Vitamin D and Endometrial Cancer

8 min
Mar 5, 2024 12:00:00 AM

Endometrial cancer

Endometrial cancer is cancer that starts in the endometrium, the lining of the uterus (womb). Each year, endometrial cancer affects approximately 46,000 U.S. women and kills about 8000.

Risk factors

Risk factors for endometrial cancer include:

  • Diet high in animal products: Eating a lot of meat, especially early in life, causes the body to produce a growth factor. Growth factors help the body grow. They also help tumors grow. Dairy products contain estrogen, a hormone that increases growth factor.
  • Alcohol consumption: There is a link between alcohol and endometrial cancer.
  • Obesity: Obesity is associated with a risk of this cancer.
  • Hormone replacement therapy and estrogen: Either oral or body-produced estrogen increases the risk of this cancer.
  • Environmental chemicals: Pesticides and air pollution have a direct effect on the risk of endometrial cancer.
  • Smoking: Smoking is associated with a risk of this cancer.

The risk of endometrial cancer is lowered by:

  • Diets high in vegetable products such as fruits, vegetables, grains, and beans
  • Oral contraceptive use, which lowers estrogen levels.
  • Physical activity

Sunlight exposure and endometrial cancer risk

Endometrial cancer is one of the top 19 cancers that are sensitive to vitamin D:
  • Ultraviolet B (UVB) light may lower the death rates of women with endometrial cancer. This is also true of many other types of cancers.
  • In one Swedish study, women exposed to more UVB (while sunbathing or indoor tanning) had a 20% to 40% lower risk of endometrial cancer.

Vitamin D and endometrial cancer

Vitamin D levels

There have been several studies on vitamin D and endometrial cancer:

  • In a U.S. study, women with this cancer were four times more likely to have low vitamin D levels.
  • Other studies compared the effects of vitamin D and the rates of breast, colon, and rectal cancers. As vitamin D levels increased from low to high values, cancer rates decreased considerably.
  • Comparable findings have been reported for endometrial cancer, which may respond in a similar manner to vitamin D.

How vitamin D works

Vitamin D has been shown to block the growth of cancer tumors. The active form of vitamin D, calcitriol, provides numerous benefits against cancer. This form of vitamin D encourages cells to either adapt to their organ or commit apoptosis (cell suicide). Calcitriol also limits blood supply to the tumor and reduces the spread of cancer.

Prevention

High levels of vitamin D are associated with a lower risk of endometrial cancer. Studies compared cancer risk in people with high (40–60 ng/mL [100–150 nmol/L]) and low (20 ng/mL [50 nmol/L]) vitamin D levels. The risk of breast, colon, and rectal cancer was reduced by 15% to 25% in women with high vitamin D levels. High levels may also lower the risk of endometrial cancer. High vitamin D levels may increase survival after cancer diagnosis. Taking 1000–4000 international units (IU) (25–100 mcg)/day of vitamin D is generally required to reach blood levels of 40–60 ng/mL (100–150 nmol/L).

Vitamin D and calcium

Taking both vitamin D and calcium provides additional protection against many types of cancer. This may include endometrial cancer. In one study, vitamin D and calcium acted independently to reduce the risk of endometrial cancer. Calcium intake of more than 1000 mg/day is recommended. This intake can be from either diet or supplements.

Treatment

There are no reported studies using vitamin D to treat endometrial cancer. However, based on higher vitamin D levels and increased cancer survival rates, vitamin D may be beneficial for those with endometrial cancer. Those with endometrial cancer might consider taking 5000 IU (125 mcg)/day of vitamin D3 (cholecalciferol) to raise blood vitamin D levels to more than 40 ng/mL (100 nmol/L).

Acknowledgements

This evidence summary was written by:

William B. Grant, Ph.D.
Sunlight, Nutrition, and Health Research Center (SUNARC)
P.O. Box 641603
San Francisco,
CA 94164-1603,
USA
www.sunarc.org
wbgrant@infionline.net

References

  1. Barbone, F. Austin, H. Partridge, E. E. Diet and endometrial cancer: a case-control study. Am J Epidemiol. 1993 Feb 15; 137 (4): 393-403.
  2. Boscoe, F. P. Schymura, M. J. Solar ultraviolet-B exposure and cancer incidence and mortality in the United States, 1993-2002. BMC Cancer. 2006; 6264.
  3. Chen, W. Clements, M. Rahman, B. Zhang, S. Qiao, Y. Armstrong, B. K. Relationship between cancer mortality/incidence and ambient ultraviolet B irradiance in China. Cancer Causes Control. 2010 Jun 16;
  4. Devesa, S. S. Grauman, D. J. Blot, W. J. Pennello, G. A. Hoover, R. N. Fraumeni, J. F. Jr. Atlas of Cancer Mortality in the United States, 1950-1994. NIH Publication No. 99-4564. 1999 April 17, 2010;
  5. Epstein, E. Lindqvist, P. G. Geppert, B. Olsson, H. A population-based cohort study on sun habits and endometrial cancer. Br J Cancer. 2009 Aug 4; 101 (3): 537-40.
  6. Fujioka T, Hasegawa M, Ishikura K, Matsushita Y, Sato M, Tanji S. Inhibition of tumor growth and angiogenesis by vitamin D3 agents in murine renal cell carcinoma. J Urol. 1998 Jul; 160 (1): 247-51.
  7. Garland, C. F. Gorham, E. D. Mohr, S. B. Garland, F. C. Vitamin D for cancer prevention: global perspective. Ann Epidemiol. 2009 Jul; 19 (7): 468-83.
  8. Goodman, M. T. Wu, A. H. Tung, K. H. McDuffie, K. Kolonel, L. N. Nomura, A. M. Terada, K. Wilkens, L. R. Murphy, S. Hankin, J. H. Association of dairy products, lactose, and calcium with the risk of ovarian cancer. Am J Epidemiol. 2002 Jul 15; 156 (2): 148-57.
  9. Goodwin, P. J. Ennis, M. Pritchard, K. I. Koo, J. Hood, N. Frequency of vitamin D (Vit D) deficiency at breast cancer (BC) diagnosis and association with risk of distant recurrence and death in a prospective cohort study of T1-3, N0-1, M0 BC. J Clin Oncol. 2008; 26 (May 20 suppl): abstr 511.
  10. Grant, W. B. An estimate of premature cancer mortality in the U.S. due to inadequate doses of solar ultraviolet-B radiation. Cancer. 2002 Mar 15; 94 (6): 1867-75.
  11. Grant, W. B. Ecologic studies of solar UV-B radiation and cancer mortality rates. Recent Results Cancer Res. 2003; 164371-7.
  12. Grant, W. B. The likely role of vitamin D from solar ultraviolet-B irradiance in increasing cancer survival. Anticancer Res. 2006 Jul-Aug; 26 (4A): 2605-14.
  13. Grant, W. B. An ecologic study of cancer mortality rates in Spain with respect to indices of solar UVB irradiance and smoking. Int J Cancer. 2007 Mar 1; 120 (5): 1123-8.
  14. Grant, W. B. An ecological study of cancer mortality rates including indices for dietary iron and zinc. Anticancer Res. 2008 May-Jun; 28 (3B): 1955-63.
  15. Grant, W. B. A critical review of Vitamin D and cancer: A report of the IARC Working Group on vitamin D. Dermato-endocrinology. 2009; 1 (1): 25-33.
  16. Grant, W. B. How strong is the evidence that solar ultraviolet B and vitamin D reduce the risk of cancer?: An examination using Hill’s criteria for causality. Dermatoendocrinol. 2009 Jan; 1 (1): 17-24.
  17. Grant, W. B. Air pollution in relation to U.S. cancer mortality rates: an ecological study; likely role of carbonaceous aerosols and polycyclic aromatic hydrocarbons. Anticancer Res. 2009 Sep; 29 (9): 3537-45.
  18. Grant, W. B. Good evidence exists that solar ultraviolet-B and vitamin D reduce the risk of ovarian cancer. Am J Obstet Gynecol. 2010 Jun 2;
  19. Grant, W. B. Garland, C. F. The association of solar ultraviolet B (UVB) with reducing risk of cancer: multifactorial ecologic analysis of geographic variation in age-adjusted cancer mortality rates. Anticancer Res. 2006 Jul-Aug; 26 (4A): 2687-99.
  20. Grant, W. B. An ecological study of cancer incidence and mortality rates in France with respect to latitude, an index for vitamin D production. Deramato-Endocrinology. 2010 April/May/June; 2 (2):
  21. Grant, W. B. Effect of interval between serum draw and follow-up period on relative risk of cancer incidence with respect to 25-hydroxyvitamin D level; implications for meta-analyses and setting vitamin D guidelines. Dermato-endocrinology. 2011; 3 (3):
  22. Helzlsouer, K. J. Overview of the Cohort Consortium Vitamin D Pooling Project of Rarer Cancers. Am J Epidemiol. 2010 Jul 1; 172 (1): 4-9.
  23. Hofmann, J. N. Yu, K. Horst, R. L. Hayes, R. B. Purdue, M. P. Long-term variation in serum 25-hydroxyvitamin D concentration among participants in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. Cancer Epidemiol Biomarkers Prev. 2010 Apr; 19 (4): 927-31.
  24. Ingraham, B. A. Bragdon, B. Nohe, A. Molecular basis of the potential of vitamin D to prevent cancer. Curr Med Res Opin. 2008 Jan; 24 (1): 139-49.
  25. Jorde, R. Sneve, M. Hutchinson, M. Emaus, N. Figenschau, Y. Grimnes, G. Tracking of serum 25-hydroxyvitamin D levels during 14 years in a population-based study and during 12 months in an intervention study. Am J Epidemiol. 2010 Apr 15; 171 (8): 903-8.
  26. Krishnan, A. V. Trump, D. L. Johnson, C. S. Feldman, D. The role of vitamin D in cancer prevention and treatment. Endocrinol Metab Clin North Am. 2010 Jun; 39 (2): 401-18, table of contents.
  27. Lappe, J. M. Travers-Gustafson, D. Davies, K. M. Recker, R. R. Heaney, R. P. Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial. Am J Clin Nutr. 2007 Jun; 85 (6): 1586-91.
  28. Lim, U. Freedman, D. M. Hollis, B. W. Horst, R. L. Purdue, M. P. Chatterjee, N. Weinstein, S. J. Morton, L. M. Schatzkin, A. Virtamo, J. Linet, M. S. Hartge, P. Albanes, D. A prospective investigation of serum 25-hydroxyvitamin D and risk of lymphoid cancers. Int J Cancer. 2009 Feb 15; 124 (4): 979-86.
  29. Leffell, D. J. Brash, D. E. Sunlight and skin cancer. Sci Am. 1996 Jul; 275 (1): 52-3, 56-9.
  30. Maia, H. J. Casoy, J. Non-contraceptive health benefits of oral contraceptives. Eur J Contracept Reprod Health Care. 2008 Mar; 13 (1): 17-24.
  31. McCullough, M. L. Bandera, E. V. Moore, D. F. Kushi, L. H. Vitamin D and calcium intake in relation to risk of endometrial cancer: a systematic review of the literature. Prev Med. 2008 Apr; 46 (4): 298-302.
  32. Negri, E. La Vecchia, C. Franceschi, S. Levi, F. Parazzini, F. Intake of selected micronutrients and the risk of endometrial carcinoma. Cancer. 1996 Mar 1; 77 (5): 917-23.
  33. Mohr, S. B. Garland, C. F. Gorham, E. D. Grant, W. B. Garland, F. C. Is ultraviolet B irradiance inversely associated with incidence rates of endometrial cancer: an ecological study of 107 countries. Prev Med. 2007 Nov; 45 (5): 327-31.
  34. Ng, K. Wolpin, B. M. Meyerhardt, J. A. Wu, K. Chan, A. T. Hollis, B. W. Giovannucci, E. L. Stampfer, M. J. Willett, W. C. Fuchs, C. S. Prospective study of predictors of vitamin D status and survival in patients with colorectal cancer. Br J Cancer. 2009 Sep 15; 101 (6): 916-23.
  35. Peterlik, M. Grant, W. B. Cross, H. S. Calcium, vitamin D and cancer. Anticancer Res. 2009 Sep; 29 (9): 3687-98.
  36. Rice, L. W. Hormone prevention strategies for breast, endometrial and ovarian cancers. Gynecol Oncol. 2010 Aug 1; 118 (2): 202-7.
  37. Salazar-Martinez, E. Lazcano-Ponce, E. Sanchez-Zamorano, L. M. Gonzalez-Lira, G. Escudero, D. E. Los Rios P. Hernandez-Avila, M. Dietary factors and endometrial cancer risk. Results of a case-control study in Mexico. Int J Gynecol Cancer. 2005 Sep-Oct; 15 (5): 938-45.
  38. Schwartz, G. G. Porta, M. Vitamin D, ecologic studies and endometrial cancer. Prev Med. 2007 Nov; 45 (5): 323-4.
  39. Tuohimaa, P. Pukkala, E. Scelo, G. Olsen, J. H. Brewster, D. H. Hemminki, K. Tracey, E. Weiderpass, E. Kliewer, E. V. Pompe-Kirn, V. McBride, M. L. Martos, C. Chia, K. S. Tonita, J. M. Jonasson, J. G. Boffetta, P. Brennan, P. Does solar exposure, as indicated by the non-melanoma skin cancers, protect from solid cancers: vitamin D as a possible explanation. Eur J Cancer. 2007 Jul; 43 (11): 1701-12.
  40. Zeleniuch-Jacquotte, A. Gallicchio, L. Hartmuller, V. Helzlsouer, K. J. McCullough, M. L. Setiawan, V. W. Shu, X. O. Weinstein, S. J. Weiss, J. M. Arslan, A. A. De Vivo, I. Gao, Y. T. Hayes, R. B. Henderson, B. E. Horst, R. L. Koenig, K. L. Patel, A. V. Purdue, M. P. Snyder, K. Steplowski, E. Yu, K. Zheng, W. Hankinson, S. E. Circulating 25-hydroxyvitamin D and risk of endometrial cancer: Cohort Consortium Vitamin D Pooling Project of Rarer Cancers. Am J Epidemiol. 2010 Jul 1; 172 (1): 36-46.
Topics: vitamin d vitamin