or absence of malignancy in each sample was confirmed by two pathologists, and HER2/ER/PR indices were determined. Descriptive and analytical statistical methods and SPSS version 22 software were used. RESULTS The average age of the patients was 51.60 ± 11.22 years old, and the average tumor size was 3.17 ± 1.28. Most tumors were grade 2 (48%). The expression of HER2, ER, and PR was positive in 24, 64, and 54%, respectively. The largest number of cases were in stage 2A. The expression level of vitamin D receptor (VDR) gene in healthy tissue (2.08 ± 1.01) was higher than tumoral tissue (0.25 ± 1.38) (P = 0.001). In tumoral and healthy tissue, VDR expression was not significant according to tumor grade, HER2, ER, PR, LVI, LN, disease stage, age, and tumor size. CONCLUSIONS The expression level of VDR in healthy tissue was significantly higher than tumoral tissue. However, there was no significant relationship between VDR and tumor grade, HER2, ER, PR, LVI, LN, disease stage, age, and tumor size.
Collapse
Affiliation(s)
- Maryam Bahador
- Department of Radiation Oncology, Kerman University of Medical Sciences, Kerman, Iran
| | - Marjan Saeedi Nejad
- Department of Radiation Oncology, Kerman University of Medical Sciences, Kerman, Iran.
| | - Shahriar Dabiri
- Department of Pathology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Maryam Fekri Soofiabadi
- Pathology and Stem Cell Research Center, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| |
Collapse
|
2
|
Khodadadiyan A, Rahmanian M, Shekouh D, Golmohammadi M, Ghaedi A, Bazrgar A, Sayadi M, Bazrafshan M, Heydari A, Bazrafshan Drissi H. Evaluating the effect of vitamin D supplementation on serum levels of 25-hydroxy vitamin D, 1,25-dihydroxy vitamin D, parathyroid hormone and renin-angiotensin-aldosterone system: a systematic review and meta-analysis of clinical trials. BMC Nutr 2023; 9:132. [PMID: 37968749 PMCID: PMC10652523 DOI: 10.1186/s40795-023-00786-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 10/30/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Vitamin D, one of the most essential micronutrients, is crucial in various health outcomes. However, previous studies showed conflicting results and uncertainty about vitamin D supplementation's optimal dosage and duration. In this study, we aimed to evaluate the vitamin D supplements efficiency on serum levels of 25-hydroxy vitamin D (25(OH)D), 1,25-dihdroxy vitamin D (1,25(OH)2D), parathyroid hormone (PTH) and renin-angiotensin-aldosterone system (RAAS) in adults. METHODS A systematic analysis of eligible and relevant randomized-controlled trials (RCT) published before April 2023 assessing the effect of vitamin D supplementations applied. The studies were identified by searching several databases, including Pubmed, Scopus, Web of Science, ProQuest, and Cochrane Register of controlled trials. RESULTS Five eligible RCTs with 346 participants in the intervention and 352 participants in the control group were assessed in our project. According to the results, there was a substantial change in 25(OH)D (SMD: 2.2, I2: 92.3, 95% Confidence Interval (CI): 1.38-3.02, P-value: 0.048) and 1,25(OH)2D (SMD:1.23, I2: 86.3, 95% CI: 0.01- 2.44, P-value < 0.010) affected by vitamin D intervention. Regarding Parathyroid hormone (PTH), however, vitamin D intervention showed a remarkable decrease (SMD: -0.75, I2: 82.4, 95% CI: (-1.3)-(-0.18), P-value < 0.010). Moreover, sensitivity analysis showed significant publication bias in terms of 25(OH)D. CONCLUSION Vitamin D supplements significantly increase the serum levels of 25(OH)D and 1,25(OH)2D and decrease PTH levels. While some studies reported decreasing effect of vitamin D supplements on RAAS activity, some reported no changes.
Collapse
Affiliation(s)
- Alireza Khodadadiyan
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahdi Rahmanian
- Cardiovascular Research Center, Shiraz University of Medical Science, Shiraz, Iran
| | - Dorsa Shekouh
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Melika Golmohammadi
- Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arshin Ghaedi
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Aida Bazrgar
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehrab Sayadi
- Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Bazrafshan
- Cardiovascular Research Center, Shiraz University of Medical Science, Shiraz, Iran
| | - Aigin Heydari
- Cardiovascular Research Center, Shiraz University of Medical Science, Shiraz, Iran
| | | |
Collapse
|
3
|
Rasmussen MQ, Tindbæk G, Nielsen MM, Merrild C, Steiniche T, Pedersen JS, Moestrup SK, Degn SE, Madsen M. Epigenetic Silencing of LRP2 Is Associated with Dedifferentiation and Poor Survival in Multiple Solid Tumor Types. Cancers (Basel) 2023; 15:cancers15061830. [PMID: 36980716 PMCID: PMC10046670 DOI: 10.3390/cancers15061830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/07/2023] [Accepted: 03/09/2023] [Indexed: 03/30/2023] Open
Abstract
More than 80% of human cancers originate in epithelial tissues. Loss of epithelial cell characteristics are hallmarks of tumor development. Receptor-mediated endocytosis is a key function of absorptive epithelial cells with importance for cellular and organismal homeostasis. LRP2 (megalin) is the largest known endocytic membrane receptor and is essential for endocytosis of various ligands in specialized epithelia, including the proximal tubules of the kidney, the thyroid gland, and breast glandular epithelium. However, the role and regulation of LRP2 in cancers that arise from these tissues has not been delineated. Here, we examined the expression of LRP2 across 33 cancer types in The Cancer Genome Atlas. As expected, the highest levels of LRP2 were found in cancer types that arise from LRP2-expressing absorptive epithelial cells. However, in a subset of tumors from these cancer types, we observed epigenetic silencing of LRP2. LRP2 expression showed a strong inverse correlation to methylation of a specific CpG site (cg02361027) in the first intron of the LRP2 gene. Interestingly, low expression of LRP2 was associated with poor patient outcome in clear cell renal cell carcinoma, papillary renal cell carcinoma, mesothelioma, papillary thyroid carcinoma, and invasive breast carcinoma. Furthermore, loss of LRP2 expression was associated with dedifferentiated histological and molecular subtypes of these cancers. These observations now motivate further studies on the functional role of LRP2 in tumors of epithelial origin and the potential use of LRP2 as a cancer biomarker.
Collapse
Affiliation(s)
| | - Gitte Tindbæk
- Department of Biomedicine, Aarhus University, 8000 Aarhus, Denmark
- Department of Clinical Biochemistry, Horsens Regional Hospital, 8700 Horsens, Denmark
| | - Morten Muhlig Nielsen
- Department of Molecular Medicine (MOMA), Aarhus University Hospital, 8200 Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus, Denmark
| | - Camilla Merrild
- Department of Biomedicine, Aarhus University, 8000 Aarhus, Denmark
| | - Torben Steiniche
- Department of Pathology, Aarhus University Hospital, 8200 Aarhus, Denmark
| | - Jakob Skou Pedersen
- Department of Molecular Medicine (MOMA), Aarhus University Hospital, 8200 Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus, Denmark
- Bioinformatics Research Center (BiRC), Aarhus University, 8000 Aarhus, Denmark
| | - Søren K Moestrup
- Department of Biomedicine, Aarhus University, 8000 Aarhus, Denmark
- Department of Cancer and Inflammation Research, University of Southern Denmark, 5230 Odense, Denmark
| | - Søren E Degn
- Department of Biomedicine, Aarhus University, 8000 Aarhus, Denmark
| | - Mette Madsen
- Department of Biomedicine, Aarhus University, 8000 Aarhus, Denmark
| |
Collapse
|
4
|
Zhang R, Zhang Y, Liu Z, Pei Y, Xu P, Chong W, Hai Y, He L, He Y, Yu J, Wang J, Fang F, Peng X. Association between Vitamin D Supplementation and Cancer Mortality: A Systematic Review and Meta-Analysis. Cancers (Basel) 2022; 14:cancers14153717. [PMID: 35954381 PMCID: PMC9367315 DOI: 10.3390/cancers14153717] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary It has been questioned whether vitamin D supplements can reduce the mortality and incidence of tumors. In this systematic review and meta-analysis of 12 randomized controlled trials with a total of 72,669 participants, vitamin D supplementation could not reduce the cancer mortality or cancer incidence. Our results suggest a reconsideration of the previous view that vitamin D supplementation could reduce overall cancer mortality is needed. Abstract Background: Vitamin D deficiency is related to increased cancer risk and deaths. However, whether vitamin D supplementation reduces cancer mortality remains unclear, and several randomized controlled trials yield inconsistent results. Methods: Medline, Embase, and the Cochrane Central Register of Controlled Trials were searched from their inception until 28 June 2022, for randomized controlled trials investigating vitamin D supplementation. Pooled relative risks (RRs) and their 95% confidence intervals (CIs) were estimated. Trials with vitamin D supplementation combined with calcium supplementation versus placebo alone and recruiting participants with cancer at baseline were excluded in the present study. Results: This study included 12 trials with a total of 72,669 participants. Vitamin D supplementation did not reduce overall cancer mortality (RR 0.96, 95% CI 0.80–1.16). However, vitamin D supplementation was associated with a reduction in lung cancer mortality (RR 0.63, 95% CI 0.45–0.90). Conclusions: Vitamin D supplementation could not reduce cancer mortality in this highly purified meta-analysis. Further RCTs that evaluate the association between vitamin D supplementation and total cancer mortality are still needed.
Collapse
Affiliation(s)
- Renjie Zhang
- Department of Biotherapy, Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu 610041, China;
| | - Yu Zhang
- Evidence-Based Medicine Center, Affiliated Hospital of Chengdu University, Chengdu 610084, China;
| | - Zheran Liu
- Department of Biotherapy and National Clinical Research Center for Geriatrics, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China; (Z.L.); (Y.P.); (L.H.); (Y.H.); (J.W.)
| | - Yiyan Pei
- Department of Biotherapy and National Clinical Research Center for Geriatrics, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China; (Z.L.); (Y.P.); (L.H.); (Y.H.); (J.W.)
| | - Ping Xu
- Sichuan University Library, Sichuan University, Chengdu 610047, China;
| | - Weelic Chong
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA 19144, USA;
| | - Yang Hai
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19144, USA;
| | - Ling He
- Department of Biotherapy and National Clinical Research Center for Geriatrics, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China; (Z.L.); (Y.P.); (L.H.); (Y.H.); (J.W.)
| | - Yan He
- Department of Biotherapy and National Clinical Research Center for Geriatrics, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China; (Z.L.); (Y.P.); (L.H.); (Y.H.); (J.W.)
| | - Jiayi Yu
- School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China;
| | - Jingjing Wang
- Department of Biotherapy and National Clinical Research Center for Geriatrics, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China; (Z.L.); (Y.P.); (L.H.); (Y.H.); (J.W.)
| | - Fang Fang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu 610041, China;
| | - Xingchen Peng
- Department of Biotherapy and National Clinical Research Center for Geriatrics, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China; (Z.L.); (Y.P.); (L.H.); (Y.H.); (J.W.)
- Correspondence:
| |
Collapse
|
5
|
Filip-Psurska B, Zachary H, Strzykalska A, Wietrzyk J. Vitamin D, Th17 Lymphocytes, and Breast Cancer. Cancers (Basel) 2022; 14:cancers14153649. [PMID: 35954312 PMCID: PMC9367508 DOI: 10.3390/cancers14153649] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary The effect of vitamin D3 on the development of breast cancer (favorable, ineffective, or even unfavorable) depends on many factors, such as age, menopausal status, or obesity. The immunomodulatory effect of vitamin D may be unfavorable in case of breast cancer progression. The effect of vitamin D on Th17 cells may depend on disease type and patients’ age. Our goal was to summarize the data available and to find indications of vitamin D treatment failure or success. Therefore, in this review, we present data describing the effects of vitamin D3 on Th17 cells, mainly in breast cancer. Abstract Vitamin D3, which is well known to maintain calcium homeostasis, plays an important role in various cellular processes. It regulates the proliferation and differentiation of several normal cells, including immune and neoplastic cells, influences the cell cycle, and stimulates cell maturation and apoptosis through a mechanism dependent on the vitamin D receptor. The involvement of vitamin D3 in breast cancer development has been observed in numerous clinical studies. However, not all studies support the protective effect of vitamin D3 against the development of this condition. Furthermore, animal studies have revealed that calcitriol or its analogs may stimulate tumor growth or metastasis in some breast cancer models. It has been postulated that the effect of vitamin D3 on T helper (Th) 17 lymphocytes is one of the mechanisms promoting metastasis in these murine models. Herein we present a literature review on the existing data according to the interplay between vitamin D, Th17 cell and breast cancer. We also discuss the effects of this vitamin on Th17 lymphocytes in various disease entities known to date, due to the scarcity of scientific data on Th17 lymphocytes and breast cancer. The presented data indicate that the effect of vitamin D3 on breast cancer development depends on many factors, such as age, menopausal status, or obesity. According to that, more extensive clinical trials and studies are needed to assess the importance of vitamin D in breast cancer, especially when no correlations seem to be obvious.
Collapse
|
6
|
Liu D, Meng X, Tian Q, Cao W, Fan X, Wu L, Song M, Meng Q, Wang W, Wang Y. Vitamin D and Multiple Health Outcomes: An Umbrella Review of Observational Studies, Randomized Controlled Trials, and Mendelian Randomization Studies. Adv Nutr 2021; 13:1044-1062. [PMID: 34999745 PMCID: PMC9340982 DOI: 10.1093/advances/nmab142] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/29/2020] [Accepted: 11/19/2021] [Indexed: 12/18/2022] Open
Abstract
Observational studies, randomized controlled trials (RCTs), and Mendelian randomization (MR) studies have yielded inconsistent results on the associations of vitamin D concentrations with multiple health outcomes. In the present umbrella review we aimed to evaluate the effects of low vitamin D concentrations and vitamin D supplementation on multiple health outcomes. We summarized current evidence obtained from meta-analyses of observational studies that examined associations between vitamin D concentrations and multiple health outcomes, meta-analyses of RCTs that investigated the effect of vitamin D supplementation on multiple health outcomes, and MR studies that explored the causal associations of vitamin D concentrations with various diseases (international prospective register of systematic reviews PROSPERO registration number CRD42018091434). A total of 296 meta-analyses of observational studies comprising 111 unique outcomes, 139 meta-analyses of RCTs comprising 46 unique outcomes, and 73 MR studies comprising 43 unique outcomes were included in the present umbrella review. Twenty-eight disease outcomes were identified by both meta-analyses of observational studies and MR studies. Seventeen of these reported disease outcomes had consistent results, demonstrating that lower concentrations of vitamin D were associated with a higher risk for all-cause mortality, Alzheimer's disease, hypertension, schizophrenia, and type 2 diabetes. The combinations of consistent evidence obtained by meta-analyses of observational studies and MR studies together with meta-analyses of RCTs showed that vitamin D supplementation was associated with a decreased risk for all-cause mortality but not associated with the risk for Alzheimer's disease, hypertension, schizophrenia, or type 2 diabetes. The results indicated that vitamin D supplementation is a promising strategy with long-term preventive effects on multiple chronic diseases and thus has the potential to decrease all-cause mortality. However, the current vitamin D supplementation strategy might not be an efficient intervention approach for these diseases, suggesting that new strategies are highly needed to improve the intervention outcomes.
Collapse
Affiliation(s)
- Di Liu
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China,Centre for Biomedical Information Technology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, China
| | - Xiaoni Meng
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China
| | - Qiuyue Tian
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China
| | - Weijie Cao
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China
| | - Xin Fan
- School of Basic Medical Sciences, Capital Medical University, Beijing, China
| | - Lijuan Wu
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China
| | - Manshu Song
- Centre for Precision Health, School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
| | - Qun Meng
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China
| | - Wei Wang
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China,Centre for Precision Health, School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia,School of Public Health, Shandong First Medical University and Shandong Academy of Medical Science, Tai'an, Shandong, China
| | | |
Collapse
|
7
|
Kumar S, Freelander A, Lim E. Type 1 Nuclear Receptor Activity in Breast Cancer: Translating Preclinical Insights to the Clinic. Cancers (Basel) 2021; 13:4972. [PMID: 34638457 PMCID: PMC8507977 DOI: 10.3390/cancers13194972] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 12/30/2022] Open
Abstract
The nuclear receptor (NR) family of transcription factors is intimately associated with the development, progression and treatment of breast cancer. They are used diagnostically and prognostically, and crosstalk between nuclear receptor pathways and growth factor signalling has been demonstrated in all major subtypes of breast cancer. The majority of breast cancers are driven by estrogen receptor α (ER), and anti-estrogenic therapies remain the backbone of treatment, leading to clinically impactful improvements in patient outcomes. This serves as a blueprint for the development of therapies targeting other nuclear receptors. More recently, pivotal findings into modulating the progesterone (PR) and androgen receptors (AR), with accompanying mechanistic insights into NR crosstalk and interactions with other proliferative pathways, have led to clinical trials in all of the major breast cancer subtypes. A growing body of evidence now supports targeting other Type 1 nuclear receptors such as the glucocorticoid receptor (GR), as well as Type 2 NRs such as the vitamin D receptor (VDR). Here, we reviewed the existing preclinical insights into nuclear receptor activity in breast cancer, with a focus on Type 1 NRs. We also discussed the potential to translate these findings into improving patient outcomes.
Collapse
Affiliation(s)
- Sanjeev Kumar
- Faculty of Medicine, St Vincent’s Clinical School, University of New South Wales, Darlinghurst 2010, Australia; (A.F.); (E.L.)
- Garvan Institute of Medical Research, University of New South Wales, Darlinghurst 2010, Australia
| | - Allegra Freelander
- Faculty of Medicine, St Vincent’s Clinical School, University of New South Wales, Darlinghurst 2010, Australia; (A.F.); (E.L.)
- Garvan Institute of Medical Research, University of New South Wales, Darlinghurst 2010, Australia
| | - Elgene Lim
- Faculty of Medicine, St Vincent’s Clinical School, University of New South Wales, Darlinghurst 2010, Australia; (A.F.); (E.L.)
- Garvan Institute of Medical Research, University of New South Wales, Darlinghurst 2010, Australia
| |
Collapse
|
8
|
Thomas R, Kenfield SA, Yanagisawa Y, Newton RU. Why exercise has a crucial role in cancer prevention, risk reduction and improved outcomes. Br Med Bull 2021; 139:100-119. [PMID: 34426823 PMCID: PMC8431973 DOI: 10.1093/bmb/ldab019] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/30/2021] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Exercise is one of several factors known to lower the risk of developing cancer, as well as improve outcomes in patients already diagnosed. People who exercise after cancer have lower rates of cancer complications, treatment toxicities, relapse and improved survival. This review highlights the supportive data and biochemical processes, which explain these potential benefits. SOURCES OF DATA PubMed, Embase, Medline and Cochrane libraries were searched for papers which addressed the effects of exercise and physical activity on cancer for this review. The search terms used were physical activity, exercise and cancer up to February 2021. We also referred to the background research required for international exercise intervention study involving men with prostate cancer (INTERVAL-GAP4) and scrutinized references within the robust papers published on this subject to ensure we did not miss any clinically studies. One hundred and eighty eight papers were included. AREAS OF AGREEMENT Exercise programmes mitigate many of the complications and risks associated with cancer, particularly thromboembolism, fatigue, weight gain, arthralgia, cognitive impairment and depression. AREAS OF CONTROVERSY Molecular and biomarker changes, resulting from exercise, suggest that exercise elicits beneficial changes in insulin-related pathways, down-regulates inflammation and serum oestrogen levels, and enhances oxidative, immune and cellular repair pathways. Nonetheless, the evidence remains preliminary. GROWING POINTS The timing, intensity and challenges of prehabilitation, adjunct and rehabilitation exercise programmes are being increasingly understood but their implementation remains sporadic. AREAS FOR DEVELOPING RESEARCH More robust clinical trial data are needed to substantiate a causal effect of exercise on overall and cancer-specific survival. These studies are ongoing. Research evaluating the most cost-efficient ways of incorporating prehabilitation, adjunct and rehabilitation programmes into routine practice would be helpful to funding bodies and health care strategists.
Collapse
Affiliation(s)
- Robert Thomas
- Department of Oncology, Addenbrooke's Hospital, Cambridge CB2 2QQ, UK
| | - Stacey A Kenfield
- Departments of Urology and Epidemiology and Biostatistics, University of California at San Francisco, Mission Hall, Box 1695-550, 16th Street, 6th Floor, San Francisco, CA 9414, USA
| | - Yuuki Yanagisawa
- Department of Medicine, Bedford Hospital, Kempston road, Bedford MK42 9DJ, UK
| | - Robert U Newton
- Exercise Medicine Research Institute, Edith Cowan University, 270 Joondalup Drive, Perth, WA 6027, Australia
| |
Collapse
|
9
|
Impact of serum vitamin D on the response and prognosis in breast cancer patients treated with neoadjuvant chemotherapy. Breast Cancer 2021; 29:156-163. [PMID: 34487328 PMCID: PMC8732931 DOI: 10.1007/s12282-021-01292-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 08/31/2021] [Indexed: 11/10/2022]
Abstract
Background Several studies have recently reported that the relationships between serum vitamin D and the prognosis or the pathological response to neoadjuvant chemotherapy (NAC) in breast cancer. However, there are no data regarding the clinical impacts of the vitamin D in Japanese breast cancer patients so far. Patients and methods In the present study, a total of 250 patients with clinical Stage I–III primary breast cancer who were treated with NAC and subsequently underwent definitive surgery were included. Serum 25-hydroxvitamin D (25(OH)D) levels were evaluated using blood samples obtained before NAC. Results The serum 25(OH)D was positively associated with age, and the serum 25(OH)D was significantly higher in postmenopausal women than that in pre/peri-menopausal women. Serum 25(OH)D level was not associated with the achievement of pathological complete response (pCR) in this cohort. The low 25(OH)D levels were significantly associated with shorter time to distant recurrence (TTDR). According to the univariate analysis, high clinical stage before NAC (cStage III) and low serum 25(OH)D level were significantly associated with the shorter TTDR, and pCR was significantly associated with the longer TTDR. According to a multivariate analysis, low serum 25(OH)D level were independent poor prognostic factors for TTDR. Conclusions The low 25(OH)D levels were significantly associated with poorer prognosis in Japanese women with operable breast cancer patients treated with NAC.
Collapse
|
10
|
Xu H, Liu Z, Shi H, Wang C. Prognostic role of vitamin D receptor in breast cancer: a systematic review and meta-analysis. BMC Cancer 2020; 20:1051. [PMID: 33131491 PMCID: PMC7603743 DOI: 10.1186/s12885-020-07559-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 10/22/2020] [Indexed: 02/06/2023] Open
Abstract
Background A higher vitamin D intake improves the prognosis of early stage breast cancer (BC) patients. We hypothesized that vitamin D intake should refer to vitamin D receptor (VDR) expression. In order to prove this hypothesis, we first intend to evaluate the correlation between VDR expression and prognosis of BC patients using meta-analysis. Methods Literatures from PubMed, Embase, and the Cochrane Library (last update by May 20, 2020) were retrieved to find studies assessing the prognostic role of VDR in BC. The hazard ratios (HRs) for patients’ survival were extracted for pooled analyses. Subgroup analysis, sensitivity analysis and meta-regression were performed to explore the sources of heterogeneity. Results Seven articles containing eight studies with 2503 patients were enrolled. The results from the pooled analyses showed that the VDR expression generally had no relationship with BC patients’ overall survival (OS), disease-free survival (DFS), cancer-specific survival (CSS), and progression-free survival (PFS) (P > 0.05). Because only the number of studies exploring the relationship between VDR expression and OS is greater than five and there is heterogeneity, we explored the sources of heterogeneity of these studies. Subgroup analyses showed that the VDR expression in the nucleus had no relationship with OS, but high total VDR expression in the nucleus and cytoplasm was related to a better OS (pooled HR = 0.41; 95% CI = 0.18–0.95; P = 0.038). In addition, in subgroup of studies using cut-off values other than ‘immunoreactive score (IRS)>5’ and ‘IRS > 25′, high VDR expression was associated with a better OS (pooled HR = 0.47; 95% CI = 0.30–0.74; P = 0.001). Sensitivity analysis showed that the result pattern was not obviously affected by any single study. Meta-regression showed that the source of heterogeneity was not country (P = 0.657), pathological type (P = 0.614), molecular type (P = 0.423), staining location (P = 0.481), or cut-off value (P = 0.509). Conclusions The protein expression level of VDR in entire BC cells evaluated by immunohistochemistry is related to the OS of BC patients. It is expected that a more individualized vitamin D intake and a more accurate prognosis assessment can be recommended for BC patients based on the VDR expression. Of course, more preclinical and clinical studies are needed.
Collapse
Affiliation(s)
- Haiyan Xu
- Department of Medical Oncology, The Second People's Hospital of Lianyungang, 41 Hailian Road, Lianyungang, 222000, China
| | - Zhenhua Liu
- Department of Radiotherapy, The First People's Hospital of Yancheng, 66 Renmin Street, Yancheng, 224005, China
| | - Hongtai Shi
- Department of Radiotherapy, The Third People's Hospital of Yancheng, 75 Juchang Street, Yancheng, 224005, China.
| | - Chunbin Wang
- Department of Oncology, The Third People's Hospital of Yancheng, 75 Juchang Street, Yancheng, 224005, China.
| |
Collapse
|
11
|
Kim H, Giovannucci E. Vitamin D Status and Cancer Incidence, Survival, and Mortality. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1268:39-52. [DOI: 10.1007/978-3-030-46227-7_3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
12
|
Huss L, Butt ST, Borgquist S, Elebro K, Sandsveden M, Rosendahl A, Manjer J. Vitamin D receptor expression in invasive breast tumors and breast cancer survival. Breast Cancer Res 2019; 21:84. [PMID: 31358030 PMCID: PMC6664551 DOI: 10.1186/s13058-019-1169-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 07/15/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Vitamin D has been suggested to prevent and improve the prognosis of several cancers, including breast cancer. We have previously shown a U-shaped association between pre-diagnostic serum levels of vitamin D and risk of breast cancer-related death, with poor survival in patients with the lowest and the highest levels respectively, as compared to the intermediate group. Vitamin D exerts its functions through the vitamin D receptor (VDR), and the aim of the current study was to investigate if the expression of VDR in invasive breast tumors is associated with breast cancer prognosis. METHODS VDR expression was evaluated in a tissue microarray of 718 invasive breast tumors. Covariation between VDR expression and established prognostic factors for breast cancer was analyzed, as well as associations between VDR expression and breast cancer mortality. RESULTS We found that positive VDR expression in the nuclei and cytoplasm of breast cancer cells was associated with favorable tumor characteristics such as smaller size, lower grade, estrogen receptor positivity and progesterone receptor positivity, and lower expression of Ki67. In addition, both intranuclear and cytoplasmic VDR expression were associated with a low risk of breast cancer mortality, hazard ratios 0.56 (95% CI 0.34-0.91) and 0.59 (0.30-1.16) respectively. CONCLUSIONS This study found that high expression of VDR in invasive breast tumors is associated with favorable prognostic factors and a low risk of breast cancer death. Hence, a high VDR expression is a positive prognostic factor.
Collapse
Affiliation(s)
- Linnea Huss
- Department of Surgery, Lund University, Skåne University Hospital, SE-205 02, Malmö, Sweden.
| | - Salma Tunå Butt
- Department of Surgery, Lund University, Skåne University Hospital, SE-205 02, Malmö, Sweden
| | - Signe Borgquist
- Department of Oncology, Aarhus University, Aarhus University Hospital, DE-8000, Aarhus C, Denmark
| | - Karin Elebro
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Skåne University Hospital, SE-221 85, Lund, Sweden
| | - Malte Sandsveden
- Department of Surgery, Lund University, Skåne University Hospital, SE-205 02, Malmö, Sweden
| | - Ann Rosendahl
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Skåne University Hospital, SE-221 85, Lund, Sweden
| | - Jonas Manjer
- Department of Surgery, Lund University, Skåne University Hospital, SE-205 02, Malmö, Sweden
| |
Collapse
|
13
|
Nutrition and Breast Cancer: A Literature Review on Prevention, Treatment and Recurrence. Nutrients 2019; 11:nu11071514. [PMID: 31277273 PMCID: PMC6682953 DOI: 10.3390/nu11071514] [Citation(s) in RCA: 162] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 06/28/2019] [Accepted: 07/01/2019] [Indexed: 12/13/2022] Open
Abstract
Breast cancer (BC) is the second most common cancer worldwide and the most commonly occurring malignancy in women. There is growing evidence that lifestyle factors, including diet, body weight and physical activity, may be associated with higher BC risk. However, the effect of dietary factors on BC recurrence and mortality is not clearly understood. Here, we provide an overview of the current evidence obtained from the PubMed databases in the last decade, assessing dietary patterns, as well as the consumption of specific food-stuffs/food-nutrients, in relation to BC incidence, recurrence and survival. Data from the published literature suggest that a healthy dietary pattern characterized by high intake of unrefined cereals, vegetables, fruit, nuts and olive oil, and a moderate/low consumption of saturated fatty acids and red meat, might improve overall survival after diagnosis of BC. BC patients undergoing chemotherapy and/or radiotherapy experience a variety of symptoms that worsen patient quality of life. Studies investigating nutritional interventions during BC treatment have shown that nutritional counselling and supplementation with some dietary constituents, such as EPA and/or DHA, might be useful in limiting drug-induced side effects, as well as in enhancing therapeutic efficacy. Therefore, nutritional intervention in BC patients may be considered an integral part of the multimodal therapeutic approach. However, further research utilizing dietary interventions in large clinical trials is required to definitively establish effective interventions in these patients, to improve long-term survival and quality of life.
Collapse
|
14
|
Kok DE, van den Berg MMGA, Posthuma L, van 't Erve I, van Duijnhoven FJB, de Roos WK, Grosfeld S, Los M, Sommeijer DW, van Laarhoven HWM, Winkels RM, Kampman E. Changes in Circulating Levels of 25-hydroxyvitamin D3 in Breast Cancer Patients Receiving Chemotherapy. Nutr Cancer 2019; 71:756-766. [PMID: 30661404 DOI: 10.1080/01635581.2018.1559938] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Cancer treatments, toxicities and their effects on lifestyle, may impact levels of vitamin D. The aim of this study was to determine serum 25-hydroxyvitamin D3 (25(OH)D3) levels before, directly after and 6 months after chemotherapy in breast cancer patients (n = 95), and a comparison group of women (n = 52) not diagnosed with cancer. Changes in 25(OH)D3 levels over time were compared using linear mixed models adjusted for age and season of blood sampling. Before start of chemotherapy, 25(OH)D3 levels were lower in patients (estimated marginal mean 55.8 nmol/L, 95% confidence interval (95%CI) 51.2-60.4) compared to the comparison group (67.2 nmol/L, 95%CI 61.1-73.3, P = 0.003). Directly after chemotherapy, 25(OH)D3 levels were slightly decreased (-5.1 nmol/L, 95%CI -10.7-0.5, P = 0.082), but ended up higher 6 months after chemotherapy (10.9 nmol/L, 95%CI 5.5-16.4, P < 0.001) compared to pre-chemotherapy values. In women without cancer, 25(OH)D3 levels remained stable throughout the study. Use of dietary supplements did not explain recovery of 25(OH)D3 levels after chemotherapy. We reported lower 25(OH)D3 levels in breast cancer patients, which decreased during chemotherapy, but recovered to levels observed in women without cancer within 6 months after chemotherapy. Suboptimal 25(OH)D3 levels in the majority of the participants highlight the relevance of monitoring in this vulnerable population.
Collapse
Affiliation(s)
- Dieuwertje E Kok
- a Division of Human Nutrition and Health , Wageningen University & Research , Wageningen , the Netherlands
| | - Maaike M G A van den Berg
- a Division of Human Nutrition and Health , Wageningen University & Research , Wageningen , the Netherlands
| | - Liesbeth Posthuma
- a Division of Human Nutrition and Health , Wageningen University & Research , Wageningen , the Netherlands
| | - Iris van 't Erve
- a Division of Human Nutrition and Health , Wageningen University & Research , Wageningen , the Netherlands
| | - Fränzel J B van Duijnhoven
- a Division of Human Nutrition and Health , Wageningen University & Research , Wageningen , the Netherlands
| | - Wilfred K de Roos
- b Department of Surgery , Hospital Gelderse Vallei , the Netherlands
| | | | - Maartje Los
- d Department of Medical Oncology, St. Antonius Hospital , Nieuwegein , the Netherlands
| | - Dirkje W Sommeijer
- e Department of Medical Oncology, Flevohospital , Almere , the Netherlands.,f Department of Medical Oncology , Academic Medical Center , Amsterdam , the Netherlands
| | | | - Renate M Winkels
- a Division of Human Nutrition and Health , Wageningen University & Research , Wageningen , the Netherlands.,g Department of Public Health Sciences, Penn State College of Medicine , Hershey , Pennsylvania , USA
| | - Ellen Kampman
- a Division of Human Nutrition and Health , Wageningen University & Research , Wageningen , the Netherlands
| |
Collapse
|
15
|
Andersen MR, Sweet E, Hager S, Gaul M, Dowd F, Standish LJ. Effects of Vitamin D Use on Health-Related Quality of Life of Breast Cancer Patients in Early Survivorship. Integr Cancer Ther 2019; 18:1534735418822056. [PMID: 30616390 PMCID: PMC7240878 DOI: 10.1177/1534735418822056] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Background: Vitamin D supplements may prevent recurrence, prolong
survival, and improve mood for women with breast cancer, although evidence for
these effects is preliminary. Methods: This report describes
vitamin D supplement use by 553 breast cancer patient/survivors (193 who used a
naturopathic oncology [NO] provider and 360 who did not) participating in a
matched cohort study of breast cancer outcomes. Results: We found
that more than half of breast cancer patients reported using vitamin D
supplements. Women who received care from NO providers in early survivorship may
be more likely to use vitamin D supplements (P < .05).
Approximately 30% of breast cancer patients with blood levels recorded in their
medical chart were potentially vitamin D deficient (<30 ng/mL). Vitamin D
supplement use at study enrollment was associated with higher levels of
self-reported health-related quality of life (HRQOL) at enrollment
(P < .05) and predicted better HRQOL at 6-month
follow-up (P < .05). Sufficient blood levels of vitamin D
recorded between enrollment and follow-up were also associated with better HRQOL
at follow-up (P < .05). Conclusions: Vitamin D
supplementation by breast cancer patients is common both during and after
treatment for breast cancer, but deficiency may also be common. NO and
conventional providers may be able to promote vitamin D sufficiency through
vitamin D supplementation and by encouraging healthy solar exposure. Further
studies should be undertaken examining whether vitamin D supplementation and
higher blood levels might improve HRQOL among women with breast cancer in early
survivorship.
Collapse
Affiliation(s)
- M Robyn Andersen
- 1 Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,2 University of Washington, Seattle, WA, USA
| | | | - Shelly Hager
- 1 Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Marcia Gaul
- 1 Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Fred Dowd
- 3 Bastyr University, Kenmore, WA, USA
| | | |
Collapse
|
16
|
Delmonico L, Costa MASM, Azevedo CMD, Silvestre RT, Scherrer LR, Ornellas MHF, Alves G. Low Levels of Vitamin D in a Cohort of Women with Impalpable Breast Lesions from Rio de Janeiro/Brazil. Asian Pac J Cancer Prev 2018; 19:3087-3092. [PMID: 30485946 PMCID: PMC6318410 DOI: 10.31557/apjcp.2018.19.11.3087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background: Low levels of vitamin D have been described as a risk factor for the development of breast cancer. The aim of this study was to evaluate the serum levels of vitamin D (25OHD) in patients with impalpable breast lesions comparing with a control group. Methods: Vitamin D quantification (25OHD) was assessed in the plasma of 65 patients with impalpable breast lesions and from 20 health controls using a chemiluminescent microparticle immunoassay. Pearson’s chi-square test and nonparametric t-Student were used to evaluate statistical significance between the clinical variables and the means of quantification of vitamin D. The receiver operating characteristic (ROC) curve was used to evaluate the correlation between age and vitamin sufficiency for the cases and the controls. Results: The prevalence of vitamin D deficiency and/or insufficiency in women with malignant lesions was 84% and 60% for the control group. Using the chi-square or Fisher’s exact test, the relationship between vitamin D levels and age presented significant association only for the control group (P=0.002). Using ROC curve, the plot area (0.778) for the control group defined a cut-off value of 45 years to age, with specificity and sensitivity of 60% and 50%, respectively. Thus, the odds ratio for vitamin D insufficiency in women over 45 years was 1.37 (P=0.011). For the case group, clinical characteristics, histological grade, and lymph node involvement did not show any significant association. Conclusion: The prevalence of vitamin D deficiency/insufficiency is high in women with impalpable breast lesions, as well as in the control group, even in a tropical city. According to the results the age advancement may be involved with the decrease in vitamin D levels in plasma, but there was no statistical association between low levels of Vitamin D and breast cancer.
Collapse
Affiliation(s)
- Lucas Delmonico
- Circulating Biomarkers Laboratory, Faculty of Medical Sciences, Rio de Janeiro State University, Rio de Janeiro, Brazil.,Medical Sciences Graduation Program (PGCM), Faculty of Medical Sciences, Rio de Janeiro State University, Rio de Janeiro, Brazil. ,
| | | | | | | | | | | | | |
Collapse
|
17
|
Abstract
Breast cancer has a high incidence worldwide. The results of substantial studis reveal that inflammation plays an important role in the initiation, development, and aggressiveness of many malignancies. The use of celecoxib, a novel NSAID, is repetitively associated with the reduced risk of the occurrence and progression of a number of types of cancer, particularly breast cancer. This observation is also substantiated by various meta-analyses. Clinical trials have been implemented on integration treatment of celecoxib and shown encouraging results. Celecoxib could be treated as a potential candidate for antitumor agent. There are, nonetheless, some unaddressed questions concerning the precise mechanism underlying the anticancer effect of celecoxib as well as its activity against different types of cancer. In this review, we discuss different mechanisms of anticancer effect of celecoxib as well as preclinical/clinical results signifying this beneficial effect.
Collapse
Affiliation(s)
- Jieqing Li
- Department of Breast Surgery, Tianjin Central Hospital of Gynecology and Obstetrics, Tianjin, China.,Division of Cancer Research and Training, Department of Internal Medicine, Charles R. Drew University of Medicine and Science, Los Angeles,CA, USA, ;
| | - Qiongyu Hao
- Division of Cancer Research and Training, Department of Internal Medicine, Charles R. Drew University of Medicine and Science, Los Angeles,CA, USA, ;
| | - Wei Cao
- Division of Cancer Research and Training, Department of Internal Medicine, Charles R. Drew University of Medicine and Science, Los Angeles,CA, USA, ; .,Department of Nuclear Medicine, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jaydutt V Vadgama
- Division of Cancer Research and Training, Department of Internal Medicine, Charles R. Drew University of Medicine and Science, Los Angeles,CA, USA, ; .,David Geffen UCLA School of Medicine and UCLA Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA, USA, ;
| | - Yong Wu
- Division of Cancer Research and Training, Department of Internal Medicine, Charles R. Drew University of Medicine and Science, Los Angeles,CA, USA, ; .,David Geffen UCLA School of Medicine and UCLA Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA, USA, ;
| |
Collapse
|
18
|
Pineda-Moncusí M, Garcia-Perez MA, Rial A, Casamayor G, Cos ML, Servitja S, Tusquets I, Diez-Perez A, Cano A, Garcia-Giralt N, Nogues X. Vitamin D levels in Mediterranean breast cancer patients compared with those in healthy women. Maturitas 2018; 116:83-88. [DOI: 10.1016/j.maturitas.2018.07.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 07/09/2018] [Accepted: 07/27/2018] [Indexed: 11/26/2022]
|
19
|
De novo vitamin D supplement use post-diagnosis is associated with breast cancer survival. Breast Cancer Res Treat 2018; 172:179-190. [PMID: 30039288 DOI: 10.1007/s10549-018-4896-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 07/17/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE Experimental laboratory data have indicated a protective effect of vitamin D on breast cancer progression, while epidemiological evidence is growing. Using pharmacy claims data, this study investigates the association between vitamin D supplement use initiated after a breast cancer diagnosis and associated mortality. METHODS Women aged 50-80 years with a record of invasive breast cancer were identified on the National Cancer Registry Ireland database (n = 5417). Initiation of de novo vitamin D post-diagnosis was identified from linked national prescription data (n = 2581, 49%). Multivariate Cox proportional hazards models were used to estimate adjusted HRs (95% CIs) for breast cancer-specific mortality. RESULTS There was a 20% reduction in breast cancer-specific mortality in de novo vitamin D users (modelled as a time-varying variable) compared to non-users (HR 0.80; 95% CI 0.64-0.99, p = 0.048) and the reduction was greater at 49% (HR 0.51; 95% CI 0.34-0.74, p < 0.001), if vitamin D was initiated soon after the breast cancer diagnosis (within 6 months). CONCLUSIONS In this large national breast cancer cohort, de novo vitamin D use post-diagnosis was found to be associated with a reduction in breast cancer-specific mortality. Vitamin D, therefore, has the potential as a non-toxic and inexpensive agent to improve survival in breast cancer patients. Findings support the need for RCTs exploring the effect of vitamin D supplementation on breast cancer survival.
Collapse
|
20
|
Kim JS, Haule CC, Kim JH, Lim SM, Yoon KH, Kim JY, Park HS, Park S, Kim SI, Cho YU, Park BW. Association between Changes in Serum 25-Hydroxyvitamin D Levels and Survival in Patients with Breast Cancer Receiving Neoadjuvant Chemotherapy. J Breast Cancer 2018; 21:134-141. [PMID: 29963108 PMCID: PMC6015976 DOI: 10.4048/jbc.2018.21.2.134] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 04/06/2018] [Indexed: 02/06/2023] Open
Abstract
Purpose We investigated the changes in serum 25-hydroxyvitamin D (25[OH]D) levels before and after neoadjuvant chemotherapy (NCT) and the associations with pathologic complete response (pCR) and survival in patients with breast cancer. Methods Serum 25(OH)D concentrations were measured pre- and post-NCT in 374 patients between 2010 and 2013. Based on a cutoff of 20 ng/mL, patients were categorized into “either sufficient” or “both deficient” groups. The associations with clinicopathological data, including pCR and survival, were analyzed using multivariable analyses. Results Patients with either pre- or post-NCT sufficient 25(OH)D levels accounted for 23.8%, and the overall pCR rate was 25.9%. Most patients showed 25(OH)D deficiency at diagnosis and 65.8% showed decreased serum levels after NCT. Changes in 25(OH)D status were associated with postmenopause status, rural residence, baseline summer examination, and molecular phenotype, but not pCR. No association between survival and 25(OH)D status was found, including in the subgroup analyses based on molecular phenotypes. Conclusion Most Korean patients with breast cancer showed vitamin D deficiency at diagnosis and a significant decrease in the serum concentration after NCT. No association with oncologic outcomes was found. Therefore, although optimal management for vitamin D deficiency is urgent for skeletal health, further research is warranted to clearly determine the prognostic role of vitamin D in patients with breast cancer who are candidates for NCT.
Collapse
Affiliation(s)
- Ji Su Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | | | - Joo Heung Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Mook Lim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Kwang Hyun Yoon
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jee Ye Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Hyung Seok Park
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Seho Park
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.,Frontier Research Institute of Convergence Sports Science, Yonsei University, Seoul, Korea
| | - Seung Il Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Young Up Cho
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Byeong-Woo Park
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
21
|
Mizrak Kaya D, Ozturk B, Kubilay P, Onur H, Utkan G, Cay Senler F, Alkan A, Yerlikaya H, Koksoy EB, Karci E, Demirkazik A, Akbulut H, Icli F. Diagnostic serum vitamin D level is not a reliable prognostic factor for resectable breast cancer. Future Oncol 2018; 14:1461-1467. [DOI: 10.2217/fon-2017-0608] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Aim: There are inconsistent results about the effects of vitamin D level on breast cancer prognosis. We aimed to investigate the effect of vitamin D levels on the prognosis of resectable breast cancer in a patient group with highly different clothing styles. Patients & methods: A total of 186 breast cancer patients were enrolled in the study. Results: Vitamin D level was sufficient, insufficient and deficient in 17.2, 52.2 and 30.6% of patients, respectively. There was a significant relationship between clothing style and serum 25 (OH) D levels. We could not establish any relation between vitamin D level and tumor characteristics or survival. Conclusion: Vitamin D supplementation can be more important than diagnostic serum vitamin D level on prognosis of breast cancer.
Collapse
Affiliation(s)
- Dilsa Mizrak Kaya
- Department of Medical Oncology, Ankara University School of Medicine, Ankara 06590, Turkey
- MD Anderson Cancer Center, The University of Texas, Houston, Texas 77030, USA
| | - Bengi Ozturk
- Department of Medical Oncology, Ankara University School of Medicine, Ankara 06590, Turkey
| | - Pinar Kubilay
- Department of Medical Oncology, Ankara University School of Medicine, Ankara 06590, Turkey
| | - Handan Onur
- Department of Medical Oncology, Ankara University School of Medicine, Ankara 06590, Turkey
| | - Gungor Utkan
- Department of Medical Oncology, Ankara University School of Medicine, Ankara 06590, Turkey
| | - Filiz Cay Senler
- Department of Medical Oncology, Ankara University School of Medicine, Ankara 06590, Turkey
| | - Ali Alkan
- Department of Medical Oncology, Ankara University School of Medicine, Ankara 06590, Turkey
| | - Halis Yerlikaya
- Department of Medical Oncology, Ankara University School of Medicine, Ankara 06590, Turkey
| | - Elif B Koksoy
- Department of Medical Oncology, Ankara University School of Medicine, Ankara 06590, Turkey
| | - Ebru Karci
- Department of Medical Oncology, Ankara University School of Medicine, Ankara 06590, Turkey
| | - Ahmet Demirkazik
- Department of Medical Oncology, Ankara University School of Medicine, Ankara 06590, Turkey
| | - Hakan Akbulut
- Department of Medical Oncology, Ankara University School of Medicine, Ankara 06590, Turkey
| | - Fikri Icli
- Department of Medical Oncology, Ankara University School of Medicine, Ankara 06590, Turkey
- Department of Medical Oncology, Ufuk University School of Medicine, Ankara 06830, Turkey
| |
Collapse
|
22
|
Hu K, Callen DF, Li J, Zheng H. Circulating Vitamin D and Overall Survival in Breast Cancer Patients: A Dose-Response Meta-Analysis of Cohort Studies. Integr Cancer Ther 2018; 17:217-225. [PMID: 28589744 PMCID: PMC6041929 DOI: 10.1177/1534735417712007] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 04/02/2017] [Accepted: 04/14/2017] [Indexed: 12/28/2022] Open
Abstract
Studies have shown that vitamin D could have a role in breast cancer survival; however, the evidence of the relationship between patients' vitamin D levels and their survival has been inconsistent. This meta-analysis explores possible dose-response relationships between vitamin D levels and overall survival by allowing for differences in vitamin D levels among populations of the various studies. Studies relating vitamin D (25-OH-D [25-hydroxyvitamin D]) levels in breast cancer patients with their survival were identified by searching PubMed and Embase. A pooled HR (hazard ratio) comparing the highest with the lowest category of circulating 25-OH-D levels were synthesized using the Mantel-Haenszel method under a fixed-effects model. A two-stage fixed-effects dose-response model including both linear (a log-linear dose-response regression) and nonlinear (a restricted cubic spline regression) models were used to further explore possible dose-response relationships. Six studies with a total number of 5984 patients were identified. A pooled HR comparing the highest with the lowest category of circulating 25-OH-D levels under a fixed-effects model was 0.67 (95% confidence interval = 0.56-0.79, P < .001). Utilizing a dose-response meta-analysis, the pooled HR for overall survival in breast cancer patients was 0.994 (per 1 nmol/L), Pfor linear trend < .001. At or above a 23.3 nmol/L threshold, for a 10 nmol/L, 20 nmol/L, or 25 nmol/L increment in circulating 25-OH-D levels, the risk of breast cancer overall mortality decreased by 6%, 12%, and 14%, respectively. There was no significant nonlinearity in the relationship between overall survival and circulating 25-OH-D levels. Our findings suggest that there is a highly significant linear dose-response relationship between circulating 25-OH-D levels and overall survival in patients with breast cancer. However, better designed prospective cohort studies and clinical trials are needed to further confirm these findings.
Collapse
Affiliation(s)
- Kejia Hu
- Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | | | - Jiayuan Li
- Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Hong Zheng
- Sichuan University, Chengdu, Sichuan, People’s Republic of China
| |
Collapse
|
23
|
Lim ST, Jeon YW, Gwak H, Kim SY, Suh YJ. Synergistic anticancer effects of ruxolitinib and calcitriol in estrogen receptor‑positive, human epidermal growth factor receptor 2‑positive breast cancer cells. Mol Med Rep 2018; 17:5581-5588. [PMID: 29436642 PMCID: PMC5865997 DOI: 10.3892/mmr.2018.8580] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 12/21/2017] [Indexed: 12/11/2022] Open
Abstract
The Janus kinase (JAK)1 and JAK2 inhibitor, ruxolitinib, and the active form of vitamin D (calcitriol) were previously reported to possess anticancer effects in breast cancer. The present study investigated the combined effects of ruxolitinib and calcitriol on an estrogen receptor (ER)‑positive, human epidermal growth factor receptor 2 (HER2)‑positive, breast cancer cell line. The ER and HER2‑positive MCF7‑HER18 breast cancer cell line was used to investigate the combination effect of ruxolitinib and calcitriol. A bromodeoxyuridine (BrdU) assay was used to investigate cell growth inhibition. The synergism of this combination therapy was examined using the Chou‑Talalay method. Cell cycle analysis was performed by flow cytometry, and apoptosis was evaluated by flow cytometry following Annexin V‑fluorescein isothiocyanate (FITC) and propidium iodide (PI) staining. Alterations in protein expression levels were analyzed by western blotting. The BrdU assay indicated that combination treatment using ruxolitinib and calcitriol produced a synergistic anti‑proliferative effect in MCF7‑HER18 breast cancer cells. Annexin V‑FITC/PI staining and cell cycle analysis identified a synergistic increase in apoptosis and sub‑G1 arrest in the presence of ruxolitinib and calcitriol. Western blot analysis revealed that these synergistic effects of ruxolitinib and calcitriol were associated with reduced protein levels of JAK2, phosphorylated JAK2, c‑Myc proto oncogene protein, cyclin‑D1, apoptosis regulator Bcl‑2 and Bcl‑2‑like protein 1, and with increased levels of caspase‑3 and Bcl‑2‑associated agonist of cell death proteins. The results of the present study demonstrated the synergistic anticancer effects of ruxolitinib and calcitriol in ER and HER2‑positive MCF7‑HER18 breast cancer cells. Based on these findings, ruxolitinib and calcitriol may have potential as a combination therapy for patients with ER and HER2‑positive breast cancer.
Collapse
Affiliation(s)
- Seung Taek Lim
- Division of Breast and Thyroid Surgical Oncology, Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Gyeonggi 16247, Republic of Korea
| | - Ye Won Jeon
- Division of Breast and Thyroid Surgical Oncology, Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Gyeonggi 16247, Republic of Korea
| | - Hongki Gwak
- Division of Breast and Thyroid Surgical Oncology, Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Gyeonggi 16247, Republic of Korea
| | - Se Young Kim
- Division of Breast and Thyroid Surgical Oncology, Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Gyeonggi 16247, Republic of Korea
| | - Young Jin Suh
- Division of Breast and Thyroid Surgical Oncology, Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Gyeonggi 16247, Republic of Korea
| |
Collapse
|
24
|
Prevalence and Predictors of Low Serum 25-Hydroxyvitamin D among Female African-American Breast Cancer Survivors. J Acad Nutr Diet 2018; 118:568-577. [PMID: 29305131 DOI: 10.1016/j.jand.2017.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 10/13/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND African-American breast cancer survivors commonly demonstrate low serum 25-hydroxyvitamin D (25(OH)D). Decreased cutaneous conversion, high levels of adiposity, and even breast cancer treatment may influence vitamin D status. Previous investigations have analyzed African-American women in aggregate with other breast cancer survivors and have not comprehensively addressed these influential factors. OBJECTIVES To determine the prevalence of low serum 25(OH)D in an exclusively African-American cohort of female breast cancer survivors with overweight/obesity and to evaluate the role of ultraviolet (UV) light exposure, body composition, and dietary sources of vitamin D on serum 25(OH)D levels. DESIGN Cross-sectional. PARTICIPANTS Pre- and postmenopausal African-American breast cancer survivors (n=244) were recruited from various neighborhoods in the city of Chicago, IL, between September 2011 and September 2014 for a larger weight loss trial. MAIN OUTCOME MEASURES Demographic, clinical, anthropometric (body mass index [calculated as kg/m2], waist circumference, and hip circumference), blood specimen, dietary intake (food frequency questionnaire), and sun behavior data were collected by trained study personnel before trial participation. Dual-energy x-ray absorptiometry was used to quantify adiposity (total, percentage, regional, visceral) and lean mass. Serum 25(OH)D was used as the biomarker reflective of vitamin D status. STATISTICAL ANALYSES Mean (±standard deviation), frequencies, and multivariate linear regression modeling. RESULTS The average participant was 57.4 years old (±10.0), 6.9 years (±5.2) from initial breast cancer diagnosis with a body mass index of 36.2 (±6.2). The majority of participants (60%) reported habitual oral vitamin D supplementation with mean intake of 327 IU (±169). Vitamin D deficiency was prevalent in 81% and 43%, when the cut points of the Endocrine Society (<30 ng/mL or <75 nmol/L) and the Institute of Medicine (<20 ng/mL or <50 nmol/L) were applied, respectively. A multivariate model adjusting for age, seasonality of blood draw, total energy intake, use of supplemental vitamin D, darker skin pigmentation, breast cancer stage, and waist-to-hip ratio was able to explain 28.8% of the observed variance in serum 25(OH)D concentrations. No significant associations were detected for body mass index or any dual-energy x-ray absorptiometry measures of body composition. CONCLUSIONS Considering the number of women who endorsed use of vitamin D supplementation, the prevalence of vitamin D deficiency among these African-American breast cancer survivors was high. Vitamin D supplementation, sun behavior, and waist-to-hip ratio may serve as future points of intervention to improve the vitamin D status of this minority survivor population.
Collapse
|
25
|
Sunil Kumar BV, Singh S, Verma R. Anticancer potential of dietary vitamin D and ascorbic acid: A review. Crit Rev Food Sci Nutr 2018; 57:2623-2635. [PMID: 26479551 DOI: 10.1080/10408398.2015.1064086] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Cancers have been the leading cause of death worldwide and poor diet and physical inactivity are major risk factors in cancer-related deaths. Micronutrients such as vitamins and minerals appear to have preventive properties against cancer. One important mechanism by which dietary changes can exert preventive effects on cancer is via the modulation of micronutrient concentrations in target tissues. Many of these micronutrients are available in the form of dietary supplements, and the intake of these supplements is prevalent in various parts of the world. However, in most cases, it is not known which micronutrient (or combination of micronutrients) is best when it comes to lowering the risk of cancer. The present review illustrates the effect of vitamin D and ascorbic acid intake on preventing cancer.
Collapse
Affiliation(s)
- B V Sunil Kumar
- a School of Animal Biotechnology , Guru Angad Dev Veterinary and Animal Sciences University , Ludhiana , India
| | - Satparkash Singh
- a School of Animal Biotechnology , Guru Angad Dev Veterinary and Animal Sciences University , Ludhiana , India
| | - Ramneek Verma
- a School of Animal Biotechnology , Guru Angad Dev Veterinary and Animal Sciences University , Ludhiana , India
| |
Collapse
|
26
|
García-Quiroz J, García-Becerra R, Lara-Sotelo G, Avila E, López S, Santos-Martínez N, Halhali A, Ordaz-Rosado D, Barrera D, Olmos-Ortiz A, Ibarra-Sánchez MJ, Esparza-López J, Larrea F, Díaz L. Chronic moderate ethanol intake differentially regulates vitamin D hydroxylases gene expression in kidneys and xenografted breast cancer cells in female mice. J Steroid Biochem Mol Biol 2017; 173:148-156. [PMID: 27639478 DOI: 10.1016/j.jsbmb.2016.09.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 08/12/2016] [Accepted: 09/12/2016] [Indexed: 01/14/2023]
Abstract
Factors affecting vitamin D metabolism may preclude anti-carcinogenic effects of its active metabolite calcitriol. Chronic ethanol consumption is an etiological factor for breast cancer that affects vitamin D metabolism; however, the mechanisms underlying this causal association have not been fully clarified. Using a murine model, we examined the effects of chronic moderate ethanol intake on tumoral and renal CYP27B1 and CYP24A1 gene expression, the enzymes involved in calcitriol synthesis and inactivation, respectively. Ethanol (5% w/v) was administered to 25-hydroxyvitamin D3-treated or control mice during one month. Afterwards, human breast cancer cells were xenografted and treatments continued another month. Ethanol intake decreased renal Cyp27b1 while increased tumoral CYP24A1 gene expression.Treatment with 25-hydroxyvitamin D3 significantly stimulated CYP27B1 in tumors of non-alcohol-drinking mice, while increased both renal and tumoral CYP24A1. Coadministration of ethanol and 25-hydroxyvitamin D3 reduced in 60% renal 25-hydroxyvitamin D3-dependent Cyp24a1 upregulation (P<0.05). We found 5 folds higher basal Cyp27b1 than Cyp24a1 gene expression in kidneys, whereas this relation was inverted in tumors, showing 5 folds more CYP24A1 than CYP27B1. Tumor expression of the calcitriol target cathelicidin increased only in 25-hydroxyvitamin D3-treated non-ethanol drinking animals (P<0.05). Mean final body weight was higher in 25-hydroxyvitamin D3 treated groups (P<0.001). Overall, these results suggest that moderate ethanol intake decreases renal and tumoral 25-hydroxyvitamin D3 bioconversion into calcitriol, while favors degradation of both vitamin D metabolites in breast cancer cells. The latter may partially explain why alcohol consumption is associated with vitamin D deficiency and increased breast cancer risk and progression.
Collapse
Affiliation(s)
- Janice García-Quiroz
- Departamento de Biología de la Reproducción, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Avenida Vasco de Quiroga No. 15, Col. Belisario Domínguez Sección XVI, C.P. 14080, Ciudad de México, Mexico
| | - Rocío García-Becerra
- Departamento de Biología de la Reproducción, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Avenida Vasco de Quiroga No. 15, Col. Belisario Domínguez Sección XVI, C.P. 14080, Ciudad de México, Mexico
| | - Galia Lara-Sotelo
- Departamento de Biología de la Reproducción, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Avenida Vasco de Quiroga No. 15, Col. Belisario Domínguez Sección XVI, C.P. 14080, Ciudad de México, Mexico
| | - Euclides Avila
- Departamento de Biología de la Reproducción, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Avenida Vasco de Quiroga No. 15, Col. Belisario Domínguez Sección XVI, C.P. 14080, Ciudad de México, Mexico
| | - Sofía López
- Departamento de Biología de la Reproducción, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Avenida Vasco de Quiroga No. 15, Col. Belisario Domínguez Sección XVI, C.P. 14080, Ciudad de México, Mexico
| | - Nancy Santos-Martínez
- Departamento de Biología de la Reproducción, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Avenida Vasco de Quiroga No. 15, Col. Belisario Domínguez Sección XVI, C.P. 14080, Ciudad de México, Mexico
| | - Ali Halhali
- Departamento de Biología de la Reproducción, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Avenida Vasco de Quiroga No. 15, Col. Belisario Domínguez Sección XVI, C.P. 14080, Ciudad de México, Mexico
| | - David Ordaz-Rosado
- Departamento de Biología de la Reproducción, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Avenida Vasco de Quiroga No. 15, Col. Belisario Domínguez Sección XVI, C.P. 14080, Ciudad de México, Mexico
| | - David Barrera
- Departamento de Biología de la Reproducción, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Avenida Vasco de Quiroga No. 15, Col. Belisario Domínguez Sección XVI, C.P. 14080, Ciudad de México, Mexico
| | - Andrea Olmos-Ortiz
- Departamento de Biología de la Reproducción, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Avenida Vasco de Quiroga No. 15, Col. Belisario Domínguez Sección XVI, C.P. 14080, Ciudad de México, Mexico
| | - María J Ibarra-Sánchez
- Unidad de Bioquímica, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Avenida Vasco de Quiroga No. 15, Col. Belisario Domínguez Sección XVI, C.P. 14080, Ciudad de México, Mexico
| | - José Esparza-López
- Unidad de Bioquímica, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Avenida Vasco de Quiroga No. 15, Col. Belisario Domínguez Sección XVI, C.P. 14080, Ciudad de México, Mexico
| | - Fernando Larrea
- Departamento de Biología de la Reproducción, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Avenida Vasco de Quiroga No. 15, Col. Belisario Domínguez Sección XVI, C.P. 14080, Ciudad de México, Mexico
| | - Lorenza Díaz
- Departamento de Biología de la Reproducción, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Avenida Vasco de Quiroga No. 15, Col. Belisario Domínguez Sección XVI, C.P. 14080, Ciudad de México, Mexico.
| |
Collapse
|
27
|
Pretreatment Serum Concentration of Vitamin D and Breast Cancer Characteristics: A Prospective Observational Mediterranean Study. Clin Breast Cancer 2017; 17:559-563. [PMID: 28601383 DOI: 10.1016/j.clbc.2017.05.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 04/26/2017] [Accepted: 05/14/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Recent studies of the correlation between breast cancer (BC) and vitamin D yielded contrasting results. Although preclinical and clinical evidence has implicated vitamin D in BC prevention and outcome, little is known about the link between vitamin D and specific BC histologically defined subtypes. In the attempt to clarify this association we correlated vitamin D levels with BC characteristics. PATIENTS AND METHODS We enrolled 220 pre- and postmenopausal women with early BC in this prospective observational trial. Data on the patients' clinical and specific BC pathological characteristics were collected and related to vitamin D levels, stratified in deficient (< 20 ng/mL), insufficient (20-30 ng/mL), and sufficient (> 30 ng/mL). BC subtypes were defined according to the 14th St Gallen Breast Cancer Conference. RESULTS Deficient vitamin D levels were correlated with Grade 3 (P = .015) and node-positive (P = .043) BC, and with a higher body mass index (P = .017). Insufficient vitamin D levels were associated with estrogen receptor expression in the primary tumor (P = .033). Vitamin D levels were unrelated to the histological molecular subtypes of BC. CONCLUSION Deficient vitamin D levels were correlated with more aggressive disease, namely, node-positive high grade BC, and with obesity. Should our findings be confirmed in larger prospective studies, nutritional programs designed to reduce body weight, and vitamin D supplementation might be considered a BC prevention strategy.
Collapse
|
28
|
Hong AR, Kim JH, Lee KH, Kim TY, Im SA, Kim TY, Moon HG, Han WS, Noh DY, Kim SW, Shin CS. Long-term effect of aromatase inhibitors on bone microarchitecture and macroarchitecture in non-osteoporotic postmenopausal women with breast cancer. Osteoporos Int 2017; 28:1413-1422. [PMID: 28083668 DOI: 10.1007/s00198-016-3899-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 12/28/2016] [Indexed: 12/13/2022]
Abstract
UNLABELLED In non-osteoporotic postmenopausal women with breast cancer, aromatase inhibitors (AIs) negatively affected bone mineral density (BMD), lumbar spine trabecular bone score (TBS) as a bone microarchitecture index, and hip geometry as a bone macroarchitecture index. INTRODUCTION AIs increase the risk of fracture in patients with breast cancer. Therefore, we aimed to evaluate the long-term skeletal effects of AIs in postmenopausal women with primary breast cancer. METHODS We performed a retrospective longitudinal observational study in non-osteoporotic patients with breast cancer who were treated with AIs for ≥3 years (T-score >-2.5). Patients with previous anti-osteoporosis treatment or those who were given bisphosphonate during AI treatment were excluded from the analysis. We serially assessed BMD, lumbar spine TBS, and hip geometry using dual-energy X-ray absorptiometry. RESULTS BMD significantly decreased from baseline to 5 years at the lumbar spine (-6.15%), femur neck (-7.12%), and total hip (-6.35%). Lumbar spine TBS also significantly decreased from baseline to 5 years (-2.12%); this change remained significant after adjusting for lumbar spine BMD. The annual loss of lumbar spine BMD and TBS slowed after 3 and 1 year of treatment, respectively, although there was a relatively constant loss of BMD at the femur neck and total hip for up to 4 years. The cross-sectional area, cross-sectional moment of inertia, minimal neck width, femur strength index, and section modulus significantly decreased, although the buckling ratio increased over the treatment period (all P < 0.001); these changes were independent of total hip BMD. CONCLUSIONS Long-term adjuvant AI treatment negatively influenced bone quality in addition to BMD in patients with breast cancer. This study suggests that early monitoring and management are needed in non-osteoporotic patients with breast cancer who are starting AIs.
Collapse
Affiliation(s)
- A R Hong
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - J H Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea.
| | - K H Lee
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - T Y Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - S A Im
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - T Y Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - H G Moon
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - W S Han
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - D Y Noh
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - S W Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
- Department of Internal Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, South Korea
| | - C S Shin
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| |
Collapse
|
29
|
Thomas RJ, Kenfield SA, Jimenez A. Exercise-induced biochemical changes and their potential influence on cancer: a scientific review. Br J Sports Med 2017; 51:640-644. [PMID: 27993842 PMCID: PMC5466928 DOI: 10.1136/bjsports-2016-096343] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2016] [Indexed: 12/20/2022]
Abstract
AIM To review and discuss the available international literature regarding the indirect and direct biochemical mechanisms that occur after exercise, which could positively, or negatively, influence oncogenic pathways. METHODS The PubMed, MEDLINE, Embase and Cochrane libraries were searched for papers up to July 2016 addressing biochemical changes after exercise with a particular reference to cancer. The three authors independently assessed their appropriateness for inclusion in this review based on their scientific quality and relevance. RESULTS 168 papers were selected and categorised into indirect and direct biochemical pathways. The indirect effects included changes in vitamin D, weight reduction, sunlight exposure and improved mood. The direct effects included insulin-like growth factor, epigenetic effects on gene expression and DNA repair, vasoactive intestinal peptide, oxidative stress and antioxidant pathways, heat shock proteins, testosterone, irisin, immunity, chronic inflammation and prostaglandins, energy metabolism and insulin resistance. SUMMARY Exercise is one of several lifestyle factors known to lower the risk of developing cancer and is associated with lower relapse rates and better survival. This review highlights the numerous biochemical processes, which explain these potential anticancer benefits.
Collapse
Affiliation(s)
| | - Stacey A Kenfield
- Department of Urology, University of California, San Francisco, California, USA
| | - Alfonso Jimenez
- Centre for Applied Biological and Exercise Sciences, Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| |
Collapse
|
30
|
|
31
|
Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H, Bozzetti F, Fearon K, Hütterer E, Isenring E, Kaasa S, Krznaric Z, Laird B, Larsson M, Laviano A, Mühlebach S, Muscaritoli M, Oldervoll L, Ravasco P, Solheim T, Strasser F, de van der Schueren M, Preiser JC. ESPEN guidelines on nutrition in cancer patients. Clin Nutr 2017. [DOI: 10.1016/j.clnu.2016.07.015 10.1016/j.clnu.2016.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
32
|
Zhang X, Harbeck N, Jeschke U, Doisneau-Sixou S. Influence of vitamin D signaling on hormone receptor status and HER2 expression in breast cancer. J Cancer Res Clin Oncol 2016; 143:1107-1122. [PMID: 28025696 DOI: 10.1007/s00432-016-2325-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 12/16/2016] [Indexed: 12/14/2022]
Abstract
PURPOSE Breast cancer is a significant global public health issue. It is the leading cause of death among women around the world, with an incidence increasing annually. In recent years, there has been more and more information in the literature regarding a protective role of vitamin D in cancer. Increasingly preclinical and clinical studies suggest that vitamin D optimal levels can reduce the risk of breast cancer development and regulate cancer-related pathways. METHOD In this review, we focus on the importance of vitamin D in breast cancers, discussing especially the influence of vitamin D signaling on estrogen receptor and human epidermal growth factor receptor 2 (HER2), two major biomarkers of breast cancer today. CONCLUSION We discuss the possibility of actual and future targeted therapeutic approaches for vitamin D signaling in breast cancer.
Collapse
Affiliation(s)
- Xi Zhang
- Brustzentrum der Universität München, Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Campus Innenstadt, Klinikum der Ludwig-Maximilians-Universität, Maistraße 11, 80337, Munich, Germany
| | - Nadia Harbeck
- Brustzentrum der Universität München, Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Campus Innenstadt, Klinikum der Ludwig-Maximilians-Universität, Maistraße 11, 80337, Munich, Germany
| | - Udo Jeschke
- Brustzentrum der Universität München, Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Campus Innenstadt, Klinikum der Ludwig-Maximilians-Universität, Maistraße 11, 80337, Munich, Germany
| | - Sophie Doisneau-Sixou
- Brustzentrum der Universität München, Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Campus Innenstadt, Klinikum der Ludwig-Maximilians-Universität, Maistraße 11, 80337, Munich, Germany. .,Faculté des Sciences Pharmaceutiques, Université Paul Sabatier Toulouse III, 31062, Toulouse Cedex 09, France.
| |
Collapse
|
33
|
Abstract
AbstractDiet may play an important role in breast cancer recurrence or survival, and therefore assessment of long-term diet among breast cancer survivors is important in breast cancer survivorship research. Given that the diet of breast cancer survivors may differ from that of the general population, the use of a FFQ specific to this group may be needed. The objective of this study was to develop a FFQ for breast cancer survivors, the most commonly used tool to measure long-term dietary patterns in nutritional epidemiological studies. We collected information on the foods and amounts of foods consumed using 3-d dietary records from a total of 192 women who had been diagnosed with stage I–III breast cancers and had undergone breast cancer surgery at least 6 months before the baseline study. A total of 1254 foods and dishes consumed were re-grouped by the similarity of the main ingredients and/or serving units, and several dishes commonly consumed among the Korean population were added. After we performed contribution analyses and variability analyses to detect between-person variation for selected nutrients, we listed a total of 123 foods and dishes for the FFQ specific to breast cancer survivors. Our breast cancer survivor-specific FFQ can be used to estimate long-term dietary intake and to examine its association with breast cancer prognosis in epidemiological studies of breast cancer in Korea.
Collapse
|
34
|
Acevedo F, Pérez V, Pérez-Sepúlveda A, Florenzano P, Artigas R, Medina L, Sánchez C. High prevalence of vitamin D deficiency in women with breast cancer: The first Chilean study. Breast 2016; 29:39-43. [DOI: 10.1016/j.breast.2016.06.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 06/21/2016] [Accepted: 06/22/2016] [Indexed: 02/01/2023] Open
|
35
|
Abstract
Cancers are among the leading causes of morbidity and mortality worldwide, and the number of new cases is expected to rise significantly over the next decades. At the same time, all types of cancer treatment, such as surgery, radiation therapy, and pharmacological therapies are improving in sophistication, precision and in the power to target specific characteristics of individual cancers. Thus, while many cancers may still not be cured they may be converted to chronic diseases. All of these treatments, however, are impeded or precluded by the frequent development of malnutrition and metabolic derangements in cancer patients, induced by the tumor or by its treatment. These evidence-based guidelines were developed to translate current best evidence and expert opinion into recommendations for multi-disciplinary teams responsible for identification, prevention, and treatment of reversible elements of malnutrition in adult cancer patients. The guidelines were commissioned and financially supported by ESPEN and by the European Partnership for Action Against Cancer (EPAAC), an EU level initiative. Members of the guideline group were selected by ESPEN to include a range of professions and fields of expertise. We searched for meta-analyses, systematic reviews and comparative studies based on clinical questions according to the PICO format. The evidence was evaluated and merged to develop clinical recommendations using the GRADE method. Due to the deficits in the available evidence, relevant still open questions were listed and should be addressed by future studies. Malnutrition and a loss of muscle mass are frequent in cancer patients and have a negative effect on clinical outcome. They may be driven by inadequate food intake, decreased physical activity and catabolic metabolic derangements. To screen for, prevent, assess in detail, monitor and treat malnutrition standard operating procedures, responsibilities and a quality control process should be established at each institution involved in treating cancer patients. All cancer patients should be screened regularly for the risk or the presence of malnutrition. In all patients - with the exception of end of life care - energy and substrate requirements should be met by offering in a step-wise manner nutritional interventions from counseling to parenteral nutrition. However, benefits and risks of nutritional interventions have to be balanced with special consideration in patients with advanced disease. Nutritional care should always be accompanied by exercise training. To counter malnutrition in patients with advanced cancer there are few pharmacological agents and pharmaconutrients with only limited effects. Cancer survivors should engage in regular physical activity and adopt a prudent diet.
Collapse
|
36
|
Jamshidinaeini Y, Akbari ME, Abdollahi M, Ajami M, Davoodi SH. Vitamin D Status and Risk of Breast Cancer in Iranian Women: A Case–Control Study. J Am Coll Nutr 2016; 35:639-646. [PMID: 27331363 DOI: 10.1080/07315724.2015.1127786] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
|
37
|
The D-Health Trial: A randomized trial of vitamin D for prevention of mortality and cancer. Contemp Clin Trials 2016; 48:83-90. [DOI: 10.1016/j.cct.2016.04.005] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 04/04/2016] [Accepted: 04/10/2016] [Indexed: 11/23/2022]
|
38
|
Williams JD, Aggarwal A, Swami S, Krishnan AV, Ji L, Albertelli MA, Feldman BJ. Tumor Autonomous Effects of Vitamin D Deficiency Promote Breast Cancer Metastasis. Endocrinology 2016; 157:1341-7. [PMID: 26934299 PMCID: PMC4816742 DOI: 10.1210/en.2015-2036] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Patients with breast cancer (BCa) frequently have preexisting vitamin D deficiency (low serum 25-hydroxyvitamin D) when their cancer develops. A number of epidemiological studies show an inverse association between BCa risk and vitamin D status in humans, although some studies have failed to find an association. In addition, several studies have reported that BCa patients with vitamin D deficiency have a more aggressive molecular phenotype and worse prognostic indicators. However, it is unknown whether this association is mechanistically causative and, if so, whether it results from systemic or tumor autonomous effects of vitamin D signaling. We found that ablation of vitamin D receptor expression within BCa cells accelerates primary tumor growth and enables the development of metastases, demonstrating a tumor autonomous effect of vitamin D signaling to suppress BCa metastases. We show that vitamin D signaling inhibits the expression of the tumor progression gene Id1, and this pathway is abrogated in vitamin D deficiency in vivo in 2 murine models of BCa. These findings are relevant to humans, because we discovered that the mechanism of VDR regulation of Inhibitor of differentiation 1 (ID1) is conserved in human BCa cells, and there is a negative correlation between serum 25-hydroxyvitamin D levels and the level of ID1 in primary tumors from patients with BCa.
Collapse
Affiliation(s)
- Jasmaine D Williams
- Department of Pediatrics (J.D.W., A.A., A.V.K., L.J., B.J.F.), Stanford School of Medicine, Stanford, California 94305; Department of Medicine (S.S.), Stanford School of Medicine, Stanford, California 94305; Department of Comparative Medicine (M.A.A.), Stanford School of Medicine, Stanford, California 94305; and Stanford Cancer Institute (B.J.F.), Stanford School of Medicine, Stanford, California 94305
| | - Abhishek Aggarwal
- Department of Pediatrics (J.D.W., A.A., A.V.K., L.J., B.J.F.), Stanford School of Medicine, Stanford, California 94305; Department of Medicine (S.S.), Stanford School of Medicine, Stanford, California 94305; Department of Comparative Medicine (M.A.A.), Stanford School of Medicine, Stanford, California 94305; and Stanford Cancer Institute (B.J.F.), Stanford School of Medicine, Stanford, California 94305
| | - Srilatha Swami
- Department of Pediatrics (J.D.W., A.A., A.V.K., L.J., B.J.F.), Stanford School of Medicine, Stanford, California 94305; Department of Medicine (S.S.), Stanford School of Medicine, Stanford, California 94305; Department of Comparative Medicine (M.A.A.), Stanford School of Medicine, Stanford, California 94305; and Stanford Cancer Institute (B.J.F.), Stanford School of Medicine, Stanford, California 94305
| | - Aruna V Krishnan
- Department of Pediatrics (J.D.W., A.A., A.V.K., L.J., B.J.F.), Stanford School of Medicine, Stanford, California 94305; Department of Medicine (S.S.), Stanford School of Medicine, Stanford, California 94305; Department of Comparative Medicine (M.A.A.), Stanford School of Medicine, Stanford, California 94305; and Stanford Cancer Institute (B.J.F.), Stanford School of Medicine, Stanford, California 94305
| | - Lijuan Ji
- Department of Pediatrics (J.D.W., A.A., A.V.K., L.J., B.J.F.), Stanford School of Medicine, Stanford, California 94305; Department of Medicine (S.S.), Stanford School of Medicine, Stanford, California 94305; Department of Comparative Medicine (M.A.A.), Stanford School of Medicine, Stanford, California 94305; and Stanford Cancer Institute (B.J.F.), Stanford School of Medicine, Stanford, California 94305
| | - Megan A Albertelli
- Department of Pediatrics (J.D.W., A.A., A.V.K., L.J., B.J.F.), Stanford School of Medicine, Stanford, California 94305; Department of Medicine (S.S.), Stanford School of Medicine, Stanford, California 94305; Department of Comparative Medicine (M.A.A.), Stanford School of Medicine, Stanford, California 94305; and Stanford Cancer Institute (B.J.F.), Stanford School of Medicine, Stanford, California 94305
| | - Brian J Feldman
- Department of Pediatrics (J.D.W., A.A., A.V.K., L.J., B.J.F.), Stanford School of Medicine, Stanford, California 94305; Department of Medicine (S.S.), Stanford School of Medicine, Stanford, California 94305; Department of Comparative Medicine (M.A.A.), Stanford School of Medicine, Stanford, California 94305; and Stanford Cancer Institute (B.J.F.), Stanford School of Medicine, Stanford, California 94305
| |
Collapse
|
39
|
Charehbili A, Hamdy NAT, Smit VTHBM, Kessels L, van Bochove A, van Laarhoven HW, Putter H, Meershoek-Klein Kranenbarg E, van Leeuwen-Stok AE, van der Hoeven JJM, van de Velde CJH, Nortier JWR, Kroep JR. Vitamin D (25-0H D3) status and pathological response to neoadjuvant chemotherapy in stage II/III breast cancer: Data from the NEOZOTAC trial (BOOG 10-01). Breast 2015; 25:69-74. [PMID: 26614548 DOI: 10.1016/j.breast.2015.10.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 10/17/2015] [Accepted: 10/20/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Serum levels of 25-OH vitamin D3 (vitamin D) have been shown to be prognostic for disease-free survival in patients with breast cancer. We investigated the predictive value of these levels for pathological response after neoadjuvant chemotherapy in patients with breast cancer taking part in the NEOZOTAC phase-III trial. Additionally, the effect of chemotherapy on vitamin D levels was studied. MATERIALS AND METHODS Serum vitamin D was measured at baseline and before the last cycle of chemotherapy. The relationship between these measurements and clinical outcome, as defined by pathological complete response in breast and lymph nodes (pCR) was examined. RESULTS Baseline and end of treatment vitamin D data were available in 169 and 91 patients, respectively. Median baseline vitamin D values were 58.0 nmol/L. In patients treated with chemotherapy only, serum vitamin D levels decreased during neoadjuvant chemotherapy (median decrease of 16 nmol/L, P = 0.003). The prevalence of vitamin D levels < 50 nmol/L increased from 38.3% at baseline to 55.9% after chemotherapy. In the total population, baseline and end of therapy vitamin D levels were not related to pathological response. No associations were found between pCR and vitamin D level changes. CONCLUSION The significant decrease in vitamin D post-neoadjuvant chemotherapy suggests that vitamin D levels should be monitored and in case of decrease of vitamin D levels, correction may be beneficial for skeletal health and possibly breast cancer outcome.
Collapse
Affiliation(s)
- A Charehbili
- Leiden University Medical Center, Department of Medical Oncology, The Netherlands; Leiden University Medical Center, Department of Surgery, The Netherlands
| | - N A T Hamdy
- Leiden University Medical Center, Department of Endocrinology & Metabolic Diseases, The Netherlands
| | - V T H B M Smit
- Leiden University Medical Center, Department of Pathology, The Netherlands
| | - L Kessels
- Deventer Ziekenhuis, Department of Clinical Oncology, The Netherlands
| | - A van Bochove
- Zaans Medisch Centrum, Department of Clinical Oncology, The Netherlands
| | - H W van Laarhoven
- Radboud Universiteit Nijmegen/AMC Amsterdam, Department of Medical Oncology, The Netherlands
| | - H Putter
- Leiden University Medical Center, Department of Medical Statistics, The Netherlands
| | | | | | - J J M van der Hoeven
- Leiden University Medical Center, Department of Medical Oncology, The Netherlands
| | - C J H van de Velde
- Leiden University Medical Center, Department of Surgery, The Netherlands
| | - J W R Nortier
- Leiden University Medical Center, Department of Medical Oncology, The Netherlands
| | - J R Kroep
- Leiden University Medical Center, Department of Medical Oncology, The Netherlands.
| |
Collapse
|
40
|
Smolensky MH, Sackett-Lundeen LL, Portaluppi F. Nocturnal light pollution and underexposure to daytime sunlight: Complementary mechanisms of circadian disruption and related diseases. Chronobiol Int 2015; 32:1029-48. [PMID: 26374931 DOI: 10.3109/07420528.2015.1072002] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Routine exposure to artificial light at night (ALAN) in work, home, and community settings is linked with increased risk of breast and prostate cancer (BC, PC) in normally sighted women and men, the hypothesized biological rhythm mechanisms being frequent nocturnal melatonin synthesis suppression, circadian time structure (CTS) desynchronization, and sleep/wake cycle disruption with sleep deprivation. ALAN-induced perturbation of the CTS melatonin synchronizer signal is communicated maternally at the very onset of life and after birth via breast or artificial formula feedings. Nighttime use of personal computers, mobile phones, electronic tablets, televisions, and the like--now epidemic in adolescents and adults and highly prevalent in pre-school and school-aged children--is a new source of ALAN. However, ALAN exposure occurs concomitantly with almost complete absence of daytime sunlight, whose blue-violet (446-484 nm λ) spectrum synchronizes the CTS and whose UV-B (290-315 nm λ) spectrum stimulates vitamin D synthesis. Under natural conditions and clear skies, day/night and annual cycles of UV-B irradiation drive corresponding periodicities in vitamin D synthesis and numerous bioprocesses regulated by active metabolites augment and strengthen the biological time structure. Vitamin D insufficiency and deficiency are widespread in children and adults in developed and developing countries as a consequence of inadequate sunlight exposure. Past epidemiologic studies have focused either on exposure to too little daytime UV-B or too much ALAN, respectively, on vitamin D deficiency/insufficiency or melatonin suppression in relation to risk of cancer and other, e.g., psychiatric, hypertensive, cardiac, and vascular, so-called, diseases of civilization. The observed elevated incidence of medical conditions the two are alleged to influence through many complementary bioprocesses of cells, tissues, and organs led us to examine effects of the totality of the artificial light environment in which humans reside today. Never have chronobiologic or epidemiologic investigations comprehensively researched the potentially deleterious consequences of the combination of suppressed vitamin D plus melatonin synthesis due to life in today's man-made artificial light environment, which in our opinion is long overdue.
Collapse
Affiliation(s)
- Michael H Smolensky
- a Department of Biomedical Engineering , Cockrell School of Engineering, The University of Texas at Austin , Austin , TX , USA
| | - Linda L Sackett-Lundeen
- b American Association for Clinical Chronobiology and Chronotherapeutics , Roseville , MN , USA , and
| | - Francesco Portaluppi
- c Hypertension Center, S. Anna University Hospital, University of Ferrara , Ferrara , Italy
| |
Collapse
|
41
|
Webb PM, de Fazio A, Protani MM, Ibiebele TI, Nagle CM, Brand AH, Blomfield PI, Grant P, Perrin LC, Neale RE. Circulating 25-hydroxyvitamin D and survival in women with ovarian cancer. Am J Clin Nutr 2015; 102:109-14. [PMID: 25971716 DOI: 10.3945/ajcn.114.102681] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 04/09/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Vitamin D status might be associated with cancer survival. Survival after ovarian cancer is poor, but the association with vitamin D has rarely been examined. OBJECTIVE We evaluated the association between serum 25-hydroxyvitamin D [25(OH)D], a marker of vitamin D status, and ovarian cancer survival. DESIGN Participants were women with invasive ovarian cancer diagnosed between 2002 and 2005 who participated in the Australian Ovarian Cancer Study. Serum samples, collected at diagnosis (n = 670) or after completion of primary treatment and before recurrence (n = 336), were assayed for 25(OH)D. Sociodemographic, dietary, and lifestyle data came from questionnaires self-completed at recruitment, and clinical and survival data were from medical records, supplemented by linkage to the Australian National Death Index (October 2011). Cox proportional hazards regression was used to estimate HRs and 95% CIs for the association between circulating 25(OH)D and survival. RESULTS Overall, 59% of the women died during follow-up, with 95% of deaths resulting from ovarian cancer. Circulating 25(OH)D concentrations (mean: 44 nmol/L) were significantly associated with age, state of residence, season of blood collection, and body mass index but not with tumor histology, stage or grade, or comorbidities. Higher 25(OH)D concentrations at diagnosis were significantly associated with longer survival (adjusted HR: 0.93; 95% CI: 0.88, 0.99 per 10 nmol/L), but there was no significant association with progression-free survival or for 25(OH)D measured after primary treatment. CONCLUSIONS In our cohort, higher serum 25(OH)D concentrations at diagnosis were associated with longer survival among women with ovarian cancer. If confirmed in other studies, this suggests that vitamin D status at diagnosis may be an independent predictor of prognosis. Furthermore, if the association is found to be causal, improving vitamin D status may improve ovarian cancer survival rates.
Collapse
Affiliation(s)
- Penelope M Webb
- QIMR Berghofer Medical Research Institute, Population Health Department, Brisbane, Australia; School of Population Health, University of Queensland, Herston, Australia;
| | - Anna de Fazio
- University of Sydney at Westmead Millennium Institute, Westmead Hospital, Sydney, Australia
| | - Melinda M Protani
- QIMR Berghofer Medical Research Institute, Population Health Department, Brisbane, Australia; School of Population Health, University of Queensland, Herston, Australia
| | - Torukiri I Ibiebele
- QIMR Berghofer Medical Research Institute, Population Health Department, Brisbane, Australia
| | - Christina M Nagle
- QIMR Berghofer Medical Research Institute, Population Health Department, Brisbane, Australia
| | - Alison H Brand
- Department of Gynaecological Oncology, Westmead Hospital, University of Sydney, Westmead, Australia
| | | | - Peter Grant
- Gynaecological Oncology Unit, Mercy Hospital for Women, Melbourne, Australia; and
| | - Lewis C Perrin
- Central Clinical Division, School of Medicine, Mater Health Services, The University of Queensland, South Brisbane, Australia
| | - Rachel E Neale
- QIMR Berghofer Medical Research Institute, Population Health Department, Brisbane, Australia
| | | |
Collapse
|
42
|
Archer SN, Oster H. How sleep and wakefulness influence circadian rhythmicity: effects of insufficient and mistimed sleep on the animal and human transcriptome. J Sleep Res 2015; 24:476-93. [PMID: 26059855 DOI: 10.1111/jsr.12307] [Citation(s) in RCA: 116] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 04/04/2015] [Indexed: 12/12/2022]
Abstract
The mammalian circadian system is a multi-oscillator, hierarchically organised system where a central pacemaker synchronises behavioural, physiological and gene expression rhythms in peripheral tissues. Epidemiological studies show that disruption of this internal synchronisation by short sleep and shift work is associated with adverse health outcomes through mechanisms that remain to be elucidated. Here, we review recent animal and human studies demonstrating the profound effects of insufficient and mistimed sleep on the rhythms of gene expression in central and peripheral tissues. In mice, sleep restriction leads to an ~80% reduction in circadian transcripts in the brain and profound disruption of the liver transcriptome. In humans, sleep restriction leads to a 1.9% reduction in circadian transcripts in whole blood, and when sleep is displaced to the daytime, 97% of rhythmic genes become arrhythmic and one-third of all genes show changes in temporal expression profiles. These changes in mice and humans include a significant reduction in the circadian regulation of transcription and translation and core clock genes in the periphery, while at the same time rhythms within the suprachiasmatic nucleus are not disrupted. Although the physiological mediators of these sleep disruption effects on the transcriptome have not been established, altered food intake, changes in hormones such as cortisol, and changes in body and brain temperature may play important roles. Processes and molecular pathways associated with these disruptions include metabolism, immune function, inflammatory and stress responses, and point to the molecular mechanisms underlying the established adverse health outcomes associated with short sleep duration and shift work, such as metabolic syndrome and cancer.
Collapse
Affiliation(s)
- Simon N Archer
- Surrey Sleep Research Centre, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Henrik Oster
- Chronophysiology Group, Medical Department I, University of Lübeck, Lübeck, Germany
| |
Collapse
|
43
|
Oh MG, Han MA, Park J, Ryu SY, Choi SW. The Prevalence of Vitamin D Deficiency among Cancer Survivors in a Nationwide Survey of the Korean Population. PLoS One 2015; 10:e0129901. [PMID: 26047013 PMCID: PMC4457839 DOI: 10.1371/journal.pone.0129901] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 05/15/2015] [Indexed: 12/13/2022] Open
Abstract
Background Recent studies have shown that inadequate vitamin D levels are associated with a poor cancer prognosis, but data regarding actual vitamin D levels in cancer survivors are limited. This study investigated the vitamin D levels and prevalence of vitamin D deficiency among Korean cancer survivors compared with non-cancer controls, and identified the factors associated with vitamin D deficiency. Methods Using the Korea National Health and Nutrition Examination Survey (KNHANES), 915 cancer survivors and 29,694 controls without a history of cancer were selected. Serum 25(OH)D levels were measured; vitamin D deficiency was defined as 25(OH)D levels less than 20 ng/mL. Chi-square tests and multiple logistic regression analyses were used to evaluate the prevalence of vitamin D deficiency and associated factors. Results Vitamin D deficiency was observed in 62.7% of cancer survivors and 67.1% of controls. Among cancer survivors, vitamin D deficiency was most prevalent among 19–44 year olds (76.2%) and among managers, professionals, and related workers (79.3%). Multiple logistic regression analysis revealed that younger cancer survivors and those who work indoors were predisposed to vitamin D deficiency. Conclusion Vitamin D deficiency was prevalent among both cancer survivors and controls in Korea. The regular evaluation and management of vitamin D levels is needed for both bone health and general health in cancer survivors.
Collapse
Affiliation(s)
- Myueng Guen Oh
- Department of Internal Medicine, Jeongup Asan Hospital, Jeongup, Korea
| | - Mi Ah Han
- Department of Preventive Medicine, College of Medicine, Chosun University, Gwangju, Korea
- * E-mail:
| | - Jong Park
- Department of Preventive Medicine, College of Medicine, Chosun University, Gwangju, Korea
| | - So Yeon Ryu
- Department of Preventive Medicine, College of Medicine, Chosun University, Gwangju, Korea
| | - Seong-Woo Choi
- Department of Preventive Medicine, College of Medicine, Chosun University, Gwangju, Korea
| |
Collapse
|
44
|
The pleiotropic effects of vitamin D in gynaecological and obstetric diseases: an overview on a hot topic. BIOMED RESEARCH INTERNATIONAL 2015; 2015:986281. [PMID: 26000308 PMCID: PMC4426767 DOI: 10.1155/2015/986281] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 01/17/2015] [Accepted: 01/20/2015] [Indexed: 12/31/2022]
Abstract
The traditionally recognized role of vitamin D consists in the regulation of bone metabolism and calcium-phosphorus homeostasis but recently a lot of in vitro and in vivo studies recognized several “noncalcemic” effects of vitamin D metabolites. Accumulating evidence suggests that the metabolic pathways of this vitamin may play a key role in the developing of gynaecological/obstetric diseases. VDR-mediated signalling pathways and vitamin D levels seem to (deeply) affect the risk of several gynaecological diseases, such as polycystic ovary syndrome (PCOS), endometriosis, and ovarian and even breast cancer. On the other hand, since also the maternal-fetal unit is under the influence of vitamin D, a breakdown in its homeostasis may underlie infertility, preeclampsia, and gestational diabetes mellitus (GDM). According to our literature review, the relationship between vitamin D and gynaecological/obstetric diseases must be replicated in future studies which could clarify the molecular machineries behind their development. We suggest that further investigation should take into account the different serum levels of this vitamin, the several actions which arise from the binding between it and its receptor (taking into account its possible polymorphism), and finally the interplay between vitamin D metabolism and other hormonal and metabolic pathways.
Collapse
|
45
|
Giammanco M, Di Majo D, La Guardia M, Aiello S, Crescimannno M, Flandina C, Tumminello FM, Leto G. Vitamin D in cancer chemoprevention. PHARMACEUTICAL BIOLOGY 2015; 53:1399-1434. [PMID: 25856702 DOI: 10.3109/13880209.2014.988274] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
CONTEXT There is increasing evidence that Vitamin D (Vit D) and its metabolites, besides their well-known calcium-related functions, may also exert antiproliferative, pro-differentiating, and immune modulatory effects on tumor cells in vitro and may also delay tumor growth in vivo. OBJECTIVE The aim of this review is to provide fresh insight into the most recent advances on the role of Vit D and its analogues as chemopreventive drugs in cancer therapy. METHODS A systematic review of experimental and clinical studies on Vit D and cancer was undertaken by using the major electronic health database including ISI Web of Science, Medline, PubMed, Scopus and Google Scholar. RESULTS AND CONCLUSION Experimental and clinical observations suggest that Vit D and its analogues may be effective in preventing the malignant transformation and/or the progression of various types of human tumors including breast cancer, prostate cancer, colorectal cancer, and some hematological malignances. These findings suggest the possibility of the clinical use of these molecules as novel potential chemopreventive and anticancer agents.
Collapse
|
46
|
Pulito C, Terrenato I, Di Benedetto A, Korita E, Goeman F, Sacconi A, Biagioni F, Blandino G, Strano S, Muti P, Mottolese M, Falvo E. Cdx2 polymorphism affects the activities of vitamin D receptor in human breast cancer cell lines and human breast carcinomas. PLoS One 2015; 10:e0124894. [PMID: 25849303 PMCID: PMC4388514 DOI: 10.1371/journal.pone.0124894] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 03/07/2015] [Indexed: 12/02/2022] Open
Abstract
Vitamin D plays a role in cancer development and acts through the vitamin D receptor (VDR). It regulates the action of hormone responsive genes and is involved in cell cycle regulation, differentiation and apoptosis. VDR is a critical component of the vitamin D pathway and different common single nucleotide polymorphisms have been identified. Cdx2 VDR polymorphism can play an important role in breast cancer, modulating the activity of VDR. The objective of this study is to assess the relationship between the Cdx2 VDR polymorphism and the activities of VDR in human breast cancer cell lines and carcinomas breast patients. Cdx2 VDR polymorphism and antiproliferative effects of vitamin D treatment were investigated in a panel of estrogen receptor-positive (MCF7 and T-47D) and estrogen receptor-negative (MDA-MB-231, SUM 159PT, SK-BR-3, BT549, MDA-MB-468, HCC1143, BT20 and HCC1954) human breast cancer cell lines. Furthermore, the potential relationship among Cdx2 VDR polymorphism and a number of biomarkers used in clinical management of breast cancer was assessed in an ad hoc set of breast cancer cases. Vitamin D treatment efficacy was found to be strongly dependent on the Cdx2 VDR status in ER-negative breast cancer cell lines tested. In our series of breast cancer cases, the results indicated that patients with variant homozygote AA were associated with bio-pathological characteristics typical of more aggressive tumours, such as ER negative, HER2 positive and G3. Our results may suggest a potential effect of Cdx2 VDR polymorphism on the efficacy of vitamin D treatment in aggressive breast cancer cells (estrogen receptor negative). These results suggest that Cdx2 polymorphism may be a potential biomarker for vitamin D treatment in breast cancer, independently of the VDR receptor expression.
Collapse
Affiliation(s)
- Claudio Pulito
- Molecular Chemoprevention Unit, Regina Elena National Cancer Institute, Rome, Italy
| | - Irene Terrenato
- Department of Epidemiology, Regina Elena National Cancer Institute, Rome, Italy
| | - Anna Di Benedetto
- Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | - Etleva Korita
- Molecular Chemoprevention Unit, Regina Elena National Cancer Institute, Rome, Italy
| | - Frauke Goeman
- Translational Oncogenomics Unit, Regina Elena National Cancer Institute, Rome, Italy
| | - Andrea Sacconi
- Translational Oncogenomics Unit, Regina Elena National Cancer Institute, Rome, Italy
| | - Francesca Biagioni
- Translational Oncogenomics Unit, Regina Elena National Cancer Institute, Rome, Italy
| | - Giovanni Blandino
- Translational Oncogenomics Unit, Regina Elena National Cancer Institute, Rome, Italy
| | - Sabrina Strano
- Molecular Chemoprevention Unit, Regina Elena National Cancer Institute, Rome, Italy
| | - Paola Muti
- Department of Oncology, Juravinski Cancer Center-McMaster University Hamilton, Hamilton, ON L8V 5C2, Ontario, Canada
| | - Marcella Mottolese
- Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | - Elisabetta Falvo
- Laboratory of Pharmacogenomics (Area Molecular Medicine), Regina Elena National Cancer Institute, Rome, Italy
- * E-mail:
| |
Collapse
|
47
|
Prognostic associations of 25 hydroxy vitamin D in NCIC CTG MA.21, a phase III adjuvant randomized clinical trial of three chemotherapy regimens in high-risk breast cancer. Breast Cancer Res Treat 2015; 150:605-11. [PMID: 25833209 DOI: 10.1007/s10549-015-3355-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 03/23/2015] [Indexed: 10/23/2022]
Abstract
Low vitamin D levels have been associated with poor breast cancer outcomes in observational studies. We examined the association of vitamin D blood levels with relapse-free survival (RFS), breast cancer-specific survival (BCSS), and overall survival (OS) in the MA.21 randomized clinical trial. Fasting blood was collected pre-chemotherapy in 934/2104 (44.4 %) of subjects; 25 hydroxy vitamin D was measured (radioimmunoassay, Diasorin) in one batch. Vitamin D was assessed as a transformed continuous factor, and categorically (quartiles and clinical classifications). Univariate and multivariate prognostic analyses (adjusted for treatment, stratification factors, and baseline imbalances) were performed using Cox models. Most patients were young (median 47.8 years), white (91.6 %) and premenopausal (69.4 %) with grade III (52 %), HER2 negative or missing (89.5 %), ER positive (61.9 %), T1-2 (89.4 %), N + (72.7 %) breast cancer. Compared to the full population, those with vitamin D levels were more likely to be white, PS 1 or 2, to have undergone mastectomy, and to have an ER + tumor. Mean vitamin D was 69.7 nmol/L (27.9 ng/ml) and did not vary by tumor subtype. The majority (80.5 %) had levels >50 nmol/L (20 ng/ml), considered adequate by Institute of Medicine. Continuous vitamin D was not multivariately associated with RFS, BCSS, or OS (p = 0.36, 0.26, 0.33, respectively); categorical vitamin D was also not associated with outcome. Vitamin D associations with RFS did not differ within ER/HER2 subgroups. There was no evidence that vitamin D blood level was associated with RFS, BCSS, and OS in MA.21; the majority of subjects had adequate vitamin D levels at study entry.
Collapse
|
48
|
Wesa KM, Segal NH, Cronin AM, Sjoberg DD, Jacobs GN, Coleton MI, Fleisher M, Dnistrian AM, Saltz LB, Cassileth BR. Serum 25-hydroxy vitamin D and survival in advanced colorectal cancer: a retrospective analysis. Nutr Cancer 2015; 67:424-30. [PMID: 25646565 DOI: 10.1080/01635581.2015.998838] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Higher serum 25-hydroxy vitamin D [25(OH)D] levels are associated with decreased colorectal cancer (CRC) incidence. In this retrospective study of Stage IV CRC patients, we evaluate whether 25(OH)D levels at diagnosis correlate with survival. Stored sera from carcinoembryonic antigen (CEA) measurements obtained between February 2005 and March 2006 were screened. The first 250 patients with CEA ± 30 days of Stage IV CRC diagnosis were included. Serum 25(OH)D levels were determined and categorized as adequate ≥ 30 ng/mL, or deficient <30 ng/mL. Multivariable Cox regression models controlling for albumin and Eastern Cooperative Oncology Group performance status were used to investigate whether higher 25(OH)D levels were associated with prolonged survival. A total of 207 patients (83%) were vitamin D-deficient (median = 21 ng/mL), with deficiencies significantly more likely among non-Hispanic black patients (P = 0.009). Higher levels were associated with prolonged survival in categorical variable analysis: adequate vs. deficient, hazard ratio = 0.61, 95% confidence interval = 0.38-0.98, P = 0.041. A majority of newly diagnosed Stage IV CRC patients are vitamin D-deficient. Our data suggest that higher 25(OH)D levels are associated with better overall survival. Clinical trials to determine whether aggressive vitamin D repletion would improve outcomes for vitamin D-deficient CRC patients are warranted.
Collapse
Affiliation(s)
- Kathleen M Wesa
- a Memorial Sloan Kettering Cancer Center, Integrative Medicine Service , New York , New York , USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Host Factors and Risk of Breast Cancer Recurrence: Genetic, Epigenetic and Biologic Factors and Breast Cancer Outcomes. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 862:143-53. [DOI: 10.1007/978-3-319-16366-6_10] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
50
|
Holm M, Olsen A, Kroman N, Tjønneland A. Lifestyle influences on the association between pre-diagnostic hormone replacement therapy and breast cancer prognosis—Results from The Danish ‘Diet, Cancer and Health’ prospective cohort. Maturitas 2014; 79:442-8. [DOI: 10.1016/j.maturitas.2014.09.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 09/15/2014] [Indexed: 11/30/2022]
|