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LETTER TO THE EDITOR
Year : 2012  |  Volume : 16  |  Issue : 6  |  Page : 1047

Vitamin D and breast cancer


1 Department of Internal Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran
2 Chemical Injuries Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran

Date of Web Publication31-Oct-2012

Correspondence Address:
Amin Saburi
Chemical Injuries Research Center, Baqiyatallah University of Medical Sciences, Mollasadra st, Vanak sq, Tehran
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2230-8210.103039

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How to cite this article:
Karbasi A, Saburi A. Vitamin D and breast cancer. Indian J Endocr Metab 2012;16:1047

How to cite this URL:
Karbasi A, Saburi A. Vitamin D and breast cancer. Indian J Endocr Metab [serial online] 2012 [cited 2019 Nov 16];16:1047. Available from: http://www.ijem.in/text.asp?2012/16/6/1047/103039

Sir,

We read with a great interest Imtiaz et al.'s paper published recently in Indian journal of Endocrinology and metabolism. [1] They skillfully design a study to determine a possible relationship between grade/stage of breast cancer (BC) and serum level of Vitamin D. Finally, they concluded that "almost all patients with breast cancer were vitamin D deficient and tumor characteristics did not show any significant associations with serum levels of vitamin D." Although this issue is a hot topic in endocrinology and oncology but in this study there are some concerns which undermine the results to make a definite conclusion.

One of the most important queries in this study is amount of cases. We can claim that if the difference between two groups (BC and Healthy) was not significant, it could because of small amount of sample size. Therefore, the authors should estimate "power" of study to rule out this query. Secondly, matching cases between two groups in an endocrinology study is critical. The authors matched groups in terms of age but menopausal status, age of menopause, race, menopausal hormone therapy, marital status, occupation, OCP use and etc should be matched. They demonstrated some demographic data for mentioned confounding factors but they did not state P-value for it to confirm matching between two groups. Thirdly, they measured only 25 (OH) 2 vitamin D although it seems that measuring total 25-OH vitamin D levels (D (2) + D (3))can present a more valid serum level of vitamin D. [2] Also, some documents define terms of vitamin D deficiency and insufficiency different with this study which can justify differences between this study and them. [2] Moreover, Secondary cause of vitamin D deficiency in patients with BC such as Idiopathic hypercalciuria, primary hyperparathyroidism and normocalcemic hyperparathyroidism should be considered in these patients before any conclusion which was not enough considered by the authors. [3]

A newly considered aspect of relation between Vitamin D and neoplastic disorders such as breast cancer is role of Vitamin D Binding Protein (VDBP) in these diseases. [4] It was confirmed that lower level of vitamin D can be associated with higher incidence and worse prognosis. [5] The anti-neoplastic role of vitamin D can be due to enhancing effect of vitamin D on immune system which was weaken by alpha-N-acetylgalactosaminidase. Vitamin D binding proteins such as S100 and GC proteins group have a significant role in malignancy and neoplasm progression. The level of these proteins may be affected by serum level of vitamin D. [6] However, Gc-MAF (macrophage activating factor) as an activated vitamin D like proteins is a useful treatment for breast cancer which is less considered previously. [7] Therefore, when we want to discussed about the role of vitamin D in neoplastic disorders, it is also better to talk about its role in enhancing the immune system as system biology. Further study focusing on therapeutic effects of vitamin D derivates either as nutritional supplement for vitamin deficiency and also immunotherapy is required.

 
   References Top

1.Imtiaz S, Siddiqui N, Raza SA, Loya A, Muhammad A. Vitamin D deficiency in newly diagnosed breast cancer patients. Indian J Endocrinol Metab 2012;16:409-13.  Back to cited text no. 1
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2.Peppone LJ, Huston AJ, Reid ME, Rosier RN, Zakharia Y, Trump DL, et al. The effect of various vitamin D supplementation regimens in breast cancer patients. Breast Cancer Res Treat. [Clinical Trial Research Support, N.I.H., Extramural]. 2011;127:171-7.  Back to cited text no. 2
    
3.Camacho PM, Dayal AS, Diaz JL, Nabhan FA, Agarwal M, Norton JG, et al. Prevalence of secondary causes of bone loss among breast cancer patients with osteopenia and osteoporosis. J Clin Oncol. [Research Support, Non-U.S. Gov't]. 2008;26:5380-5.  Back to cited text no. 3
    
4.Ghanei M, Shohrati M, Saburi A. The new aspects of immunotherapy in prostate cancer. Cancer immunology, immunotherapy: CII. 2012 Jun 27.  Back to cited text no. 4
    
5.Abbas S, Linseisen J, Slanger T, Kropp S, Mutschelknauss EJ, Flesch- Janys D, et al. Serum 25-hydroxyvitamin D and risk of post-menopausal breast cancer--results of a large case-control study. Carcinogenesis. [Research Support, Non-U.S. Gov't]. 2008;29:93-9.  Back to cited text no. 5
    
6.Nagasawa H, Uto Y, Sasaki H, Okamura N, Murakami A, Kubo S, et al. Gc protein (vitamin D-binding protein): Gc genotyping and GcMAF precursor activity. Anticancer Res 2005;25:3689-95.  Back to cited text no. 6
[PUBMED]    
7.Yamamoto N, Suyama H, Ushijima N. Immunotherapy of metastatic breast cancer patients with vitamin D-binding protein-derived macrophage activating factor (GcMAF). Int J Cancer 2008;122:461-7.  Back to cited text no. 7
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