October is breast cancer awareness month. By this point in time all of us are fully aware of the impact of breast cancer upon our families and our society. The American Cancer Society has estimated that in 2009, there will be over 192,000 new cases of invasive breast cancer diagnosed and 62,000 new cases of DCIS (localized breast cancer), with 40,000 women dying of breast cancer.
I am looking forward to the day when October is renamed "Breast Cancer Prevention Month". Integrative medicine doctors have an increasing toolbox of tests and natural treatments in our armamentarium that can reduce the risk of breast cancer or the recurrence of breast cancer, and I see new patients every week who want this extra help.
Prevention is the hallmark of the approach to breast cancer. Even with a woman who has been diagnosed with breast cancer, once she has completed her treatment of surgery, chemotherapy and/or radiation, she is back in breast cancer prevention mode. At that point, she is trying to prevent a recurrence of her breast cancer.
In the integrative medicine doctors' toolbox there are many approaches to help prevent breast cancer. These range from correcting estrogen dominance imbalances to detoxification of environmental estrogens from her body, using the techniques of naturopathic medicine.
At the present time, there is no integrative medicine modality for the treatment and prevention of breast cancer, with more data and research than vitamin D. There is so much information showing that this vitamin, which is really not a vitamin but a hormone, in sufficient daily doses can help protect against breast cancer.
Because for the last year I have been focusing my work in integrative medicine through the lens of vitamin D, I would like to review in this article several of the studies showing the importance of sufficient vitamin D to protect against breast cancer.
The Lappe Prospective study of Vitamin D and cancer prevention
In this study, Joan Lappe PhD, RN and colleagues looked prospectively at more than 400 postmenopausal women over a four-year period of time. In one group the women were given 1100 IU of vitamin D and 1000 mg of calcium daily. The control group did not receive this. The results of the study were that the women who took the vitamin D and calcium over the ensuing four years reduced their rate of cancer by an amazing 60%. In fact the authors looked in more detail and found that for every 10 ng/ml increase in a woman's vitamin D blood level, the relative risk of cancer dropped by 35%. These data were not limited to breast cancer but included all cancers.
In this study originally presented in 2008, Pamela Goodwin, M.D. and colleagues, retrospectively looked at more than 500 women over a period of 11 years. What she and her colleagues found was that those women who had been deficient in vitamin D at the time of their breast cancer diagnosis were 73% more likely to die from breast cancer than those with sufficient vitamin D at the time of diagnosis. In addition those that were deficient in vitamin D at the time of their diagnosis of breast cancer were almost twice as likely to have recurrence or spread over those years.
My wife and I had the pleasure to listen to an interview of one of the authors of this article. Much to our shock and chagrin the author pointed out that because the study was retrospective they would never recommend that a woman newly diagnosed with breast cancer take more than the minimum daily requirement (RDA) of vitamin D. They specifically said that they would never recommend additional vitamin D until more randomized placebo-controlled prospective studies were done. This will take an additional 5 to 10 years.
When I presented this information to my staff of mostly women they too were shocked that in light of the data the researcher was not recommending newly diagnosed breast cancer patients take additional vitamin D.
In my own practice of medicine, I have never had a newly diagnosed breast cancer patient who came to me for integrative medicine support of her breast cancer diagnosis, have a vitamin D level measured by her oncologist. What is wrong with this picture?
Epidemiological Study about breast cancer
In a major epidemiological study by Cedric Garland PhD and others, the researchers exhaustively reviewed the medical literature on the relationship between breast cancer and vitamin D levels. According to the analysis done in this article, if women kept their vitamin D blood levels at approximately 52 ng/ml, we could expect a 50% reduction in the risk of breast cancer.
In light of this study I endeavor to keep all of my patients who have a high risk for breast cancer or who have had breast cancer already above a blood level of 52 ng/ml.
So what should we do?
The gold standard for medical decision making is the randomized placebo-controlled double-blind prospective study. The study I presented above by Dr. Lappe is one of the few such prospective studies that have already been published using vitamin D. Of course more are on the way.
So the question arises should a woman raise her blood levels higher than the current national average, and will she be harmed by taking a dose of vitamin D that allows her to do this?
My position, and the position of many vitamin D researchers is that because vitamin D is so inexpensive and because the relative risk of overdose of vitamin D is very small, what is the harm in raising women's blood levels to protect against breast cancer? We would only be raising her level into what is now recognized in the medical literature to be optimal. In my opinion, given that vitamin D overdose does not begin until blood levels of 100 ng/ml and more probably 150 ng/ml, what is the harm in women taking doses of vitamin D high enough to get their blood levels up this high, as long as they monitor their blood on a regular basis to assure there is no overdose?
The data is so strong and every year getting stronger. Why don't we take action now? How many more women need to get breast cancer or die from it before we make a move?
As written about in The Structure of Scientific Revolutions, by Thomas Kuhn, it takes many years or even decades, for new findings in science and medicine to take hold in a way that the population as a whole can benefit. In many cases this is because of an unreasonable need for certainty.
Arthur Schopenhauer, the famous philosopher, said this best when he stated: "All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident."
I believe we are in transition between the second and the third stages of Schopenhauer's description in regards to vitamin D. Appropriate (higher) levels of vitamin D are being opposed but not violently so at this point in time. But just the same, these higher levels of vitamin D are still not yet encouraged by the majority of physicians.
Unfortunately I believe it will take another 5 to 10 years until the prospective studies are strong enough to convince the most conservative physicians of the benefits of this amazing vitamin, so that all Americans and all people of the world can benefit from what many of us see as a necessary dose of this very important vitamin.
But ask yourself if you need to wait that long?
I invite your comments and thoughts.
To your improving health!
Soram Khalsa, M.D., has practiced integrative medicine and been a member of the medical staff at Cedars Sinai Medical Center for over 30 years. He is a clinical professor of medicine at the Southwest College of Naturopathic Medicine and a member of the Naturopathic Medicine Advisory Council for the state of California.