Vitamin D has been identified as a weak protective factor for postmenopausal breast cancer (relative risk [RR]~0.9), while high breast density has been identified as a strong risk factor (RR~4–6). To test the hypothesis that there is an association between vitamin D intake, but not circulating vitamin D levels, and mammographic breast density among women in our study we conducted a cross-sectional study of 165 screening mammography patients at Nashville General Hospital’s Breast Health Center (NGH-BHC), a public facility serving medically indigent and underserved women. Dietary and total (dietary plus supplements) vitamin D, calcium intakes were estimated by the AAFQ and blood samples were analyzed for 25-Hydroxyvitamin D [25(OH)D3]. Average percent breast density for the left and right breasts combined was estimated from digitized films using an interactive-thresholding method available through Cumulus software. After statistical adjustment for age, race and body mass index, the results revealed there were significant trends of decreasing breast density with increasing vitamin D and calcium intake among premenopausal, but not among postmenopausal women. There was no association between serum vitamin D and breast density in pre- or postmenopausal women. Confirmation of our findings in larger studies may assist in clarifying the role of vitamin D in breast density.

SummaryA multi-institutional collaboration was forged to implement a study of the relationship between Vitamin D and breast density among medically underserved women. This effort resulted in techniques to measure vitamin D levels, breast density, and sunlight exposure. Outcomes from this collaboration may provide insight to researchers conducting similar investigations. KeywordsVitamin D; mammography; underinsured; methods; women's healthThe Vitamin D Behavior and Essence Study ("Got D'ViBE?") was funded by the U54 Meharry-Vanderbilt Alliance grant to examine the role between vitamin D levels and mammographic breast density for a medically underserved population. Mammographic density is an intermediate indicator of breast cancer risk. Percent breast density is associated with number of epithelial and nonepithelial breast cells. 1 Women with increased mammographic density are more likely than women with lower densities to develop ductal carcinomas in situ and proliferative lesions such as atypical hyperplasia and hyperplasia without atypia. 2 Both atypical hyperplasia and hyperplasia without atypia are related to increased breast cancer risk. Vitamin D has chemo-preventive properties that inhibit cellular proliferation such as breast density. [3][4][5] The results between breast density and vitamin D intake suggest vitamin D could reduce risk by influencing breast tissue morphology. [6][7] The association between vitamin D and mammographic density has been examined [8][9][10] showing an inverse [11][12][13] The "Got D'ViBE?" study is positioned to significantly determine the relationship between vitamin D deficiency, its causal factors, and increased breast density in African American women. Vitamin D has public health benefit by identifying high risk women for routine supplementation or vitamin D deficiency screening to insure adequate concentrations. These preventative efforts may avert premature deaths or breast cancer diagnosis in African American female populations, statistically having higher mortality from this disease. 18 This report describes how contributions from different disciplines and institutions were solicited and synthesized to define the research question, design the study, develop methods for data collection, and facilitate study implementation. These details may assist researchers in conducting similar investigations. Methods of collaborationThe pilot study's primary objective was to establish the feasibility of assembling a screening mammography cohort at Nashville General Hospital's-Breast Health Center (NGH-BHC), a public facility serving medically indigent and underserved populations to assess the relationship of vitamin D intake, obesity, and sun exposure on breast density and ultimately breast cancer risk. The long-term goal of this study is to generate non-invasive interventions using vitamin D intake as a modifiable risk factor to lower breast density and to decrease risk of breast cancer in minority women, a population more susceptible to later-stage, advanced breast cancer. Our pr...