SEAN DAVENPORTBRIANNA CANTRELL

ASHLEY CLARKDANA OMARIEMILY SMITH

OLIVIA WOOLIVER

Breast Cancer

Breast Cancer

Breast cancer refers to a malignant tumor that has developed from cells in the breast

Cells of the lobules Milk producing glands

Ducts Passages that drain milk from the lobules to the nipple

Less commonly: Stromal tissues, which include the fatty and fibrous

connective tissues of the breast.

What are the symptoms?

Swelling of all or part of the breastSkin irritation or dimplingBreast painNipple pain or the nipple turning inwardRedness, scaliness, or thickening of the

nipple or breast skinNipple discharge other than breast milkLump in the underarm area

Overview of Vitamin D

Role in serum calcium homeostasis – acts to increase or decrease serum calcium levelsAlso aids in calcium homeostasis in

other areas such as bone, kidney, intestine, etc.

Helps to maintain/control normal cell growth, differentiation, and proliferation

Overview of Calcium

Calcium plays a regulatory role in cell proliferation, differentiation, and apoptosis

Experimental studies show that Calcium intake is related to: An inverse relationship with mammographic breast

density Decreased fat-induced epithelial hyperproliferation of

the mammary gland and chemically-induced mammary carcinogenesis in rodents

Reduced amount of breast cancer precursors in epidemiologic studies

Study 1: Intakes of Calcium and Vitamin D and Breast Cancer Risk in Women

Background Increasing Calcium and Vitamin D intake in female

mice led to regression in mammary tumors. Evaluation of Calcium and Vitamin D intake Subjects were divided into groups

10,578 Premenopausal women 20,909 Post menopausal women

45 years or older

Dietary Assessment

Food frequency questionnaireAverage use of food and beverages

past 12 monthsCalcium and Vitamin D intakes

included sources from both Diets and Supplements

Ascertainment of Breast Cancer Cases

Follow up questionnaires on whether breast cancer was diagnosed Every 6 months for first year Annually after first year

Medical records attained to confirm diagnosis/death

Average 10 year follow-up of incident invasive breast cancer 276 premenopausal women diagnosed 743 post menopausal women diagnosed

Influences

Examination of dietary factors Vitamin DPhosphorusFatLactose

Results

Relation to function: Premenopausal women

Higher intakes of total Calcium & Vitamin D were associated with lower risk of breast cancer

Postmenopausal women No association between calcium/Vitamin

D levels and risk of breast cancer Possible explanation: relationship between

Calcium, Vitamin D, and IGFs

Discussion

Calcium, Vitamin D, and IGFs:Suggestion that Calcium & Vitamin D

have anti-cancer effects on breast cancer cells expressing high levels of IGF-1 & IGF binding protein 3

Promote growth inhibitionIGF levels decline with age

Strengths Weaknesses

Large sample sizeProspective designLong durationHigh follow-up rates

Possible confoundNutrient intake only

assessed onceVitamin D intake

from sunlight exposure

Discussion

Study 2: Long-term dietary calcium intake and breast cancer risk in a prospective cohort of women

To examine the potential association between Calcium intake and breast cancer risk and whether this association varies by ER/PR status of the breast tumor

Subjects and Methods

Swedish Mammography CohortPopulation-based cohort of 61,433 women

cancer-free at baselineEnrollment: 1987-1990Two questionnaires:

Baseline 1997

Case ascertainment for ER/PR status Pathology labs, Clinical databases

Results

17.4 year follow up on average 4.81% developed invasive breast cancer

Of these cases: 62.4% ER+/PR+ 20.2% ER+/PR- 12.9% ER-/PR- 4.5% ER-/PR+

Adjustments made for: Dietary Vitamin D Conjugated Linoleic Acid intake

Results

Results

Highest Calcium Intake 34% less likely to develop ER-/PR- breast cancer

Overall Calcium Intake Decreased receptor-negative species of breast cancer However, association was not statistically significant

Strengths Weakness

Prospective and population based design

Large sample sizeDetailed info on dietInfo on hormone

receptor status

Dietary intake was self-administered FFQ

Confounding variables

Discussion

Conclusion

Nutrient Mechanisms: Calcium absorption is positively correlated with

vitamin D intake Vitamin D works inversely with estrogen receptors

(ERs) and progesterone receptors (PRs), and actually has its own receptors (VDRs) in mammary glands/tissue Apart from its role in aiding calcium absorption, the

receptors for vitamin D found here could indicate a bigger part in preventing cancer

This facet needs further research for conclusive evidence

Pros Cons

Easier to administer

Cheaper than conducting a Randomized Control Study (RCT)

Hard to identify controls

Blinding is difficult Recall &/or

volunteer bias

Cohort: designed to show incidence; best for predicting risk factors in research, based on exposure or no exposure

Questions