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Evidence Analysis Case StudyLauren Gizzi

Is there a correlation between serum vitamin D levels and the

development and/or progression of breast cancer?

OVERVIEW• Background of Breast Cancer• Background of Serum Vitamin D• Introduction of Patient• EAL Question• PICO• Inclusion & Exclusion criteria• Included Articles• Excluded Articles• Conclusion & Grade

Breast Cancer• Breast cancer is an uncontrolled growth of breast cells.• It usually begins in the cells of the lobules or the ducts• Less commonly it can begin in the stromal tissues• Overtime it can invade healthy breast tissue and into

the lymph nodes.• Once in the lymph nodes- it has access to spread to

other body parts via pathways.• Breast Cancer’s stage refers to how far the cancer

cells have spread beyond the original tumor.

Types of Breast Cancer• DCIS- Ductal Carcinoma In

Situ- (non-invasive)

• IDC – Invasive Ductal Carcinoma• Tubular Carcinoma• Medullary Carcinoma• Mucinous Carcinoma• Papillary Carcinoma• Cribriform Carcinoma

• ILC- Invasive Lobular Carcinoma In Situ (non-invasive)

• Inflammatory Breast Cancer

• LCIS- Lobular Carcinoma

• Male Breast Cancer

• Paget’s Disease of the Nipple

• Phllodes Tumor of the Breast

• Recurrent and Metastatic Breast Cancer

Breast Cancer Subtypes

• Four major molecular subtypes:• Luminal A• Luminal B• Triple negative/basal-like• HER2 type

TNM Staging System• TNM

(Tumor, Node, Metastasis)TX – the tumor can’t be measured or foundT0 – no evidence of the primary tumorTis – cancer is “in situ”T1,2,3,or 4 – numbers based on the size of the tumor and extent to which it has grown into the neighboring tissue. The higher the # the larger the tumor and/or the more it has grown into the breast tissue

NX – the nearby lymph nodes cant be measuredN0 – nearby lymph nodes do not contain cancerN1,2, or 3 – Based on the # of lymph nodes involved and how much cancer is found in them. The higher the # the greater the extent of the lymph node involvement

MX – metastasis cant be measured or foundM0 – there is no distant metastasisM1 – distant metastasis is present

Stages of Breast Cancer

• Stage 0• Stage I• Stage II• Stage III • Stage IV

Breast Cancer Classifications

• HR+ or HR-• ER+ or ER– • PR+ or PR–

• HER2+ or HER2– • Triple+ or Triple–

Vitamin D

• Fat-soluble vitamin that is important for good overall health and strong and healthy bones. Also an important factor in making sure muscles, heart, lungs, and brain work well and your body can fight infection.

• Serum 25(OH)D is the best indicator of vitamin D statusSerum 25 hydroxy-vitamin D abbreviated as 25OHD

How do we get vitamin D

• Sunlight*• Naturally in the diet:• Fatty Fish (salmon & tuna)• Fish liver oil (cod liver oil)• Liver• Egg yolks

• Fortified Foods• Milk• Juice• Breads• Cereals

• Dietary Supplements and/or MVI

Introduction to Patient-LL

• LL is a 42 year old woman with R sided breast cancer.

• Underwent R sided mastectomy w/ a L prophylactic Mastectomy

• She will require radiation post op and will have a latissimus flap preformed on the R to protect the expander tissue

• Cancer type: invasive ductal carcinomaRight – Stage 3 T3N3 ER+, PR+, HER2-

Is there a correlation between serum vitamin D

levels and the development and/or progression of breast

cancer?

PICO

P-population I-intervention O-outcome

Women with breast cancer

Serum vitamin D concentrations

Concentration levels affect breast cancer development and/or progression of the disease

Inclusion/Exclusion CriteriaCRITERIA INCLUDED EXCLUDEDSubjects Non-pregnant

womanPregnant women,

non-human (animals) & men

Age _ _Health Status Breast Cancer Other Cancers

Year 1999-present Prior to 1999Outcome Affect on

development and/or progression

Affect on SurvivalOther

Study Design Case-ControlProspective

Meta-analysisOther

Intervention Vitamin D Other vitamins/minerals

Search Plan & Results• Search Engines:• Science Direct• AACR Journals• Google Scholar• Mahoney Library• Open Access

• Search Terms:• Breast Cancer• Serum Vitamin D• Development

• Total Number of Articles: 15• Included:6• Excluded: 9

If you would like to know more about this topic and the results of the case study, please feel

free to contact me.Thank You