The Who, What, Where, When and Sometimes, Why.

Vitamin D and breast cancer risk

This summary table contains detailed information about research studies. Summary tables are a useful way to look at the science behind many breast cancer guidelines and recommendations. However, to get the most out of the tables, it’s important to understand some key concepts. Learn how to read a research table.

Introduction: Whether or not vitamin D may lower the risk of breast cancer is under study.

Most of the vitamin D a person gets comes from the sun and a small amount comes from diet.

Vitamin D through sunlight exposure and diet

Findings from studies on vitamin D (through diet alone or diet plus sunlight exposure) and breast cancer risk are mixed.

Studying vitamin D with measures of sunlight exposure and diet has some challenges. It’s hard to measure sunlight exposure. And, because so many foods that contain vitamin D also contain calcium, it’s hard to single out the effects of vitamin D alone.

Blood levels of vitamin D

Blood levels of vitamin D are a good marker of vitamin D exposure. By studying blood levels of vitamin D, researchers avoid the measurement issues with sunlight exposure and diet.

Findings from studies on a possible link between blood levels of vitamin D and breast cancer risk are mixed. 

Learn more about vitamin D and breast cancer risk.

Learn more about vitamin D.

Learn about the strengths and weaknesses of different types of studies

See how this risk factor compares with other risk factors for breast cancer.

 

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Komen Perspectives

Read our perspective on the vitamin D and breast cancer risk.*

 

*Please note, the information provided within Komen Perspectives articles is only current as of the date of posting. Therefore, some information may be out of date at this time.

 

Study selection criteria: For studies with measures of sunlight exposure and dietary intake of vitamin D: Randomized controlled trialsprospective cohort studies and nested case-control studies with at least 800 breast cancer cases, and meta-analyses.

For studies of blood levels of vitamin D: Prospective cohort studies and nested case-control studies with at least 500 breast cancer cases.

Table note: Relative risk above 1 indicates increased risk. Relative risk below 1 indicates decreased risk.

 Sunlight Exposure and Dietary Intake of Vitamin D

Study

Study Population
(number of participants)

Follow-up
(years)

Measure(s) of
Vitamin D

Relative Risk of Breast Cancer
in Women with a High Exposure
to Vitamin D Compared to
Women with Low Exposure,
RR (95% CI)

Randomized controlled trials

Women’s Health Initiative [1]

36,282
(1,667 cases)

11

Supplement
intake

 Postmenopausal women: 
1.04
(0.94-1.14)†

VITAL Trial [2]

25,871
(246 cases)

5

Supplement
intake

 Postmenopausal women: 
1.02
(0.79-1.31)

Prospective cohort studies

EPIC [3]

319,985
(7,760 cases)

9

Dietary
intake

Premenopausal women:
1.07
(0.87-1.32)

Postmenopausal women:
1.02
(0.90-1.16)

Nurses’ Health Study [4]

88,691
(3,482 cases)

16

Dietary and
supplement
intake

Premenopausal women:
0.72
(0.55-0.94)

Postmenopausal women:
0.94
(0.80-1.10) 

French E3N Cohort [5]

67,721
(2,871 cases)

10

Dietary
intake

Premenopausal women:
1.03
(0.85-1.25)

Postmenopausal women:
0.92
(0.83-1.02) 

   

Sun exposure:
High vs. low
level of sun exposure
in place of residence

 Premenopausal women:
0.85
(0.67-1.08)

Postmenopausal women:
0.92
(0.82-0.98)

Cancer Prevention Study II Nutrition Cohort [6]

68,567
(2,855 cases)

8-9

Dietary and
supplement
intake

Postmenopausal women:
0.95
(0.81-1.13)

Iowa Women’s Health Study [7]

34,321
(2,440 cases)

18

Dietary and
supplement
intake

Postmenopausal women:
0.89
(0.77-1.03) 

Sisters Study [8]

50,884
(1,642 cases)‡

5

Dietary and
supplement
intake

Pre- and postmenopausal women:
0.90
(0.78-1.05) 

 

 

 

Sun exposure:
High vs. low level of sun exposure in place of residence

Pre- and postmenopausal women:
1.06
(0.91-1.23) 

Women’s Health Study [9]

31,487
(1,019 cases)

10

Dietary and
supplement
intake

Premenopausal women:
0.65
(0.42-1.00)

Postmenopausal women:
1.30
(0.97-1.73) 

Norwegian Women and Cancer Study [10]

41,811
(948 cases)

9

Dietary and
supplement
intake

 Pre- and postmenopausal women:
1.07
(0.87-1.32)

   

Sun exposure:
More than one
sunburn per year
vs. none

 Pre- and postmenopausal women:
0.95
(0.75-1.21)§

VITAL Cohort [11]

35,016
(880 cases)

6

Supplement
intake

Postmenopausal women:
0.68
(0.50-0.92)

Women’s Lifestyle and Health Cohort Study [12]

41,889
(840 cases)

13

Dietary
intake

Pre- and postmenopausal women:
0.9
(0.8-1.1) 

   

Sun exposure:
2 or more
sunburns per year
vs. none

Pre- and postmenopausal women:
1.1
(0.9-1.4)¶

Meta-analyses

Chen et al. [13]

11 studies

Various

Dietary and
supplement
intake

Pre- and postmenopausal women:
0.91
(0.83-1.00)

Kim and Je [14]

10 studies

Various

Dietary and
supplement
intake

Pre- and postmenopausal women:
0.95
(0.88-1.01)

Gissel et al. [15]

6 studies

Various

Dietary and
supplement
intake

 Pre- and postmenopausal women:
0.98
(0.93-1.03)

Sperati et al. [16]

2 studies

Various

Supplement intake

Postmenopausal women:
1.11
(0.74-1.68)

† Breast cancer risk among women randomized to take a supplement containing vitamin D and calcium versus women randomized to a placebo for 7 years (with continued follow-up).  

‡ All women in the study have a sister who has been diagnosed with breast cancer.

§ Average number of sunburns per year. Sun exposure as measured by weeks per year spent on sunbathing vacations and tanning bed use was also not related to breast cancer risk. 

¶ Sunburns from ages 10-19. Findings also showed other measures of sun exposure were not related to breast cancer risk including sunburns during other ages, weeks per year spent on sunbathing vacations and tanning bed use. 

 

 Blood Levels of Vitamin D

 Study

 Study Population
(number of participants)

 Follow-up
(years)

Relative Risk of Breast Cancer
in Women with Higher Blood Levels
of Vitamin D (25-hydroxyvitamin D)
Compared to Women with Lower Levels,
RR (95% CI)

Nested case-control studies

 

Cases

Controls

  

Sisters Study [8]

1,600‡

1,822‡

5

Premenopausal women:
1.06
(0.67-1.68)

Postmenopausal women:
0.72
(0.56-0.92)

New York University Women’s Health Study and Northern Sweden Mammary Screening Cohort [17]

1,585

2,940

9||

Premenopausal women:
0.67
(0.48-0.92)

Postmenopausal women:
1.21
(0.92-1.58)

Nurses’ Health Study [18]

1,502

1,502

20

 Pre- and postmenopausal women:
0.87
(0.67-1.13)**

EPIC [19]

1,391

1,391

4||

 Pre- and postmenopausal women:
1.07
(0.85-1.36)

Women’s Health Initiative [1,20]

1,080

1,080

7

 Postmenopausal women:
1.06
(0.78-1.43)

Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial [21]

1,005

1,005

4-12

 Postmenopausal women:
1.04
(0.75-1.45)

Malmo Diet and Cancer Study [22]

764

764

10-15

Pre- and postmenopausal women:
0.93
(0.66-1.33) 

French E3N Cohort [23]

636

1,272

10

 Pre- and postmenopausal women:
0.73
(0.55-0.96)

Melbourne Collaborative Cohort Study [24]

634

1,332

14

 Pre- and postmenopausal women:
0.95
(0.79-1.15)

Nurses’ Health Study II [25]

613

1,218

8-11

 Pre- and postmenopausal women:
1.29
(0.92-1.81)

Cancer Prevention Study-II [26]

516

516

4-7

 Postmenopausal women:
1.09
(0.70-1.68)

Meta-analyses

Kim and Je [14]

14 nested case-control and
cohort studies

Pre- and postmenopausal women:
0.92
(0.83-1.02)

Chen et al. [27]

10 nested case-control studies and
1 retrospective study

 Pre- and postmenopausal women:
0.86
(0.75-1.00)

Mohr et al. [28]

5 nested case-control studies

 Pre- and postmenopausal women:
0.87
(0.77-0.99)

U.S. Preventive Services Task Force [29]

 4 nested case-control studies

 Pre- and postmenopausal women:
0.99
(0.97-1.01)

‡ All women in the study have a sister who has been diagnosed with breast cancer.

|| Average number of years between blood collection and breast cancer diagnosis in cases.

** Among women with blood collection during the winter, results were similar, relative risk of 1.10 (0.75-1.60). Among women with blood collection during the summer, those with higher blood levels of vitamin D had a lower risk of breast cancer compared to those with lower blood levels of vitamin D, relative risk 0.66 (0.46-0.94). 

References

  1. Cauley JA, Chlebowski RT, Wactawski-Wende J, et al. for the Women’s Health Initiative Investigators. Calcium plus vitamin D supplementation and health outcomes five years after active intervention ended: the Women’s Health Initiative. J Womens Health (Larchmt). 22(11):915-29, 2013.
  2. Manson JE, Cook NR, Lee IM, et al. for the VITAL Research Group. Vitamin D supplements and prevention of cancer and cardiovascular disease. N Engl J Med. 380(1):33-44, 2019.
  3. Abbas S, Linseisen J, Rohrmann S, et al. Dietary intake of vitamin d and calcium and breast cancer risk in the European prospective investigation into cancer and nutrition. Nutr Cancer. 65(2):178-87, 2013.
  4. Shin MH, Holmes MD, Hankinson SE, Wu K, Colditz GA, Willett WC. Intake of dairy products, calcium, and vitamin d and risk of breast cancer. J Natl Cancer Inst. 94(17):1301-11, 2002.
  5. Engel P, Fagherazzi G, Mesrine S, Boutron-Ruault MC, Clavel-Chapelon F. Joint effects of dietary vitamin D and sun exposure on breast cancer risk: results from the French E3N cohort. Cancer Epidemiol Biomarkers Prev. 20(1):187-98, 2011.
  6. McCullough ML, Rodriguez C, Diver WR, et al. Dairy, calcium, and vitamin D intake and postmenopausal breast cancer risk in the Cancer Prevention Study II Nutrition Cohort. Cancer Epidemiol Biomarkers Prev. 14(12):2898-904, 2005.
  7. Robien K, Cutler GJ, Lazovich D. Vitamin D intake and breast cancer risk in postmenopausal women: the Iowa Women’s Health Study. Cancer Causes Control. 18(7):775-82, 2007.
  8. O’Brien KM, Sandler DP, Taylor JA, Weinberg CR. Serum vitamin D and risk of breast cancer within five years. Environ Health Perspect. 125(7):077004, 2017.
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  11. Brasky TM, Lampe JW, Potter JD, Patterson RE, White E. Specialty supplements and breast cancer risk in the VITamins And Lifestyle (VITAL) Cohort. Cancer Epidemiol Biomarkers Prev. 19(7):1696-708, 2010.
  12. Kuper H, Yang L, Sandin S, Lof M, Adami HO, Weiderpass E. Prospective study of solar exposure, dietary vitamin D intake, and risk of breast cancer among middle-aged women. Cancer Epidemiol Biomarkers Prev. 18(9):2558-61, 2009.
  13. Chen P, Hu P, Xie D, Qin Y, Wang F, Wang H. Meta-analysis of vitamin D, calcium and the prevention of breast cancer. Breast Cancer Res Treat. 121(2):469-77, 2010.
  14. Kim Y, Je Y. Vitamin D intake, blood 25(OH)D levels, and breast cancer risk or mortality: a meta-analysis. Br J Cancer. 110(11):2772-84, 2014.
  15. Gissel T, Rejnmark L, Mosekilde L, Vestergaard P. Intake of vitamin D and risk of breast cancer–a meta-analysis. J Steroid Biochem Mol Biol. 111(3-5):195-9, 2008.
  16. Sperati F, Vici P, Maugeri-Saccà M, et al. Vitamin D supplementation and breast cancer prevention: a systematic review and meta-analysis of randomized clinical trials. PLoS One. 8(7):e69269, 2013.
  17. Scarmo S, Afanasyeva Y, Lenner P, et al. Circulating levels of 25-hydroxyvitamin D and risk of breast cancer: a nested case-control study. Breast Cancer Res. 15(1):R15, 2013.
  18. Eliassen AH, Warner ET, Rosner B, et al. Plasma 25-hydroxyvitamin D and risk of breast cancer in women followed over 20 years. Cancer Res. 76(18):5423-30, 2016.
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  20. Neuhouser ML, Manson JE, Millen A, et al. The influence of health and lifestyle characteristics on the relation of serum 25-hydroxyvitamin D with risk of colorectal and breast cancer in postmenopausal women. Am J Epidemiol. 175(7):673-84, 2012.
  21. Freedman DM, Chang SC, Falk RT, et al. Serum levels of vitamin D metabolites and breast cancer risk in the prostate, lung, colorectal, and ovarian cancer screening trial. Cancer Epidemiol Biomarkers Prev. 17(4):889-94, 2008.
  22. Almquist M, Bondeson AG, Bondeson L, Malm J, Manjer J. Serum levels of vitamin D, PTH and calcium and breast cancer risk-a prospective nested case-control study. Int J Cancer. 127(9):2159-68, 2010.
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  24. Heath AK, Hodge A, Ebeling PR, et al. Circulating 25-hydroxyvitamin D concentration and risk of breast, prostate, and colorectal cancers: the Melbourne Collaborative Cohort Study. Cancer Epidemiol Biomarkers Prev. 28(5):900-908, 2019.
  25. Eliassen AH, Spiegelman D, Hollis BW, Horst RL, Willett WC, Hankinson SE. Plasma 25-hydroxyvitamin D and risk of breast cancer in the Nurses’ Health Study II. Breast Cancer Res. 13(3):R50, 2011.
  26. McCullough ML, Stevens VL, Patel R, et al. Serum 25-hydroxyvitamin D concentrations and postmenopausal breast cancer risk: a nested case control study in the Cancer Prevention Study-II Nutrition Cohort. Breast Cancer Res. 11(4):R64, 2009.
  27. Chen P, Li M, Gu X, et al. Higher blood 25(OH)D level may reduce the breast cancer risk: evidence from a Chinese population based case-control study and meta-analysis of the observational studies. PLoS One. 8(1):e49312, 2013.
  28. Mohr SB, Gorham ED, Alcaraz JE, et al. Serum 25-hydroxyvitamin D and prevention of breast cancer: pooled analysis. Anticancer Res. 31(9):2939-48, 2011.
  29. Chung M, Lee J, Terasawa T, Lau J, Trikalinos TA. Vitamin D with or without calcium supplementation for prevention of cancer and fractures: an updated meta-analysis for the U.S. Preventive Services Task Force. Ann Intern Med. 155(12):827-38, 2011. 

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