Abstract
Background : Vitamin D deficiency has been associated with poor prognosis in breast cancer. A new molecular classification of breast cancer is being increasingly used that is based on expression of estrogen receptors, progesterone receptors and Her2/neu amplification and is found to correlate well with prognosis and outcome of disease. The present study was designed to determine serum vitamin D deficiency in these molecular subtypes of breast cancer. Methods: Estimation of serum vitamin D levels by chemiluminiscence was done in a cohort of 99 breast cancer patients and 25 age matched healthy controls. Breast cancer patients were further grouped into luminal A, luminal B, Her2/neu enriched and triple negative subtypes based on immunohistochemistry results. Non-parametric tests were performed to compare vitamin D levels in different groups. Results: 54.6%, 60%, 66.6% and 84.2% of patients with luminal A, luminal B, Her2/neu enriched and triple negative subtypes respectively were found to be vitamin D deficient (<20ng/mL) as compared to only 20% in healthy controls. More aggressive Her2/neu enriched and triple negative subtype patients had significantly lower serum vitamin D levels than the luminal subtypes of breast cancer. Conclusion: Vitamin D deficiency is more prevalent and significantly lower levels are found in more aggressive subtypes of breast cancer. Vitamin D supplementation must be considered in these forms of breast cancer to improve outcome.
Highlights
In addition to maintaining calcium and phosphate homeostasis, vitamin D has been proposed to have antiproliferative effects on various cancer subtypes
The mean serum vitamin D levels in all the groups of breast cancer patients was found to be significantly lower than the healthy controls with p value < 0.05 as shown in table 2 and figure 1
On subdividing the groups based on the levels of vitamin D, it was observed that luminal A type breast cancer patients had 54.6% (n=35) patients with deficient vitamin D, 32.8% (n=21) had insufficient serum vitamin D levels and only 12.5% (n=8) were having sufficient vitamin D levels
Summary
In addition to maintaining calcium and phosphate homeostasis, vitamin D has been proposed to have antiproliferative effects on various cancer subtypes. A microarray based molecular classification proposed by Perou and colleagues[7] and validated by others has become the most acceptable classification to determine prognosis. It classifies the breast cancer into luminal A, luminal B, Her2neu enriched and basal type/ triple negative breast cancer (TNBC) based on the tumor cells expression of estrogen receptor(ER), progesterone receptor (PR) or Her2/neu amplification. A new molecular classification of breast cancer is being increasingly used that is based on expression of estrogen receptors, progesterone receptors and Her2/neu amplification and is found to correlate well with prognosis and outcome of disease. The present study was designed to determine serum vitamin D deficiency in these molecular subtypes of breast cancer
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