Breast Cancer

BRIANNA CANTRELL ASHLEY CLARK SEAN DAVENPORT DANA OMARI EMILY SMITH OLIVIA WOOLIVER

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 breast

Skin irritation or dimpling

Breast pain Nipple pain or the nipple turning inward Redness, scaliness, or thickening of the

nipple or breast skin Nipple discharge other than breast milk Lump in the underarm area

Overview of Vitamin D
Role in serum calcium homeostasis acts to

increase or decrease serum calcium levels Also 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 questionnaire
Average

use of food and beverages past 12

months Calcium 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

D Phosphorus Fat Lactose

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 inhibition IGF levels decline with age

Discussion
Strengths Weaknesses

Large sample size Prospective design Long duration High follow-up rates

Possible confound Nutrient intake only

assessed once Vitamin D intake from sunlight exposure

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 Cohort

Population-based cohort of 61,433 women cancer-

free at baseline Enrollment: 1987-1990 Two 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 Decreased receptor-negative species of breast cancer However, association was not statistically significant

Overall Calcium Intake

Discussion
Strengths Weakness

Prospective and

Dietary intake was self-

population based design Large sample size Detailed info on diet Info on hormone receptor status

administered FFQ Confounding variables

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

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

Pros
Easier to administer Cheaper than

Cons
Hard to identify

conducting a Randomized Control Study (RCT)

controls Blinding is difficult Recall &/or volunteer bias

Questions