Vitamin D and Breast Cancer Risk: The NHANES I Epidemiologic Follow-up Study, 1971–1975 to 1992

Esther M. John; Gary G. Schwartz; Darlene M. Dreon; Jocelyn Koo

DOI: Published May 1999

Article Figures & Data

Tables

Table 1

Sunlight exposure and breast cancer risk among white women: NHANES I Epidemiologic Follow-up Study, 1971–1975 to 1992

	Breast cancer cases	Age-adjusted RR (95% CI)	Multivariate-adjusted RR (95% CI)^a
Sun exposure determined by physician
Unimpressive	94	1.0	1.0
Moderate	75	0.89 (0.66–1.20)	0.85 (0.63–1.15)
Considerable	20	0.70 (0.43–1.14)	0.70 (0.43–1.14)
P for trend		P = 0.14	P = 0.11
Actinic skin damage
None^b	62	1.0	1.0
None^c	53	0.95 (0.66–1.37)	0.92 (0.64–1.34)
Minimal	51	0.91 (0.62–1.33)	0.88 (0.60–1.29)
Moderate/severe	24	0.80 (0.49–1.31)	0.80 (0.48–1.29)
P for trend		P = 0.38	P = 0.32
Recreational sun exposure
Rare or never	40	1.0	1.0
Occasional	55	0.70 (0.46–1.06)	0.65 (0.43–0.98)
Frequent	60	0.70 (0.47–1.05)	0.66 (0.44–0.99)
P for trend		P = 0.12	P = 0.08
Occupational sun exposure
Rare or never	81	1.0	1.0
Occasional	44	1.05 (0.73–1.51)	1.06 (0.73–1.53)
Frequent	29	0.60 (0.39–0.91)	0.64 (0.41–0.98)
P for trend		P = 0.03	P = 0.07
Combined recreational and occupational sun exposure
Low	32	1.0	1.0
Medium	99	0.67 (0.45–1.01)	0.81 (0.56–1.17)
High	23	0.50 (0.29–0.86)	0.67 (0.42–1.06)
P for trend		P = 0.01	P = 0.06

^a Adjusted for age, education, age at menarche, age at menopause, body mass index, frequency of alcohol consumption, and physical activity.
^b No actinic skin damage and unimpressive sun exposure, as determined by the physician.
^c No actinic skin damage and moderate or considerable sun exposure, as determined by the physician.

Table 2

Residential sun exposure and breast cancer risk among white women: NHANES I Epidemiologic Follow-up Study, 1971–1975 to 1992

	Breast cancer cases	Age-adjusted RR (95% CI)	Multivariate-adjusted RR (95% CI)^a
Region of residence^b
Northeast	51	1.0	1.0
Midwest	48	0.82 (0.55–1.22)	0.83 (0.56–1.23)
West	51	0.81 (0.55–1.20)	0.78 (0.53–1.16)
South	40	0.66 (0.44–1.00)	0.71 (0.47–1.09)
P for trend		P = 0.06	P = 0.11
Solar radiation at longest residence^c
Low	83	1.0	1.0
Medium	67	1.13 (0.82–1.56)	1.17 (0.85–1.62)
High	38	0.70 (0.48–1.03)	0.73 (0.50–1.08)
P for trend		P = 0.13	P = 0.19
Solar radiation at place of birth
Low	79	1.0	1.0
Medium	64	0.97 (0.69–1.34)	0.99 (0.72–1.39)
High	35	0.69 (0.46–1.02)	0.73 (0.49–1.09)
P for trend		P = 0.08	P = 0.16

^a Adjusted for age, education, age at menarche, age at menopause, body mass index, frequency of alcohol consumption, and physical activity.
^b Northeast: Maine, Vermont, New Hampshire, Massachusetts, Connecticut, Rhode Island, New York, New Jersey, and Pennsylvania; Midwest: Ohio, Illinois, Indiana, Michigan, Wisconsin, Minnesota, Iowa, and Missouri; West: Washington, Oregon, California, Nevada, New Mexico, Arizona, Texas, Oklahoma, Kansas, Nebraska, North Dakota, South Dakota, Idaho, Utah, Colorado, Montana, and Wyoming; South: Delaware, Maryland, District of Columbia, West Virginia, Virginia, Kentucky, Tennessee, North Carolina, South Carolina, Georgia, Florida, Alabama, Mississippi, Louisiana, and Arkansas.
^c Low: Maine, Vermont, New Hampshire, Massachusetts, Connecticut, Rhode Island, New York, Pennsylvania, Ohio, Michigan, Minnesota, and Washington; Medium: New Jersey, Delaware, Maryland, District of Columbia, West Virginia, Virginia, North Carolina, South Carolina, Indiana, Kentucky, Tennessee, Wisconsin, Illinois, Iowa, Missouri, North Dakota, South Dakota, Montana, Oregon; High: Georgia, Florida, Alabama, Mississippi, Arkansas, Louisiana, Nebraska, Kansas, Oklahoma, Texas, Wyoming, Colorado, New Mexico, Idaho, Utah, Arizona, Nevada, and California.

Table 3

Sunlight exposure and dietary vitamin D and breast cancer risk among white women, by region of residence: NHANES I Epidemiologic Follow-up Study, 1971–1975 to 1992

	Low solar radiation^a			Medium solar radiation^a			High solar radiation^a
		Breast cancer cases	Multivariate-adjusted RR (95% CI)^b	Breast cancer cases	Multivariate adjusted RR (95% CI)^b	Breast cancer cases	Multivariate-adjusted RR (95% CI)^b
Sun exposure determined by physician
Unimpressive	38	1.0	37	1.0	18	1.0
Moderate/considerable	45	1.20 (0.77–1.86)	30	0.71 (0.44–1.15)	19	0.58 (0.30–0.11)
Actinic skin damage
None	49	1.0	41	1.0	23	1.0
Minimal	23	1.07 (0.64–1.78)	19	0.98 (0.54–1.77)	9	0.77 (0.34–1.73)
Moderate/severe	11	1.18 (0.59–2.36)	7	0.77 (0.33–1.79)	6	0.69 (0.27–1.78)
Dietary vitamin D (IU)
<100	36	1.0	31	1.0	17	1.0
100–199	18	0.97 (0.55–1.71)	21	1.15 (0.66–2.01)	12	1.20 (0.57–2.53)
≥200	20	0.92 (0.53–1.59)	13	0.91 (0.47–1.75)	7	0.75 (0.31–1.84)
Combined recreational and occupational sun exposure
Low	15	1.0	9	1.0	8	1.0
Medium	44	0.53 (0.29–0.97)	34	0.83 (0.39–1.76)	19	0.54 (0.23–1.25)
High	9	0.40 (0.17–0.94)	10	0.77 (0.31–1.93)	4	0.35 (0.10–1.20)
MD sun exposure and dietary vitamin D^c
Low sun and <200 IU	25	1.0	31	1.0	14	1.0
High sun and ≥200 IU	10	1.13 (0.53–2.43)	9	0.84 (0.40–1.77)	3	0.36 (0.10–1.31)

^a Level of solar radiation in state of longest residence.
^b Adjusted for age, education, age at menarche, age at menopause, body mass index, frequency of alcohol consumption, and physical activity.

Table 4

Dietary and supplemental intake of vitamin D and breast cancer risk among white women: NHANES I Epidemiologic Follow-up Study, 1971–1975 to 1992

	Breast cancer cases	Age-adjusted RR (95% CI)	Multivariate-adjusted RR (95% CI)^a
Dietary vitamin D
<100 IU	86	1.0	1.0
100–199 IU	51	1.03 (0.73–1.45)	1.05 (0.74–1.49)
≥200 IU	40	0.84 (0.58–1.23)	0.85 (0.59–1.24)
P for trend		P = 0.43	P = 0.48
Supplement use (multivitamins or single vitamin D)
Never	133	1.0	1.0
Weekly	13	0.94 (0.53–1.65)	0.89 (0.50–1.58)
Daily	31	0.93 (0.63–1.38)	0.89 (0.60–1.32)
P for trend		P = 0.69	P = 0.52
Vitamin D from food or supplements
<100 IU without daily supplements	73	1.0	1.0
100–199 IU without daily supplements	41	0.98 (0.67–1.44)	1.01 (0.69–1.49)
≥200 IU or daily supplements	63	0.87 (0.62–1.21)	0.86 (0.61–1.20)
P for trend		P = 0.40	P = 0.37

^a Adjusted for age, education, age at menarche, age at menopause, body mass index, frequency of alcohol consumption, physical activity, and calcium intake.

Table 5

Vitamin D from sunlight exposure and diet and breast cancer risk among white women: NHANES I Epidemiologic Follow-up Study, 1971–1975 to 1992

	Breast cancer cases	Age-adjusted RR (95% CI)	Multivariate- adjusted RR (95% CI)^a
Sun exposure and dietary vitamin D^b
Low sun and <200 IU	71	1.0	1.0
Low sun and ≥200 IU	18	0.79 (0.57–1.11)	0.75 (0.54–1.06)
High sun and <200 IU	65	0.78 (0.46–1.31)	0.77 (0.46–1.29)
High sun and ≥200 IU	22	0.72 (0.45–1.17)	0.71 (0.44–1.14)
P for trend		P = 0.11	P = 0.08

^a Adjusted for age, education, age at menarche, age at menopause, body mass index, frequency of alcohol consumption, physical activity, and calcium intake.
^b Low sun, unimpressive sun exposure, as determined by the physician; high sun, moderate or considerable sun exposure, as determined by the physician.