Abstract
Introduction: Vitamin D deficiency can be critical and is reported to be as one of the factors for development and progression of breast carcinoma.
 Aims & Objectives: To measure and compare 25(OH)D (calcidiol) levels in healthy females and in breast carcinoma patients in four different stages. Place and 
 duration of study: This cross sectional study and research was conducted in Shaikh Zayed Medical Complex in the Department of Biochemistry and Chemical Pathology from Jan 2018 to Jan 2019. The patients were selected from INMOL Cancer Hospital, Lahore.
 Material & Methods: The study was carried out on 39 healthy females (controls) and 156 newly diagnosed cases of carcinoma breast from stage I to IV, 39 patients of each stage. 25(OH)D was determined in blood samples of patients by ADVIA Centaur (XP) immunoassay system.
 Results: In this study the mean 25(OH)D level of healthy females with mean age of 41.7 ± 15.8 years, was 25.1 ± 5.5ng/ml. 25(OH) D level of breast cancer patients was found to be decreasing with stage progression. For the stage I the average 25(OH)D level was 12.31ng/ml, stage II was 9 ng/ml, stage III was 8.3 ng/ml and stage IV was 8.4 ng/ml.
 Conclusion: It was found that healthy group of females had higher values of serum vitamin D levels as compared to breast carcinoma patients. Low concentration of serum vitamin D may contribute to the progression of stage of breast carcinoma.
Highlights
Vitamin D deficiency can be critical and is reported to be as one of the factors for development and progression of breast carcinoma
25.1±5.5ng/ml, with disease at stage I was 12.3±2.3 ng/ml, at stage II was 9.0±1.0 ng/ml, at stage III was 8.3±1.6 ng/ml and at stage IV was 8.4±2.0. ng/ml According to Kruskal Wallis ANOVA, statistically significant difference was observed between vitamin D level of respondents among healthy female group and four stages of disease. i.e p value =
According to a case control study an inverse relationship existed between breast carcinoma and serum vitamin D level that was taken after breast cancer diagnosis but different results were obtained in a prospective study where measurements were taken long before diagnosis.[29]
Summary
Vitamin D deficiency can be critical and is reported to be as one of the factors for development and progression of breast carcinoma. Breast carcinoma are classified on cell origin (ductal or lobular carcinoma) and cell appearance (well, moderately and poorly differentiated).[22] American Joint Committee on Cancer (AJCC) staging system has designated staging by TNM Classification into four stages of breast cancer.[23] Major risk factor of breast carcinoma is the family history in 1st degree relative.[24] Recurrence and survival rates depend upon the number of lymph nodes involved.[25] Modifiable risk factors of breast cancer are BMI, physical activity, breast feeding, dietary fat, alcohol and smoking.[26] In addition to the lymph node status, size and histological grade of tumor, lymphatic / vascular invasion and response to neoadjuvant therapy are necessary for determining the prognosis and recurrence of the disease.[27] Treatment of breast cancer involves surgery, chemotherapy, radiotherapy, hormone blocking agents and biological agents (monoclonal antibodies) depending on which stage of the cancer is to be treated.[28] some studies have been done where stages of breast cancer were compared with serum vitamin D levels but there is no evidence regarding relationship of stages and lymph node involvement in carcinoma breast with vitamin D levels.[6,29] If a relationship between lower serum level of vitamin D and progression of breast cancer is found, it might be helpful to reduce morbidity and improve prognosis in a newly diagnosed cases of breast cancer by prescribing vitamin D along with other treatments. Vitamin D intake and sunlight exposure maybe one of the modifiable risk factor for breast cancer progression.[30]
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