Breast Cancer Research and Treatment

, Volume 102, Issue 3, pp 323–328 | Cite as

Changes in risk of death from breast cancer with season and latitude

Sun exposure and breast cancer survival in Norway
  • Alina Carmen Porojnicu
  • Zoya Lagunova
  • Trude Eid Robsahm
  • Jens Petter Berg
  • Arne Dahlback
  • Johan Moan


The Norwegian counties can conveniently be divided in three groups with different annual UV exposures and different incidence rates of squamous cell carcinoma (SCC) of the skin. In view of the hypothesis that latitude and season of diagnosis may play a role for breast cancer progression, the prognosis of breast cancer as determined for summer and winter diagnosis, were evaluated in the three residential regions. Two age groups were analysed separately (stratification at 50 years). For all regions, and for all ages, the prognosis was best for women diagnosed in the summer season (Relative risk (RR) of death was 15–25% lower for summer diagnosis versus winter diagnosis). There was no significant seasonal variation of the number of new cases. For women diagnosed before the age of 50, a geographical gradient in cancer prognosis was also found (RR of death 0.6, 95% CI: 0.5–0.7 for cases diagnosed in southeast Norway and RR of death 0.8, 95% CI: 0.6–1.1 for diagnosis in the north of Norway). This is in agreement with a 1.5 times larger annual UV exposures and 3–4 times larger incidence rates of SCC in the southeast region when compared with the north region. For women diagnosed after the age of 50, no significant difference was found between the three regions. Despite a 17% higher vitamin D intake from food in north of Norway no difference in cancer survival was found for diagnosis during winter (when no significant differences in the levels of UV exposure can be detected between regions).

The overall data support our earlier hypothesis that season of diagnosis and therapy start improves the survival for breast cancer.


Breast cancer survival Solar exposure Active vitamin D 


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The present work was supported by Sigval Bergesen D.Y. og hustru Nankis Foundation and by The Research Foundation of The Norwegian Radium Hospital.


  1. 1.
    Lim HS, Roychoudhuri R, Peto J, Schwartz G, Baade P, Moller H (2006) Cancer survival is dependent on season of diagnosis and sunlight exposure. Int J Cancer DOI 10.002/ijc.22052 Google Scholar
  2. 2.
    Moan J, Porojnicu AC, Robsahm TE, Dahlback A, Juzeniene A, Tretli S, Grant W (2005) Solar radiation, vitamin D and survival rate of colon cancer in Norway. J Photochem Photobiol B 78:189–193PubMedCrossRefGoogle Scholar
  3. 3.
    Porojnicu AC, Robsahm TE, Dahlback A, Berg JP, Christiani DC, Moan J (2005) Seasonal and geographical variations in lung cancer prognosis in Norway. A possible beneficial role of sun-induced vitamin D (submitted) Google Scholar
  4. 4.
    Robsahm TE, Tretli S, Dahlback A, Moan J (2004) Vitamin D3 from sunlight may improve the prognosis of breast-, colon- and prostate cancer (Norway). Cancer Causes Control 15:149–158PubMedCrossRefGoogle Scholar
  5. 5.
    Moan J, Porojnicu AC (2006) The photobiology of vitamin D – a topic of renewed focus. Tidsskr Nor Laegeforen 126:1048–1052PubMedGoogle Scholar
  6. 6.
    Holick MF (1994) Vitamin D: photobiology, metabolism and clinical application. In: Arias IM, Boyer JL, Fausto N, Jakoby WB, Schachter D, Shafritz DA (eds) The liver: biology␣and photobiology. Raven Press, New York, pp 543– 562Google Scholar
  7. 7.
    Kitanaka S, Takeyama K, Murayama A, Sato T, Okumura K, Nogami M, Hasegawa Y, Niimi H, Yanagisawa J, Tanaka T, Kato S (1998) Inactivating mutations in the 25-hydroxyvitamin D3 1alpha-hydroxylase gene in patients with pseudovitamin D-deficiency rickets. N Engl J Med 338:653–661PubMedCrossRefGoogle Scholar
  8. 8.
    Cross HS, Peterlik M, Reddy GS, Schuster I (1997) Vitamin D metabolism in human colon adenocarcinoma-derived Caco-2 cells: expression of 25-hydroxyvitamin D3-1alpha-hydroxylase activity and regulation of side-chain metabolism. J Steroid Biochem Mol Biol 62:21–28PubMedCrossRefGoogle Scholar
  9. 9.
    Zehnder D, Bland R, Williams MC, McNinch RW, Howie AJ, Stewart PM, Hewison M (2001) Extrarenal expression of 25-hydroxyvitamin d(3)-1 alpha-hydroxylase. J Clin Endocrinol Metab 86:888–894PubMedCrossRefGoogle Scholar
  10. 10.
    Townsend K, Banwell CM, Guy M, Colston KW, Mansi JL, Stewart PM, Campbell MJ, Hewison M (2005) Autocrine metabolism of vitamin D in normal and malignant breast tissue. Clin Cancer Res 11:3579–3586PubMedCrossRefGoogle Scholar
  11. 11.
    Armstrong BK, Kricker A, English DR (1997) Sun exposure␣and skin cancer. Australas J Dermatol 38(Suppl 1):S1–S6Google Scholar
  12. 12.
    MacLaughlin J, Holick MF (1985) Aging decreases the capacity of human skin to produce vitamin D3. J Clin Invest 76:1536–1538PubMedCrossRefGoogle Scholar
  13. 13.
    Statistics Norway (2006) http://www ssb no/english/subjects/02/01/10/innvbef_en/. Cited 03 July 2006Google Scholar
  14. 14.
    Scotto J, Fears TR, Fraumeni JFJ (1983) Incidence of nonmelanoma skin cancer in the United States. NCI NIH Google Scholar
  15. 15.
    Matsuoka LY, Wortsman J, Haddad JG, Kolm P, Hollis BW (1991) Racial pigmentation and the cutaneous synthesis of vitamin D. Arch Dermatol 127:536–538PubMedCrossRefGoogle Scholar
  16. 16.
    Dahlback A, Stamnes K (1991) A new spherical model for computing the radiation field available for photolysis and heating rate at twilight. Planet Space Sci 39:671–683CrossRefGoogle Scholar
  17. 17.
    Stamnes K, Tsay SC, Wiscombe W, Jayaweera K (1988) Numerically stable algorithm for discrete-ordinate-method for radiative transfer in multiple scattering and emitting layered media. Appl Opt 27:2502–2509CrossRefGoogle Scholar
  18. 18.
    Falch JA, Oftebro H, Haug E (1987) Early postmenopausal bone loss is not associated with a decrease in circulating levels of 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, or vitamin D-binding protein. J Clin Endocrinol Metab 64:836–841PubMedCrossRefGoogle Scholar
  19. 19.
    Johansson L, Solvoll K (1999) Norkost 1997 Norwegian National Dietary Survey. Report by The National Council for Nutrition and Physical Activity. Oslo, pp 45–46Google Scholar
  20. 20.
    Brustad M, Alsaker E, Engelsen O, Aksnes L, Lund E (2004) Vitamin D status of middle-aged women at 65–71 degrees N in relation to dietary intake and exposure to ultraviolet radiation. Public Health Nutr 7:327–335PubMedCrossRefGoogle Scholar
  21. 21.
    Statistics Norway (2006) http://www ssb no/en/reise/main html. Cited 03 July 2006Google Scholar
  22. 22.
    Colston KW, Hansen CM (2002) Mechanisms implicated in the growth regulatory effects of vitamin D in breast cancer. Endocr Relat Cancer 9:45–59PubMedCrossRefGoogle Scholar
  23. 23.
    Gewirtz DA, Sundaram S, Magnet KJ (2000) Influence of topoisomerase II inhibitors and ionizing radiation on growth arrest and cell death pathways in the breast tumor cell. Cell Biochem Biophys 33:19–31PubMedCrossRefGoogle Scholar
  24. 24.
    James SY, Mackay AG, Colston KW (1995) Vitamin D derivatives in combination with 9-cis retinoic acid promote active cell death in breast cancer cells. J Mol Endocrinol 14:391–394PubMedGoogle Scholar
  25. 25.
    Ravid A, Rocker D, Machlenkin A, Rotem C, Hochman A, Kessler-Icekson G, Liberman UA, Koren R (1999) 1,25-Dihydroxyvitamin D3 enhances the susceptibility of breast cancer cells to doxorubicin-induced oxidative damage. Cancer Res 59:862–867PubMedGoogle Scholar
  26. 26.
    Vink-van Wijngaarden T, Pols HA, Buurman CJ, van den Bemd GJ, Dorssers LC, Birkenhager JC, van Leeuwen JP (1994) Inhibition of breast cancer cell growth by combined treatment with vitamin D3 analogues and tamoxifen. Cancer Res 54:5711–5717PubMedGoogle Scholar
  27. 27.
    Wang Q, Yang W, Uytingco MS, Christakos S, Wieder R (2000) 1,25-Dihydroxyvitamin D3 and all-trans-retinoic acid sensitize breast cancer cells to chemotherapy-induced cell death. Cancer Res 60:2040–2048PubMedGoogle Scholar
  28. 28.
    Agoston ES, Hatcher MA, Kensler TW, Posner GH (2006) Vitamin D analogs as anti-carcinogenic agents. Anticancer Agents Med Chem 6:53–71PubMedCrossRefGoogle Scholar
  29. 29.
    Barger-Lux MJ, Heaney RP, Lanspa SJ, Healy JC, DeLuca HF (1995) An investigation of sources of variation in calcium absorption efficiency. J Clin Endocrinol Metab 80:406–411PubMedCrossRefGoogle Scholar
  30. 30.
    Colodro IH, Brickman AS, Coburn JW, Osborn TW, Norman AW (1978) Effect of 25-hydroxy-vitamin D3 on intestinal absorption of calcium in normal man and patients with renal failure. Metabolism 27:745–753PubMedCrossRefGoogle Scholar
  31. 31.
    Tuohimaa P, Golovko O, Kalueff A, Nazarova N, Qiao S, Syvala H, Talonpoika R, Lou YR (2005) Calcidiol and prostate cancer. J Steroid Biochem Mol Biol 93:183–190PubMedCrossRefGoogle Scholar
  32. 32.
    Segersten U, Holm PK, Bjorklund P, Hessman O, Nordgren H, Binderup L, Akerstrom G, Hellman P, Westin G (2005) 25-Hydroxyvitamin D3 1alpha-hydroxylase expression in breast cancer and use of non-1alpha-hydroxylated vitamin D analogue. Breast Cancer Res 7:R980–R986PubMedCrossRefGoogle Scholar
  33. 33.
    Kemmis CM, Salvador SM, Smith KM, Welsh J (2006) Human mammary epithelial cells express CYP27B1 and are growth inhibited by 25-hydroxyvitamin D-3, the major circulating form of vitamin D-3. J Nutr 136:887–892PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2006

Authors and Affiliations

  • Alina Carmen Porojnicu
    • 1
  • Zoya Lagunova
    • 1
  • Trude Eid Robsahm
    • 2
  • Jens Petter Berg
    • 3
    • 4
  • Arne Dahlback
    • 5
  • Johan Moan
    • 1
    • 5
  1. 1.Department of Radiation BiologyInstitute for Cancer ResearchOsloNorway
  2. 2.The Cancer Registry of NorwayInstitute of Population-based Cancer ResearchOsloNorway
  3. 3.Hormone LaboratoryAker University HospitalOsloNorway
  4. 4.Faculty Division Aker University HospitalUniversity of OsloOsloNorway
  5. 5.Department of PhysicsUniversity of OsloOsloNorway

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