A CALL FOR MORE VITAMIN D RESEARCH PDF

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2006;56;250-251CA Cancer J Clin A CALL FOR MORE VITAMIN D RESEARCH

This information is current as of November 24, 2006

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asymptomatic and their immune systems clear

the infection.

When it persists, though, HPV can cause

intraepithelial lesions in the cervix, vagina, or

vulva. Left untreated, some of these lesions can

progress to cancer.In 4 clinical trials involving nearly 21,000 women

and teenage girls, Gardasil was nearly 100% effec-

tive in preventing precancerous cervical, vagi-

nal, and vulvar lesions caused by HPV-16 and

HPV-18. No cervical lesions related to these

HPV types developed among the 8,487 women

in the vaccine group, compared with 53 cases

among the 8,460 women in the placebo group.

Similarly, no high-grade vaginal or vulvar lesions

developed in 8,641 vaccinated women compared

with 24 cases in 8,667 unvaccinated women.

Gardasil was 99% effective in preventing gen-

ital warts caused by HPV-6 and HPV-11, accord-

ing to Merck. There was just one case among

7,897 women vaccinated with Gardasil compared

with 91 cases in 7,899 unvaccinated women.

Approval of the vaccine does not mean women

can forget about Pap tests, experts stressed.

It is critical that girls and young women who

receive the vaccine continue to follow screening

guidelines, said Debbie Saslow, PhD, American

Cancer Society (ACS) Director of Breast and

Gynecologic Cancer.Thats because Gardasil only targets 4 HPV

types; there are as many as 40 strains of the virus

that can be sexually transmitted, and some of these

others can also cause cancer. About 30% of cer-

vical cancers will not be prevented by the vaccine.

Ideally, the vaccine should be given before

the onset of sexual activity and thus possible

exposure to HPV. Young women who are already

sexually active can still benefit, but the likely

benefit decreases: The likelihood of exposure to

at least one of the 4 HPV types in the vaccine is

high within the first 2 years of onset of sexual

activity. However, very few women will have

been exposed to all four of the HPV types. The

vaccine, which is given as 3 injections over a

period of 6 months, will protect against only

those HPV types to which recipients have not

been exposed.

A second HPV vaccine called Cervarix is in

development by GlaxoSmithKline. The com-

pany has not yet submitted its vaccine to the

FDA for approval.

Head-to-head comparisons of the two vac-

cines have not been done, so it is not clear whetherone performs better than the other. Cervarix pro-

tects against HPV types 16 and 18, but not 6 and

11, and thus will not prevent genital warts.

Side effects from Gardasil were mild, the FDA

said, and included pain or tenderness at the injec-

tion site.

A CALL FOR MORE VITAMIN D RESEARCH

US and Canadian health groups say the poten-

tial role of vitamin D in cancer prevention deserves

more research. The American Cancer Society

(ACS) joined the Canadian Cancer Society and

six other health groups in issuing a statement of

findings from the first North American confer-

ence on vitamin D, held in March.

The conference brought together experts in

nutrition, epidemiology, dermatology, oncology,

and other fields to discuss what is and is not known

about vitamin D and its effect on human health.

The consensus: There is still much to learn

about how much vitamin D people need forgood health, how much might be too much,

andperhaps most importantlythe best way

to get enough.

The statement is available on the Web site of

the Canadian Cancer Society at http://www.

cancer.ca/ccs/internet/mediareleaselist/

0,,3172_615815452_1056572174_langId-en.

html. In addition to the Canadian and American

Cancer Societies, other groups signing onto the

statement include the American College of

Rheumatology, Canadian Dermatology Associ-

ation, Dietitians of Canada, National Council on

Skin Cancer Prevention (US), Osteoporosis Canada,

and the World Health Organization Collaborative

Centre for the Promotion of Sun Protection.

There is no dispute among medical profes-

sionals that vitamin D is beneficial for our health,

and there is no dispute that sun exposure is the

250 CA A Cancer Journal for Clinicians

News & Views


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major source of vitamin D for most of us, said

ACS deputy chief medical officer Len Lichtenfeld,

MD, who participated in the conference. But

there is also no dispute that exposure to ultra-

violet (UV) radiation from the sun and other

sources can be harmful.That is why making recommendations about

vitamin D is problematic.

UV light in the form of UVA and UVB is

known to raise the risk of melanoma and non-

melanoma skin cancers, as well as cataracts. But

vitamin D is crucial to bone health, and there is

growing evidence that it may have a role in pre-

venting some cancers, especially colorectal cancers.

Because vitamin D occurs naturally in only a

few foods and is added to just a handful of oth-

ers, many experts worry that some Americans get

too little vitamin D to reap these potential ben-

efits. Yet few are willing to encourage sun expo-

sure with its well-known dangers. UVB radiation

is what spurs the skin to produce vitamin D.

The health groups statement acknowledges this

conundrum and concludes that a balance of some

sun exposure and vitamin D supplementation

may be the best answer for now.

To minimize the health risks associated with

UVB radiation exposure while maximizing the

potential benefits of optimum vitamin D status,

[dietary] supplementation and small amounts ofsun exposure are the preferred methods of obtain-

ing vitamin D, the consensus statement says.

Current intake recommendations for vitamin

D, set by the Institute of Medicine, are 200 inter-

national units (IU) a day for children and adults

up to age 50; 400 IU for adults age 5170; and

600 IU for adults age 71 and older.

However, those levels are considered ade-

quate intake to maintain bone health and nor-

mal calcium metabolism. They do not reflect

the other potential health benefits of vitamin D.

Indeed, many experts consider these levels too

low for optimal health, and recommend as much

as 1,000 IU daily.

The statement of findings from the health

group does not go so far as to recommend that

level of vitamin D. Rather, it calls for more

research to determine the optimal amount and

encourages the public to discuss supplementa-

tion with a health care professional.

The statement says those at greatest risk of

having too little vitamin D include the following:

Elderly people.

Babies who are exclusively breast-fed. People with dark skin (darker-skinned people

need more sun exposure to make vitamin D).

People who dont get any sun exposure (those

who are housebound or who cover their bod-

ies with clothing for religious or cultural rea-

sons).

People who live in colder climates such as the

northern United States and Canada in win-

ter (above 37 latitude).

Lichtenfeld said people must also use com-

mon sense when deciding what constitutes a

small amount of sun exposure. Five minutes

may be enough for some, but not others.

There is no one size fits all recommenda-

tion for people to follow in determining how

much sun exposure is adequate to obtain health-

ful vitamin D levels, he said.

How much sun any single person might need

depends on many things: their age, the amount

of vitamin D obtained from their diet, skin dark-

ness, and sunshine intensity where they live. It

will take more research to figure out specifics.

Avoiding the sun at all costs, for most of us,simply doesnt make sense, Lichtenfeld acknowl-

edged. But that doesnt mean people should

bake themselves outside or in a tanning booth.

The ACS does not advocate seeking sun expo-

sure for the purpose of obtaining vitamin D.

The ACS is in the process of updating its skin

cancer prevention guidelines and currently recom-

mends reducing sun exposure to reduce the risk

of skin cancer. Although the guidelines note that

vitamin D is important to good health, the ACS

does not currently have a recommendation about

vitamin D as a way to treat or prevent cancer.

FERTILITY GUIDELINES ADDRESS OFTEN-IGNORED

TREATMENT SIDE EFFECT

New guidelines from the American Society of

Clinical Oncology (ASCO) say physicians should

251Volume 56 Number 5 September/October 2006

CA Cancer J Clin 2006;56:249253

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