Serum 25(OH)D, Vitamin D Intake, and Breast Cancer Recurrence in the WHEL Study

描述（由申请人提供）：乳腺癌是美国妇女中最常见的恶性肿瘤，2007年估计有178,480例女性乳腺癌病例和40,460例死亡。流行病学和实验室证据表明，维生素D可能对乳腺癌发病率有保护作用；然而，目前还没有大型研究表明维生素D和乳腺癌复发之间的关系。我们假设血清25(OH)D浓度与乳腺癌复发呈负相关，并且这种关系将比饮食或补充维生素D与复发的关系更强。维生素D作为一种预防方法具有巨大的潜力，可以减少三级疾病，因为它没有与通常接触有关的毒性，并且今天美国200多万乳腺癌幸存者可以很容易地以一种经济有效的方式增加饮食和/或补充维生素D。妇女健康饮食和生活研究（WHEL）是一项大型饮食干预试验，旨在研究高蔬菜、低脂肪饮食在减少乳腺癌复发方面的有效性，为有效开展此类研究提供了框架。因此，在WHEL研究中，使用嵌套病例对照设计，提出的工作的具体目的是：1)在基线时测量WHEL队列中妇女循环25(OH)D水平，并评估血清25(OH)D与乳腺癌复发之间的关系；2)评价膳食及补充维生素D摄入量与乳腺癌复发的关系；3)探讨钙、维生素A、类胡萝卜素或体型，通过血清浓度和饮食摄入数据来改变25(OH)D与乳腺癌复发之间的关系。两个次要目的是：1)探索血清25(OH)D、维生素D摄入量和乳腺癌复发之间的关系是否因肿瘤雌激素受体状态或绝经状态而异；2)基于补充和膳食维生素D摄入量、种族、季节和体型的数据建立循环25(OH)D水平的预测模型。本文提出的工作有可能对乳腺癌生存复发产生直接、低成本的影响。公共卫生相关性：维生素D作为一种预防方法具有巨大的潜力，可以减少三级疾病，因为它没有与常规接触相关的毒性，并且今天在美国超过200万乳腺癌幸存者可以很容易地以经济有效的方式增加饮食和/或补充维生素D。在拟议的工作中，我们假设血清25(OH)D浓度与乳腺癌复发呈负相关，并且这种关系将比饮食或补充维生素D与复发的关系更强。

DESCRIPTION (provided by applicant): Breast cancer is the most common malignancy among women in the United States, with an estimated 178,480 cases and 40,460 deaths from breast cancer among women projected for 2007. Epidemiological and laboratory evidence indicates that vitamin D may be protective against breast cancer incidence; however, no large studies have addressed the association between vitamin D and breast cancer recurrence. We hypothesize that serum concentrations of 25(OH)D are inversely associated with breast cancer recurrence, and that this relationship will be stronger than that for dietary or supplemental intake of vitamin D and recurrence. Vitamin D holds significant potential as a preventive approach to reduce tertiary disease in that there is no toxicity related to usual exposure, and increases in dietary and/or supplemental vitamin D could be easily adopted in a cost-efficient manner by the over 2 million breast cancer survivors in the United States today. The Women's Healthy Eating and Living (WHEL) Study, a large dietary intervention trial of the effectiveness of a high-vegetable, low-fat diet in reducing breast cancer recurrence, provides the framework for conducting such a study in an efficient manner. Therefore, within the WHEL Study and using a nested case-control design, the specific aims of the proposed work are to 1) Measure circulating 25(OH)D levels in women in the WHEL cohort at baseline and evaluate the association between serum 25(OH)D and breast cancer recurrence; 2) Evaluate the association between dietary and supplemental intake of vitamin D and breast cancer recurrence; 3) Explore whether calcium, vitamin A, carotenoids, or body size, modify the association between 25(OH)D and breast cancer recurrence using serum concentrations and dietary intake data. Two secondary aims are: 1) To explore whether the association between serum 25(OH)D, intake of vitamin D, and breast cancer recurrence vary by tumor estrogen- receptor status or menopausal status and 2) To create a predictive model of circulating 25(OH)D levels based on data for supplemental and dietary vitamin D intake, race, season, and body size. The work proposed herein has the potential to have immediate, low-cost impact on breast cancer survival recurrence. PUBLIC HEALTH RELEVANCE: Vitamin D holds significant potential as a preventive approach to reduce tertiary disease in that there is no toxicity related to usual exposure, and increases in dietary and/or supplemental vitamin D could be easily adopted in a cost-efficient manner by the over 2 million breast cancer survivors in the United States today. In the proposed work, we hypothesize that serum concentrations of 25(OH)D are inversely associated with breast cancer recurrence, and that this relationship will be stronger than that for dietary or supplemental intake of vitamin D and recurrence.