Differences in vitamin D status likely explain racial disparities in breast cancer mortality rates in the southeast
Bibliographic record
Abstract
The recent article in Cancer by Adams and colleagues1 found that after diagnosis of breast cancer, African American women had significantly higher breast cancer–specific and all-cause mortality rates than did European American women, and this effect persisted after consideration of commonly accepted risk factors. One factor not considered was vitamin D status. Solar ultraviolet B (UVB) irradiance is the most important source of vitamin D for most North Americans. Solar UVB dose has been found to be inversely correlated with breast cancer mortality rates in ecological studies for both African American and European American women.2 Vitamin D has also been found to be associated with survival rates after diagnosis of breast cancer. In a study in Canada with an 11.6-year follow-up period after breast cancer diagnosis, women with deficient vitamin D levels had an increased risk of distant recurrence and death compared with those who had sufficient levels.3 In detail, women with serum 25-hydroxyvitamin D (25(OH)D) levels <20 ng/mL, compared with those who had levels >30 ng/mL, had a multivariate adjusted hazard ratio of 1.71 (95% confidence interval, 1.02-2.86) for distant recurrence, and of 1.60 (95% confidence interval, 0.96-2.64) for death.3 There is also evidence from observational studies that serum 25(OH)D level affects breast cancer incidence rates.4 The relative risk versus 25(OH)D level outlined in that study4 might be used to estimate the breast cancer disparity in the United States. It was found that in the 2001 to 2004 period, mean serum 25(OH)D levels was 15 ng/mL in African American women and 26 ng/mL in European American women.5 These levels indicate a 46% higher breast cancer incidence rate for African Americans based on the relationship in the results of Grant.4 Because it is likely that vitamin D competes with more risk-modifying factors in cancer incidence than in cancer mortality rates (vitamin D reduces tumor angiogenesis and metastasis), the disparity for mortality rates might be higher. Therefore, future studies on racial disparities in breast cancer mortality should include serum 25(OH)D levels at the time of diagnosis, as well as, if necessary, vitamin D supplementation to reach and maintain serum 25(OH)D levels between 30 and 40 ng/mL. Dr Grant receives funding from the UV Foundation (McLean, Virginia), Bio-Tech Pharmacal (Fayetteville, Arkansas), the Vitamin D Council (San Luis Obispo, California), and the Vitamin D Society (Canada). The other authors make no disclosures. William B. Grant PhD*, Luca Mascitelli MD , Mark R. Goldstein MD , * Sunlight, Nutrition, and Health Research Center (SUNARC), San Francisco, California, Comando Brigata Alpina "Julia", Medical Service, Udine, Italy, 1845 Veterans Park Drive, Suite 110, Naples, Florida.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".