Incidence of hematologic malignancy and cause-specific mortality in the Women's Health Initiative randomized controlled trial of calcium and vitamin D supplementation

Cancer. 2017 Nov 1;123(21):4168-4177. doi: 10.1002/cncr.30858. Epub 2017 Jun 27.

Abstract

Background: Prior evidence of a possible link between vitamin D status and hematologic malignancy (HM) in humans comes from observational studies, leaving unresolved the question of whether a true causal relationship exists.

Methods: The authors performed a secondary analysis of data from the Women's Health Initiative Calcium/Vitamin D (CaD) trial, a large randomized controlled trial of CaD supplementation compared with placebo in older women. Kaplan-Meier and Cox proportional hazards survival analysis methods were used to evaluate the relationship between treatment assignment and 1) incident HM and 2) HM-specific mortality over 10 years following randomization. HMs were classified by cell type (lymphoid, myeloid, or plasma cell) and analyzed as distinct endpoints in secondary analyses.

Results: A total of 34,763 Women's Health Initiative CaD trial participants (median age, 63 years) had complete baseline covariate data and were eligible for analysis. Women assigned to CaD supplementation had a significantly lower risk of incident HM (hazard ratio [HR], 0.80; 95% confidence interval [95% CI], 0.65-0.99) but not HM-specific mortality (HR, 0.77 [95% CI, 0.53-1.11] for the entire cohort; and HR, 1.03 [95% CI, 0.70-1.51] among incident HM cases after diagnosis). In secondary analyses, protective associations were found to be most robust for lymphoid malignancies, with HRs of 0.77 (95% CI, 0.59-1.01) and 0.46 (95% CI, 0.24-0.89), respectively, for cancer incidence and mortality in those assigned to CaD supplementation.

Conclusions: The current post hoc analysis of data from a large and well-executed randomized controlled trial demonstrates a protective association between modest CaD supplementation and HM risk in older women. Additional research concerning the relationship between vitamin D and HM is warranted. Cancer 2017;123:4168-4177. © 2017 American Cancer Society.

Keywords: epidemiology; hematologic neoplasms; lymphoma; risk factors; vitamin D; women.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Calcium / administration & dosage*
  • Cause of Death
  • Confidence Intervals
  • Dietary Supplements
  • Hematologic Neoplasms / classification
  • Hematologic Neoplasms / epidemiology*
  • Hematologic Neoplasms / mortality
  • Humans
  • Incidence
  • Kaplan-Meier Estimate
  • Lymphoma / epidemiology
  • Lymphoma / mortality
  • Middle Aged
  • Proportional Hazards Models
  • Vitamin D / administration & dosage*
  • Vitamins / administration & dosage*
  • Women's Health

Substances

  • Vitamins
  • Vitamin D
  • Calcium