Article

Calcium Plus Vitamin D Supplementation and the Risk of Colorectal Cancer

Department of Social and Preventive Medicine, University at Buffalo, 270 Farber Hall, Buffalo, NY 14214, USA.
New England Journal of Medicine (Impact Factor: 55.87). 03/2006; 354(7):684-96. DOI: 10.1056/NEJMoa055222
Source: PubMed

ABSTRACT

Higher intake of calcium and vitamin D has been associated with a reduced risk of colorectal cancer in epidemiologic studies and polyp recurrence in polyp-prevention trials. However, randomized-trial evidence that calcium with vitamin D supplementation is beneficial in the primary prevention of colorectal cancer is lacking.
We conducted a randomized, double-blind, placebo-controlled trial involving 36,282 postmenopausal women from 40 Women's Health Initiative centers: 18,176 women received 500 mg of elemental calcium as calcium carbonate with 200 IU of vitamin D3 [corrected] twice daily (1000 mg of elemental calcium and 400 IU of vitamin D3) and 18,106 received a matching placebo for an average of 7.0 years. The incidence of pathologically confirmed colorectal cancer was the designated secondary outcome. Baseline levels of serum 25-hydroxyvitamin D were assessed in a nested case-control study.
The incidence of invasive colorectal cancer did not differ significantly between women assigned to calcium plus vitamin D supplementation and those assigned to placebo (168 and 154 cases; hazard ratio, 1.08; 95 percent confidence interval, 0.86 to 1.34; P=0.51), and the tumor characteristics were similar in the two groups. The frequency of colorectal-cancer screening and abdominal symptoms was similar in the two groups. There were no significant treatment interactions with baseline characteristics.
Daily supplementation of calcium with vitamin D for seven years had no effect on the incidence of colorectal cancer among postmenopausal women. The long latency associated with the development of colorectal cancer, along with the seven-year duration of the trial, may have contributed to this null finding. Ongoing follow-up will assess the longer-term effect of this intervention. (ClinicalTrials.gov number, NCT00000611.).

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    • "Cigarette smoking has been associated with increased incidence and mortality from CRC [9]. Physical activity, diet high in fruits and vegetables , fiber, resistant starch, folic acid and folate, vitamin B6 (pyridoxine), calcium and dairy products , vitamin D, magnesium, garlic, fish consumption and drugs (aspirin and NSAIDs) are protective factors against CRC [10] [11] [12] [13] [14] [15] [16] [17] [18] [19] [20]. "
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    • "A meta-analysis of 35 independent case-control and cohort studies investigating the association of serum 25(OH)D levels with cancer showed a consistent inverse relationship between circulating 25(OH)D levels and colorectal cancer risk [11]; no similar conclusions could however be drawn for other cancer sites. Notably, so far none of the randomised, controlled trials has shown that vitamin D supplementation can prevent cancer [12] [13] although the increase in vitamin D serum levels achieved in one of these trials, the Women's Health Initiative study, was probably insufficient [14]. "
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