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

描述（由申请人提供）：乳腺癌是美国女性中最常见的恶性肿瘤，预计2007年女性中乳腺癌估计有178，480例，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，没有大型研究涉及维生素D与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，并且这种关系比饮食或补充维生素D与复发的关系更强。维生素D作为减少三级疾病的预防方法具有重大潜力，因为没有与通常暴露相关的毒性，并且今天美国超过200万乳腺癌幸存者可以以具有成本效益的方式容易地采用饮食和/或补充维生素D的增加。妇女健康饮食和生活（WHEL）研究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，为以有效的方式进行此类研究提供了框架。因此，在WHEL研究中，使用巢式病例对照设计，拟议工作的具体目标是：1）测量基线时WHEL队列中女性的循环25（OH）D水平，并评估血清25（OH）D与乳腺癌复发之间的关联; 2）评估饮食和补充维生素D摄入与乳腺癌复发之间的关联; 3）探索钙、维生素A、类胡萝卜素或体型是否改变了25（OH）D与乳腺癌复发之间的关联，使用血清浓度和饮食摄入数据。两个次要目标是：1）探讨血清25（OH）D、维生素D摄入量和乳腺癌复发之间的关联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、季节和体型的数据创建循环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作为减少三级疾病的预防方法具有重大潜力，因为没有与通常暴露相关的毒性，并且今天美国超过200万乳腺癌幸存者可以以具有成本效益的方式容易地采用饮食和/或补充维生素D的增加。在这项研究中，我们假设血清中25（OH）D浓度与乳腺癌复发呈负相关，并且这种关系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.