Lung cancer
Lung cancer is a cancer starting in the lungs. Lung cancer is the leading cause of cancer death in the United States. Annually, it affects approximately 220,000 and kills about 157,000.
Risk factors
The primary risk factor for lung cancer is:
- Smoking.
Other risk factors include:
- Air pollution (coal-fired power plants, diesel-fueled vehicles, wood fires, industrial chemicals, and smoke)
- Indoor cooking fires (especially in China)
- Asbestos fibers (industrial sites such as shipbuilding and manufacturers of brake linings)
- Radon (radioactive element that escapes from the ground into homes)
- Dietary fat may be a risk factor.
The risk of lung cancer may be lowered by calcium. This mineral can be added by diet (green leafy vegetables or milk) or supplements.
Sunlight exposure and lung cancer risk
According to studies, an increase in solar ultraviolet-B (UVB) light lowers the rate of lung cancer and resultant deaths:
- Three studies found a lower risk of lung cancer in those living at higher elevations. UVB light is stronger at higher altitudes.
- Farmers have a much lower incidence of lung cancer and less resultant deaths than the general population. Farmers work outside and get a lot of UVB light.
- Geographical studies of populations often found those living in regions with higher solar UVB levels had lower rates of lung cancer.
Vitamin D and lung cancer
Vitamin D levels
There are no reported studies researching a possible link between vitamin D levels and the incidence of lung cancer. Two studies in Europe found higher 1- to 2-year survival rates for those diagnosed with lung cancer in the summer compared to diagnosis in winter. Higher vitamin D levels in the summer may account for this finding. This is also true for several other types of cancer.
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
Based studies of breast and colorectal cancer and some evidence regarding lung cancer, it appears that lifetime vitamin D levels above 40 ng/mL (100 nmol/L) may reduce the risk lung cancer.
Vitamin D and calcium
Obtaining vitamin D from sunlight and/or supplements and increasing calcium intake may reduce the risk of lung cancer.
Treatment
A number of studies have connected lung cancer survival rates with vitamin D blood levels, seasons, and vitamin D plus calcium intake. These studies strongly suggest that vitamin D can play an important role in improving prognosis of those diagnosed with lung cancer. However, more studies are required to confirm these findings. People with early stage non-small cell lung cancer and high vitamin D levels had better survival outcomes. However, no effect of higher vitamin D levels was seen for people with advanced non-small cell lung cancer.
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
[email protected]
Complete bibliography of research used in this summary
The research we have cited in our summary is listed below, with links to PubMed abstracts and full-text for those who wish to explore further.
References
- Alavanja, M. C. Field, R. W. Sinha, R. Brus, C. P. Shavers, V. L. Fisher, E. L. Curtain, J. Lynch, C. F. Lung cancer risk and red meat consumption among Iowa women. Lung Cancer. 2001 Oct; 34 (1): 37-46.
- Amsel, J. Waterbor, J. W. Oler, J. Rosenwaike, I. Marshall, K. Relationship of site-specific cancer mortality rates to altitude. Carcinogenesis. 1982; 3 (5): 461-5.
- Bidoli, E. Franceschi, S. Dal Maso, L. Guarneri, S. Barbone, F. Cancer mortality by urbanization and altitude in a limited area in Northeastern Italy. Rev Epidemiol Sante Publique. 1993; 41 (5): 374-82.
- Blair, a et al. Cancer risk among Danish and Italian farmers. A review. Scand J Work Environ Health. 1985 Dec; 11 (6): 397-407.
- Brot, C. Jorgensen, N. R. Sorensen, O. H. The influence of smoking on vitamin D status and calcium metabolism. Eur J Clin Nutr. 1999 Dec; 53 (12): 920-6.
- Brownson, R. C. Reif, J. S. Chang, J. C. Davis, J. R. Cancer risks among Missouri farmers. Cancer. 1989 Dec 1; 64 (11): 2381-6.
- Buchner, F. L. Bueno-de-Mesquita, H. B. Ros, M. M. Overvad, K. Dahm, C. C. Hansen, et al. Variety in fruit and vegetable consumption and the risk of lung cancer in the European prospective investigation into cancer and nutrition. Cancer Epidemiol Biomarkers Prev. 2010 Sep; 19 (9): 2278-86.
- 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;
- Chishimba, L. Thickett, D. R. Stockley, R. A. Wood, A. M. The vitamin D axis in the lung: a key role for vitamin D-binding protein. Thorax. 2010 May; 65 (5): 456-62.
- Darby, S. Whitley, E. Doll, R. Key, T. Silcocks, P. Diet, smoking and lung cancer: a case-control study of 1000 cases and 1500 controls in South-West England. Br J Cancer. 2001 Mar 2; 84 (5): 728-35.
- De Stefani, E. Brennan, P. Boffetta, P. Mendilaharsu, M. Deneo-Pellegrini, H. Ronco, A. Olivera, L. Kasdorf, H. Diet and adenocarcinoma of the lung: a case-control study in Uruguay. Lung Cancer. 2002 Jan; 35 (1): 43-51.
- 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;
- 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.
- Giovannucci, E. Liu, Y. Rimm, E. B. Hollis, B. W. Fuchs, C. S. Stampfer, M. J. Willett, W. C. Prospective study of predictors of vitamin D status and cancer incidence and mortality in men. J Natl Cancer Inst. 2006 Apr 5; 98 (7): 451-9.
- 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; 94 (6): 1867-75.
- Grant, W. B. Lower vitamin-D production from solar ultraviolet-B irradiance may explain some differences in cancer survival rates. J Natl Med Assoc. 2006 Mar; 98 (3): 357-64.
- 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.
- Grant, W. B. Does solar ultraviolet irradiation affect cancer mortality rates in China?. Asian Pac J Cancer Prev. 2007 Apr-Jun; 8 (2): 236-42.
- 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.
- Grant, W. B. Benefits of vitamin D in reducing the risk of cancer: Time to include vitamin D in cancer treatment?. J Soc Integr Oncol. 2010 Summer; 8 (3): 81-8.
- Grant, W. B. Relation between prediagnostic serum 25-hydroxyvitamin D level and incidence of breast, colorectal, and other cancers. J Photochem Photobiol B. 2010 May 12;
- 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):
- Hajjar, I. Kotchen, T. Regional variations of blood pressure in the United States are associated with regional variations in dietary intakes: the NHANES-III data. The Journal of nutrition. 2003 Jan; 133 (1): 211-4.
- Heist, R. S. Zhou, W. Wang, Z. Liu, G. Neuberg, D. Su, L. Asomaning, K. Hollis, B. W. Lynch, T. J. Wain, J. C. Giovannucci, E. Christiani, D. C. Circulating 25-Hydroxyvitamin D, VDR Polymorphisms, and Survival in Advanced Non-Small-Cell Lung Cancer. J Clin Oncol. 2008 Oct 20;
- 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.
- Hosgood, H. D., 3rd Chapman, R. Shen, M. Blair, A. Chen, E. Zheng, T. Lee, K. M. He, X. Lan, Q. Portable stove use is associated with lower lung cancer mortality risk in lifetime smoky coal users. Br J Cancer. 2008 Dec 2; 99 (11): 1934-9.
- 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.
- Jemal, A. Center, M. M. DeSantis, C. Ward, E. M. Global patterns of cancer incidence and mortality rates and trends. Cancer Epidemiol Biomarkers Prev. 2010 Aug; 19 (8): 1893-907.
- Jemal, A. Siegel, R. Xu, J. Ward, E. Cancer statistics, 2010. CA Cancer J Clin. 2010 Sep-Oct; 60 (5): 277-300.
- Jorde, R. Saleh, F. Figenschau, Y. Kamycheva, E. Haug, E. Sundsfjord, J. Serum parathyroid hormone (PTH) levels in smokers and non-smokers. The fifth Tromsø study. Eur J Endocrinol. 2005 Jan.; 52 (1): 39-45.
- 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.
- Lim, H. S. Roychoudhuri, R. Peto, J. Schwartz, G. Baade, P. Moller, H. Cancer survival is dependent on season of diagnosis and sunlight exposure. Int J Cancer. 2006; 1191530-36.
- 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.
- Mahabir, S. Forman, M. R. Dong, Y. Q. Park, Y. Hollenbeck, A. Schatzkin, A. Mineral intake and lung cancer risk in the NIH-American Association of Retired Persons Diet and Health study. Cancer Epidemiol Biomarkers Prev. 2010 Aug; 19 (8): 1976-83.
- Mohr, S. B. Garland, C. F. Gorham, E. D. Grant, W. B. Garland, F. C. Could ultraviolet B irradiance and vitamin D be associated with lower incidence rates of lung cancer?. J Epidemiol Community Health. 2008 Jan; 62 (1): 69-74.
- Nakagawa, K. Kawaura, A. Kato, S. Takeda, E. Okano, T. 1 alpha,25-Dihydroxyvitamin D(3) is a preventive factor in the metastasis of lung cancer. Carcinogenesis. 2005 Feb; 26 (2): 429-40.
- Peterlik, M. Grant, W. B. Cross, H. S. Calcium, vitamin D and cancer. Anticancer Res. 2009 Sep; 29 (9): 3687-98.
- Peto, R. Darby, S. Deo, H. Silcocks, P. Whitley, E. Doll, R. Smoking, smoking cessation, and lung cancer in the UK since 1950: combination of national statistics with two case-control studies. BMJ. 2000 Aug 5; 321 (7257): 323-9.
- Porojnicu, A. Robsahm, T. E. Berg, J. P. Moan, J. Season of diagnosis is a predictor of cancer survival. Sun-induced vitamin D may be involved: a possible role of sun-induced Vitamin D. J Steroid Biochem Mol Biol. 2007 Mar; 103 (3-5): 675-8.
- Porojnicu, A. C. Robsahm, T. E. Dahlback, A. Berg, J. P. Christiani, D. Bruland, O. S. Moan, J. Seasonal and geographical variations in lung cancer prognosis in Norway. Does Vitamin D from the sun play a role?. Lung Cancer. 2007 Mar; 55 (3): 263-70.
- Pukkala, E et al. Occupation and cancer – follow-up of 15 million people in five Nordic countries. Acta Oncol. 2009; 48 (5): 646-790.
- Rheem, D. S. Baylink, D. J. Olafsson, S. Jackson, C. S. Walter, M. H. Prevention of colorectal cancer with vitamin D. Scand J Gastroenterol. 2010 Aug; 45 (7-8): 775-84.
- Sato, T. Takusagawa, K. Asoo, N. Konno, K. Antitumor effect of 1 alpha-hydroxyvitamin D3. Tohoku J Exp Med. 1982 Dec; 138 (4): 445-6.
- Seidler, A. Hammer, G. P. Husmann, G. Konig, J. Krtschil, A. Schmidtmann, I. Blettner, M. Cancer risk among residents of Rhineland-Palatinate winegrowing communities: a cancer-registry based ecological study. J Occup Med Toxicol. 2008; 312.
- Srinivasan, M. Parwani, A. V. Hershberger, P. A. Lenzner, D. E. Weissfeld, J. L. Nuclear Vitamin D receptor expression is associated with improved survival in non-small cell lung cancer. J Steroid Biochem Mol Biol. 2010 Oct 16;
- Wang, G. Y. Lu, C. Q. Zhang, R. M. Hu, X. H. Luo, Z. W. The E-cadherin gene polymorphism 160C->A and cancer risk: A HuGE review and meta-analysis of 26 case-control studies. Am J Epidemiol. 2008 Jan 1; 167 (1): 7-14.
- Weinberg, C. R. Brown, K. G. Hoel, D. G. Altitude, radiation, and mortality from cancer and heart disease. Radiat Res. 1987 Nov; 112 (2): 381-90.
- Weinstein, S. J. Yu, K. Horst, R. L. Parisi, D. Virtamo, J. Albanes, D. Serum 25-hydroxyvitamin d and risk of lung cancer in male smokers: a nested case-control study. PLoS One. 2011; 6 (6): e20796.
- Zhou, W. Heist, R. S. Liu, G. Asomaning, K. Neuberg, D. S. Hollis, B. W. Wain, J. C. Lynch, T. J. Giovannucci, E. Su, L. Christiani, D. C. Circulating 25-hydroxyvitamin D levels predict survival in early-stage non-small-cell lung cancer patients. J Clin Oncol. 2007 Feb 10; 25 (5): 479-85.
- Zhou, W. Heist, R. S. Liu, G. Neuberg, D. S. Asomaning, K. Su, L. Wain, J. C. Lynch, T. J. Giovannucci, E. Christiani, D. C. Polymorphisms of vitamin D receptor and survival in early-stage non-small cell lung cancer patients. Cancer Epidemiol Biomarkers Prev. 2006 Nov; 15 (11): 2239-45.
- Zhou, W. Suk, R. Liu, G. Park, S. Neuberg, D. S. Wain, J. C. Lynch, T. J. Giovannucci, E. Christiani, D. C. Vitamin D is associated with improved survival in early-stage non-small cell lung cancer patients. Cancer Epidemiol Biomarkers Prev. 2005 Oct; 14 (10): 2303-9.
- Zhuravel, E. Efanova, O. Shestakova, T. Glushko, N. Mezhuev, O. Soldatkina, M. Pogrebnoy, P. Administration of vitamin D3 improves antimetastatic efficacy of cancer vaccine therapy of Lewis lung carcinoma. Exp Oncol. 2010 Mar; 32 (1): 33-9.