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Vitamin D and calcium supplementation and one-year change in mammographic density in the women's health initiative calcium and vitamin D trial.

ABSTRACT: Calcium and vitamin D may be inversely related to breast cancer risk, in part by affecting mammographic density. However, results from previous, mostly cross-sectional studies have been mixed, and there have been few randomized clinical trials of the effect of calcium and vitamin D supplementation on change in mammographic density.We assessed the effect of one year of supplementation on mammographic density in 330 postmenopausal women enrolled in the Women's Health Initiative hormone therapy (HT) and calcium and vitamin D (CaD) trials. Women were randomized to receive 1,000 mg/d of elemental calcium carbonate plus 400 IU/d of vitamin D(3) or placebo.After approximately one year, mammographic density decreased 2% in the CaD supplementation group and increased 1% in the placebo group (ratio of means = 0.97; 95% CI = 0.81-1.17). Results suggested potential interaction by HT use (P = 0.08). Among women randomized to HT placebo, the ratio of mean density comparing CaD supplementation and placebo groups was 0.82 (95% CI = 0.61-1.11) vs. 1.16 (95% CI = 0.92-1.45) in women randomized to active HT. In sensitivity analyses limited to women taking ? 80% of study supplements, ratios were 0.67 (95% CI = 0.41-1.07) in women not assigned to HT and 1.07 (95% CI = 0.79-1.47) women assigned to HT.We observed no overall effect of vitamin D and calcium supplementation on mammographic density after one year.Potential interaction between these nutrients and estrogen as related to mammographic density warrants further study.

SUBMITTER: Bertone-Johnson ER

PROVIDER: S-EPMC3297717 | biostudies-literature | 2012 Mar

REPOSITORIES: biostudies-literature

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Vitamin D and calcium supplementation and one-year change in mammographic density in the women's health initiative calcium and vitamin D trial.

Bertone-Johnson Elizabeth R ER McTiernan Anne A Thomson Cynthia A CA Wactawski-Wende Jean J Aragaki Aaron K AK Rohan Thomas E TE Vitolins Mara Z MZ Tamimi Rulla M RM Johnson Karen C KC Lane Dorothy D Rexrode Kathryn M KM Peck Jennifer D JD Chlebowski Rowan T RT Sarto Gloria G Manson Joann E JE

Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology 20120117 3

<h4>Background</h4>Calcium and vitamin D may be inversely related to breast cancer risk, in part by affecting mammographic density. However, results from previous, mostly cross-sectional studies have been mixed, and there have been few randomized clinical trials of the effect of calcium and vitamin D supplementation on change in mammographic density.<h4>Methods</h4>We assessed the effect of one year of supplementation on mammographic density in 330 postmenopausal women enrolled in the Women's He ...[more]

PMID: 22253296

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Project description:SummaryThe Women's Health Initiative (WHI) double-blind, placebo-controlled clinical trial randomly assigned 36,282 postmenopausal women in the U.S. to 1,000 mg elemental calcium carbonate plus 400 IU of vitamin D(3) daily or placebo, with average intervention period of 7.0 years. The trial was designed to test whether calcium plus vitamin D supplementation in a population in which the use of these supplements was widespread would reduce hip fracture, and secondarily, total fracture and colorectal cancer.IntroductionThis study further examines the health benefits and risks of calcium and vitamin D supplementation using WHI data, with emphasis on fractures, cardiovascular disease, cancer, and total mortality.MethodsWHI calcium and vitamin D randomized clinical trial (CT) data through the end of the intervention period were further analyzed with emphasis on treatment effects in relation to duration of supplementation, and these data were contrasted and combined with corresponding data from the WHI prospective observational study (OS).ResultsAmong women not taking personal calcium or vitamin D supplements at baseline, the hazard ratio [HR] for hip fracture occurrence in the CT following 5 or more years of calcium and vitamin D supplementation versus placebo was 0.62 (95 % confidence interval (CI), 0.38-1.00). In combined analyses of CT and OS data, the corresponding HR was 0.65 (95 % CI, 0.44-0.98). Supplementation effects were not apparent on the risks of myocardial infarction, coronary heart disease, total heart disease, stroke, overall cardiovascular disease, colorectal cancer, or total mortality, while evidence for a reduction in breast cancer risk and total invasive cancer risk among calcium plus vitamin D users was only suggestive.ConclusionThough based primarily on a subset analysis, long-term use of calcium and vitamin D appears to confer a reduction that may be substantial in the risk of hip fracture among postmenopausal women. Other health benefits and risks of supplementation at doses considered, including an elevation in urinary tract stone formation, appear to be modest and approximately balanced.

Dataset Information

Vitamin D and calcium supplementation and one-year change in mammographic density in the women's health initiative calcium and vitamin D trial.

Publications

Vitamin D and calcium supplementation and one-year change in mammographic density in the women's health initiative calcium and vitamin D trial.

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