Life Choices can Tip Risks and Benefits of Vitamin D
Life is a balancing act. Regularly we find ourselves weighing circumstances. An obvious example is work-life balance. A classic nutritional example is vitamin D status. When exposed to sunlight, skin can synthesize vitamin D3. However sun exposure, especially sunburns, increases the risk skin cancer. Skin cancer is the most common cancer in the US.
Guy Jr and colleagues report the incidence of skin cancer is increasing. Using data from the 2002-2011 Medical Expenditure Panel Survey, they report a 44% increase in the number of adults treated for skin cancer between 2002-06 and 2007-2011. The average annual total cost for skin cancer more than doubled, from $3.6 billion to $8.1 billion. Yes, that is a B not an M. Billion. Nearly 5 million adults are treated for skin cancer annually. The average annual cost per person for melanoma and nonmelanoma treatment in 2007-2011 was $1,643 yet out-of-pocket costs were only 6.7% of the total. Beyond the emotional burden, skin cancer clearly stresses individual and healthcare budgets.
Sun exposure is a primary risk factor for skin cancer. However, maintaining adequate serum 25(OH)D3 levels is essential to maintain strong bones, muscles and functional immune system. There is a risk/benefit balancing act when relying upon sun exposure to maintain adequate serum 25(OH)D3 concentrations without increasing the risk of skin cancer.
Low serum 25(OH)D3 concentrations are associated with increased cancer incidence and mortality in men, leading Giovannucci and colleagues to hypothesize that vitamin D supplementation might reduce cancer risk. Vitamin D intake from diet or dietary supplements does not seem to exert any protective effect against skin cancer development, even among women. Of course, like many nutritional interventions, most of the participants did not have low serum 25(OH)D3 concentrations.
Once again, we have another example of the risks of suboptimal nutrient status. In the case of skin cancer, ase, it is our strategy to increase nutritional status (sun exposure versus dietary intake) which tips the balance.
Guy Jr GP, Machlin SR, Ekwueme DU, Yabroff KR. Prevalence and costs of skin cancer treatment in the US, 2002-2006 and 2007-2011. 2014 Am J Prev Med doi: 10.1016/j.amepre.2014.08.036
Tang JY, Fu T, LeBlanc E, Manson JE, Feldman D, Linos E, Vitolins MZ, Zeitouni NC, Larson J, Stefanick ML. Calcium plus vitamin D supplementation and the risk of nonmelanoma and melanoma skin cancer: Post hoc analyses of the Women’s Health Initiative Randomized Controlled Trial. 2011 J Clin Oncol doi: 10.1200/JCO.2011.34.5967
Rosso S, Zanetti R, Pippione M, Sancho-Garnier H. Parallel risk assessment of melanoma and basal cell carcinoma: skin characteristics and sun exposure. 1998 Melanoma Res 8(6):573-583
Giovannucci E, Liu Y, Rimm EB, Hollis BW, Fuchs CS, Stampfer MJ, Willett WC. Prospective study of predictors of vitamin D status and cancer incidence and mortality in men. 2006 JNCI doi: 10.1093/jnci/djj101
Caini S, Boniol M, Tosti G, Magi S, Medri M, Stanganelli I, Palli D, Assedi M, Del Marmol V, Gandini S. Vitamin D and melanoma and non-melanoma skin cancer risk and prognosis: A comprehensive review and meta-analysis. 2014 Eur J Cancer doi: 10.1016/j.ejca.2014.06.024
Schwalfenberg GK. A review of the critical role of vitamin D in the functioning of the immune system and the clinical implications of vitamin D deficiency. 2010 Mol Nutr Food Res doi: 10.1002/mnfr.201000174
Pojednic RM, Ceglia L. The emerging biomolecular role of vitamin D in skeletal muscle. 2014 Exerc Sport Sci Rev doi: 10.1249/JES.0000000000000013