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A CALL FOR MORE VITAMIN D RESEARCH
CA Cancer J Clin 2006;56;250-251

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News & Views
asymptomatic and their immune systems clear
the infection.
When it persists, though, HPV can cause
intraepithelial lesions in the cervix, vagina, or
vulva. Left untreated, some of these lesions can
progress to cancer.
In 4 clinical trials involving nearly 21,000 women
and teenage girls, Gardasil was nearly 100% effec-
tive in preventing precancerous cervical, vagi-
nal, and vulvar lesions caused by HPV-16 and
HPV-18. No cervical lesions related to these
HPV types developed among the 8,487 women
in the vaccine group, compared with 53 cases
among the 8,460 women in the placebo group.
Similarly, no high-grade vaginal or vulvar lesions
developed in 8,641 vaccinated women compared
with 24 cases in 8,667 unvaccinated women.
Gardasil was 99% effective in preventing gen-
ital warts caused by HPV-6 and HPV-11, accord-
ing to Merck. There was just one case among
7,897 women vaccinated with Gardasil compared
with 91 cases in 7,899 unvaccinated women.
Approval of the vaccine does not mean women
can forget about Pap tests, experts stressed.
“It is critical that girls and young women who
receive the vaccine continue to follow screening
guidelines,” said Debbie Saslow, PhD, American
Cancer Society (ACS) Director of Breast and
Gynecologic Cancer.
That’s because Gardasil only targets 4 HPV
types; there are as many as 40 strains of the virus
that can be sexually transmitted, and some of these
others can also cause cancer. About 30% of cer-
vical cancers will not be prevented by the vaccine.
Ideally, the vaccine should be given before
the onset of sexual activity and thus possible
exposure to HPV. Young women who are already
sexually active can still benefit, but the likely
benefit decreases: The likelihood of exposure to
at least one of the 4 HPV types in the vaccine is
high within the first 2 years of onset of sexual
activity. However, very few women will have
been exposed to all four of the HPV types. The
vaccine, which is given as 3 injections over a
period of 6 months, will protect against only
those HPV types to which recipients have not
been exposed.
250 CA A Cancer Journal for Clinicians
A second HPV vaccine called Cervarix is in
development by GlaxoSmithKline. The com-
pany has not yet submitted its vaccine to the
FDA for approval.
Head-to-head comparisons of the two vac-
cines have not been done, so it is not clear whether
one performs better than the other. Cervarix pro-
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tects against HPV types 16 and 18, but not 6 and
11, and thus will not prevent genital warts.
Side effects from Gardasil were mild, the FDA
said, and included pain or tenderness at the injec-
tion site.
A CALL FOR MORE VITAMIN D RESEARCH
US and Canadian health groups say the poten-
tial role of vitamin D in cancer prevention deserves
more research. The American Cancer Society
(ACS) joined the Canadian Cancer Society and
six other health groups in issuing a statement of
findings from the first North American confer-
ence on vitamin D, held in March.
The conference brought together experts in
nutrition, epidemiology, dermatology, oncology,
and other fields to discuss what is and is not known
about vitamin D and its effect on human health.
The consensus: There is still much to learn
about how much vitamin D people need for
good health, how much might be too much,
and—perhaps most importantly—the best way
to get enough.
The statement is available on the Web site of
the Canadian Cancer Society at http://www.
cancer.ca/ccs/inter net/mediareleaselist/
0,,3172_615815452_1056572174_langId-en.
html. In addition to the Canadian and American
Cancer Societies, other groups signing onto the
statement include the American College of
Rheumatology, Canadian Dermatology Associ-
ation, Dietitians of Canada, National Council on
Skin Cancer Prevention (US), Osteoporosis Canada,
and the World Health Organization Collaborative
Centre for the Promotion of Sun Protection.
“There is no dispute among medical profes-
sionals that vitamin D is beneficial for our health,
and there is no dispute that sun exposure is the

major source of vitamin D for most of us,” said
ACS deputy chief medical officer Len Lichtenfeld,
MD, who participated in the conference. “But
there is also no dispute that exposure to ultra-
violet (UV) radiation from the sun and other
sources can be harmful.”
That is why making recommendations about
vitamin D is problematic.
UV light in the form of UVA and UVB is
known to raise the risk of melanoma and non-
melanoma skin cancers, as well as cataracts. But
vitamin D is crucial to bone health, and there is
growing evidence that it may have a role in pre-
venting some cancers, especially colorectal cancers.
Because vitamin D occurs naturally in only a
few foods and is added to just a handful of oth-
ers, many experts worry that some Americans get
too little vitamin D to reap these potential ben-
efits. Yet few are willing to encourage sun expo-
sure with its well-known dangers. UVB radiation
is what spurs the skin to produce vitamin D.
The health groups’ statement acknowledges this
conundrum and concludes that a balance of some
sun exposure and vitamin D supplementation
may be the best answer for now.
“To minimize the health risks associated with
UVB radiation exposure while maximizing the
potential benefits of optimum vitamin D status,
[dietary] supplementation and small amounts of
sun exposure are the preferred methods of obtain-
ing vitamin D,” the consensus statement says.
Current intake recommendations for vitamin
D, set by the Institute of Medicine, are 200 inter-
national units (IU) a day for children and adults
up to age 50; 400 IU for adults age 51–70; and
600 IU for adults age 71 and older.
However, those levels are considered “ade-
quate intake” to maintain bone health and nor-
mal calcium metabolism. They do not reflect
the other potential health benefits of vitamin D.
Indeed, many experts consider these levels too
low for optimal health, and recommend as much
as 1,000 IU daily.
The statement of findings from the health
group does not go so far as to recommend that
level of vitamin D. Rather, it calls for more
research to determine the optimal amount and
CA Cancer J Clin 2006;56:249–253
encourages the public to discuss supplementa-
tion with a health care professional.
The statement says those at greatest risk of
having too little vitamin D include the following:
• Elderly people.
• Babies who are exclusively breast-fed.
• People with dark skin (darker-skinned people
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need more sun exposure to make vitamin D).
• People who don’t get any sun exposure (those
who are housebound or who cover their bod-
ies with clothing for religious or cultural rea-
sons).
• People who live in colder climates such as the
northern United States and Canada in win-
ter (above 37° latitude).
Lichtenfeld said people must also use com-
mon sense when deciding what constitutes a
“small amount” of sun exposure. Five minutes
may be enough for some, but not others.
“There is no ‘one size fits all’ recommenda-
tion for people to follow in determining how
much sun exposure is adequate to obtain health-
ful vitamin D levels,” he said.
How much sun any single person might need
depends on many things: their age, the amount
of vitamin D obtained from their diet, skin dark-
ness, and sunshine intensity where they live. It
will take more research to figure out specifics.
“Avoiding the sun at all costs, for most of us,
simply doesn’t make sense,” Lichtenfeld acknowl-
edged. “But that doesn’t mean people should
bake themselves outside or in a tanning booth.
The ACS does not advocate seeking sun expo-
sure for the purpose of obtaining vitamin D.”
The ACS is in the process of updating its skin
cancer prevention guidelines and currently recom-
mends reducing sun exposure to reduce the risk
of skin cancer. Although the guidelines note that
vitamin D is important to good health, the ACS
does not currently have a recommendation about
vitamin D as a way to treat or prevent cancer.
FERTILITY GUIDELINES ADDRESS OFTEN-IGNORED
TREATMENT SIDE EFFECT
New guidelines from the American Society of
Clinical Oncology (ASCO) say physicians should
Volume 56 • Number 5 • September/October 2006 251