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J Natl Med Assoc. 2006 March; 98(3): 357–364.
PMCID: PMC2576130

Lower vitamin-D production from solar ultraviolet-B irradiance may explain some differences in cancer survival rates.


Black Americans diagnosed with cancer generally have lower survival rates than white Americans, even after adjustment for stage of cancer at time of discovery and level of treatment received. The hypothesis developed in this work is that these lower cancer survival rates may be due to lower serum 25-hydroxyvitamin D [25(OH)DI for black Americans attributed to lower production rates of vitamin D from solar ultraviolet-B (UVB) irradiance due to darker skin. Black Americans generally have 50-75% as much serum 25(OH)D as white Americans, and vitamin D is now thought to reduce the risk of incidence and mortality for 18 types of cancer. To explore this hypothesis, data for mortality rates for various types of cancer for the period 1970-1994 for black Americans were used with indices for solar UVB levels for July, smoking, alcohol consumption, urban residence and poverty level, all averaged by state, in multiple linear regression analyses using the ecologic approach. Solar UVB was found significantly inversely correlated with mortality rates for breast, colon, esophageal, gastric and rectal cancers for black Americans, albeit with lower associations than for white Americans. Smoking and alcohol consumption were also significantly correlated with several cancers. Based on these results, it seems worthwhile to conduct observational, prevention and intervention studies to further test the hypothesis that vitamin D can reduce the risk of cancer incidence and death.

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  • Piffath TA, Whiteman MK, Flaws JA, Fix AD, Busht TL. Ethnic differences in cancer mortality trends in the US, 1950-1992. Ethn Health. 2001 May;6(2):105–119. [PubMed]
  • Bach Peter B, Schrag Deborah, Brawley Otis W, Galaznik Aaron, Yakren Sofia, Begg Colin B. Survival of blacks and whites after a cancer diagnosis. JAMA. 2002 Apr 24;287(16):2106–2113. [PubMed]
  • Clegg Limin X, Li Frederick P, Hankey Benjamin F, Chu Kenneth, Edwards Brenda K. Cancer survival among US whites and minorities: a SEER (Surveillance, Epidemiology, and End Results) Program population-based study. Arch Intern Med. 2002 Sep 23;162(17):1985–1993. [PubMed]
  • Jemal Ahmedin, Clegg Limin X, Ward Elizabeth, Ries Lynn A G, Wu Xiaocheng, Jamison Patricia M, Wingo Phyllis A, Howe Holly L, Anderson Robert N, Edwards Brenda K. Annual report to the nation on the status of cancer, 1975-2001, with a special feature regarding survival. Cancer. 2004 Jul 1;101(1):3–27. [PubMed]
  • Jemal Ahmedin, Murray Taylor, Ward Elizabeth, Samuels Alicia, Tiwari Ram C, Ghafoor Asma, Feuer Eric J, Thun Michael J. Cancer statistics, 2005. CA Cancer J Clin. 2005 Jan-Feb;55(1):10–30. [PubMed]
  • Shavers Vickie L, Brown Martin L. Racial and ethnic disparities in the receipt of cancer treatment. J Natl Cancer Inst. 2002 Mar 6;94(5):334–357. [PubMed]
  • Madison Terri, Schottenfeld David, James Sherman A, Schwartz Ann G, Gruber Stephen B. Endometrial cancer: socioeconomic status and racial/ethnic differences in stage at diagnosis, treatment, and survival. Am J Public Health. 2004 Dec;94(12):2104–2111. [PubMed]
  • Leistikow Bruce. Lung cancer rates as an index of tobacco smoke exposures: validation against black male approximate non-lung cancer death rates, 1969-2000. Prev Med. 2004 May;38(5):511–515. [PubMed]
  • Leistikow Bruce N, Tsodikov Alexander. Cancer death epidemics in United States Black males: evaluating courses, causation, and cures. Prev Med. 2005 Aug;41(2):380–385. [PubMed]
  • Prout George R, Jr, Wesley Margaret N, McCarron Peter G, Chen Vivien W, Greenberg Raymond S, Mayberry Robert M, Edwards Brenda K. Survival experience of black patients and white patients with bladder carcinoma. Cancer. 2004 Feb 1;100(3):621–630. [PubMed]
  • O'Malley Cynthia D, Le Gem M, Glaser Sally L, Shema Sarah J, West Dee W. Socioeconomic status and breast carcinoma survival in four racial/ethnic groups: a population-based study. Cancer. 2003 Mar 1;97(5):1303–1311. [PubMed]
  • Polednak Anthony P. Racial differences in mortality from obesity-related chronic diseases in US women diagnosed with breast cancer. Ethn Dis. 2004 Autumn;14(4):463–468. [PubMed]
  • Chlebowski Rowan T, Chen Zhao, Anderson Garnet L, Rohan Thomas, Aragaki Aaron, Lane Dorothy, Dolan Nancy C, Paskett Electra D, McTiernan Anne, Hubbell F Alan, et al. Ethnicity and breast cancer: factors influencing differences in incidence and outcome. J Natl Cancer Inst. 2005 Mar 16;97(6):439–448. [PubMed]
  • Newman Lisa A. Breast carcinoma in African-American and White women: application of molecular biology to understand outcome disparities. Cancer. 2004 Sep 15;101(6):1261–1263. [PubMed]
  • Rosenberg Jarrett, Chia Yen Lin, Plevritis Sylvia. The effect of age, race, tumor size, tumor grade, and disease stage on invasive ductal breast cancer survival in the U.S. SEER database. Breast Cancer Res Treat. 2005 Jan;89(1):47–54. [PubMed]
  • Garner Elizabeth I O. Cervical cancer: disparities in screening, treatment, and survival. Cancer Epidemiol Biomarkers Prev. 2003 Mar;12(3):242s–247s. [PubMed]
  • Patel Divya A, Barnholtz-Sloan Jill S, Patel Mehul K, Malone John M, Jr, Chuba Paul J, Schwartz Kendra. A population-based study of racial and ethnic differences in survival among women with invasive cervical cancer: analysis of Surveillance, Epidemiology, and End Results data. Gynecol Oncol. 2005 May;97(2):550–558. [PubMed]
  • Slattery Martha L, Samowtiz W, Ma K, Murtaugh M, Sweeney C, Levin TR, Neuhausen S. CYP1A1, cigarette smoking, and colon and rectal cancer. Am J Epidemiol. 2004 Nov 1;160(9):842–852. [PubMed]
  • Tammemagi C Martin, Neslund-Dudas Christine, Simoff Michael, Kvale Paul. Lung carcinoma symptoms--an independent predictor of survival and an important mediator of African-American disparity in survival. Cancer. 2004 Oct 1;101(7):1655–1663. [PubMed]
  • Tomar Scott L, Loree Michael, Logan Henrietta. Racial differences in oral and pharyngeal cancer treatment and survival in Florida. Cancer Causes Control. 2004 Aug;15(6):601–609. [PubMed]
  • Barnholtz-Sloan Jill S, Tainsky Michael A, Abrams Judith, Severson Richard K, Qureshi Faisal, Jacques Suzanne M, Levin Nancy, Schwartz Ann G. Ethnic differences in survival among women with ovarian carcinoma. Cancer. 2002 Mar 15;94(6):1886–1893. [PubMed]
  • Biggs Mary Lou, Schwartz Stephen M. Differences in testis cancer survival by race and ethnicity: a population-based study, 1973-1999 (United States). Cancer Causes Control. 2004 Jun;15(5):437–444. [PubMed]
  • Sherman Mark E, Devesa Susan S. Analysis of racial differences in incidence, survival, and mortality for malignant tumors of the uterine corpus. Cancer. 2003 Jul 1;98(1):176–186. [PubMed]
  • Miller Jordan A G, Rege Robert V, Ko Clifford Y, Livingston Edward H. Health care access and poverty do not explain the higher esophageal cancer mortality in African Americans. Am J Surg. 2004 Jul;188(1):22–26. [PubMed]
  • Steyerberg Ewout W, Earle Craig C, Neville Bridget A, Weeks Jane C. Racial differences in surgical evaluation, treatment, and outcome of locoregional esophageal cancer: a population-based analysis of elderly patients. J Clin Oncol. 2005 Jan 20;23(3):510–517. [PubMed]
  • Reddy Sreekanth, Shapiro Marc, Morton Ronald, Jr, Brawley Otis W. Prostate cancer in black and white Americans. Cancer Metastasis Rev. 2003 Mar;22(1):83–86. [PubMed]
  • Gilligan Timothy. Social disparities and prostate cancer: mapping the gaps in our knowledge. Cancer Causes Control. 2005 Feb;16(1):45–53. [PubMed]
  • Dignam JJ, Redmond CK, Fisher B, Costantino JP, Edwards BK. Prognosis among African-American women and white women with lymph node negative breast carcinoma: findings from two randomized clinical trials of the National Surgical Adjuvant Breast and Bowel Project (NSABP). Cancer. 1997 Jul 1;80(1):80–90. [PubMed]
  • Rex Douglas K, Rawl Susan M, Rabeneck Linda, Rex Emilie K, Hamilton Frank. Colorectal cancer in African Americans. Rev Gastroenterol Disord. 2004 Spring;4(2):60–65. [PubMed]
  • Garland CF, Garland FC. Do sunlight and vitamin D reduce the likelihood of colon cancer? Int J Epidemiol. 1980 Sep;9(3):227–231. [PubMed]
  • Garland C, Shekelle RB, Barrett-Connor E, Criqui MH, Rossof AH, Paul O. Dietary vitamin D and calcium and risk of colorectal cancer: a 19-year prospective study in men. Lancet. 1985 Feb 9;1(8424):307–309. [PubMed]
  • Grant William B. An estimate of premature cancer mortality in the U.S. due to inadequate doses of solar ultraviolet-B radiation. Cancer. 2002 Mar 15;94(6):1867–1875. [PubMed]
  • van den Bemd GJCM, Chang GTG. Vitamin D and vitamin D analogs in cancer treatment. Curr Drug Targets. 2002 Feb;3(1):85–94. [PubMed]
  • Lamprecht Sergio A, Lipkin Martin. Chemoprevention of colon cancer by calcium, vitamin D and folate: molecular mechanisms. Nat Rev Cancer. 2003 Aug;3(8):601–614. [PubMed]
  • Robsahm Trude Eid, Tretli Steinar, Dahlback Arne, Moan Johan. Vitamin D3 from sunlight may improve the prognosis of breast-, colon- and prostate cancer (Norway). Cancer Causes Control. 2004 Mar;15(2):149–158. [PubMed]
  • Moan Johan, Porojnicu Alina Carmen, Robsahm Trude Eid, Dahlback Arne, Juzeniene Asta, Tretli Steinar, Grant William. Solar radiation, vitamin D and survival rate of colon cancer in Norway. J Photochem Photobiol B. 2005 Mar 1;78(3):189–193. [PubMed]
  • Zhou Wei, Suk Rebecca, Liu Geoffrey, Park Sohee, Neuberg Donna S, Wain John C, Lynch Thomas J, Giovannucci Edward, Christiani David C. Vitamin D is associated with improved survival in early-stage non-small cell lung cancer patients. Cancer Epidemiol Biomarkers Prev. 2005 Oct;14(10):2303–2309. [PubMed]
  • Matsuoka LY, Wortsman J, Chen TC, Holick MF. Compensation for the interracial variance in the cutaneous synthesis of vitamin D. J Lab Clin Med. 1995 Nov;126(5):452–457. [PubMed]
  • Harris SS, Dawson-Hughes B. Seasonal changes in plasma 25-hydroxyvitamin D concentrations of young American black and white women. Am J Clin Nutr. 1998 Jun;67(6):1232–1236. [PubMed]
  • Looker Anne C, Dawson-Hughes B, Calvo MS, Gunter EW, Sahyoun NR. Serum 25-hydroxyvitamin D status of adolescents and adults in two seasonal subpopulations from NHANES III. Bone. 2002 May;30(5):771–777. [PubMed]
  • Harris SS, Soteriades E, Coolidge JA, Mudgal S, Dawson-Hughes B. Vitamin D insufficiency and hyperparathyroidism in a low income, multiracial, elderly population. J Clin Endocrinol Metab. 2000 Nov;85(11):4125–4130. [PubMed]
  • Harkness Laura S, Cromer Barbara A. Vitamin D deficiency in adolescent females. J Adolesc Health. 2005 Jul;37(1):75–75. [PubMed]
  • Studzinski GP, Moore DC. Sunlight--can it prevent as well as cause cancer? Cancer Res. 1995 Sep 15;55(18):4014–4022. [PubMed]
  • Giovannucci Edward. The epidemiology of vitamin D and cancer incidence and mortality: a review (United States). Cancer Causes Control. 2005 Mar;16(2):83–95. [PubMed]
  • Corder EH, Friedman GD, Vogelman JH, Orentreich N. Seasonal variation in vitamin D, vitamin D-binding protein, and dehydroepiandrosterone: risk of prostate cancer in black and white men. Cancer Epidemiol Biomarkers Prev. 1995 Sep;4(6):655–659. [PubMed]
  • Ingles SA, Coetzee GA, Ross RK, Henderson BE, Kolonel LN, Crocitto L, Wang W, Haile RW. Association of prostate cancer with vitamin D receptor haplotypes in African-Americans. Cancer Res. 1998 Apr 15;58(8):1620–1623. [PubMed]
  • Platz EA, Rimm EB, Willett WC, Kantoff PW, Giovannucci E. Racial variation in prostate cancer incidence and in hormonal system markers among male health professionals. J Natl Cancer Inst. 2000 Dec 20;92(24):2009–2017. [PubMed]
  • Hu Shasa, Ma Fangchao, Collado-Mesa Fernando, Kirsner Robert S. Ultraviolet radiation and incidence of non-Hodgkin's lymphoma among Hispanics in the United States. Cancer Epidemiol Biomarkers Prev. 2004 Jan;13(1):59–64. [PubMed]
  • Greenland S. Ecologic versus individual-level sources of bias in ecologic estimates of contextual health effects. Int J Epidemiol. 2001 Dec;30(6):1343–1350. [PubMed]
  • Weed Douglas L. Environmental epidemiology: basics and proof of cause-effect. Toxicology. 2002 Dec 27;181-182:399–403. [PubMed]
  • Holick MF. Photosynthesis of vitamin D in the skin: effect of environmental and life-style variables. Fed Proc. 1987 Apr;46(5):1876–1882. [PubMed]
  • Leffell DJ, Brash DE. Sunlight and skin cancer. Sci Am. 1996 Jul;275(1):52–59. [PubMed]
  • Kimlin Michael G. The climatology of Vitamin D producing ultraviolet radiation over the United States. J Steroid Biochem Mol Biol. 2004 May;89-90(1-5):479–483. [PubMed]
  • Giovino GA, Schooley MW, Zhu BP, Chrismon JH, Tomar SL, Peddicord JP, Merritt RK, Husten CG, Eriksen MP. Surveillance for selected tobacco-use behaviors--United States, 1900-1994. MMWR CDC Surveill Summ. 1994 Nov 18;43(3):1–43. [PubMed]
  • Cresanta JL. Epidemiology of cancer in the United States. Prim Care. 1992 Sep;19(3):419–441. [PubMed]
  • Freedman DM, Dosemeci M, McGlynn K. Sunlight and mortality from breast, ovarian, colon, prostate, and non-melanoma skin cancer: a composite death certificate based case-control study. Occup Environ Med. 2002 Apr;59(4):257–262. [PMC free article] [PubMed]
  • Krieger N, Quesenberry C, Jr, Peng T, Horn-Ross P, Stewart S, Brown S, Swallen K, Guillermo T, Suh D, Alvarez-Martinez L, et al. Social class, race/ethnicity, and incidence of breast, cervix, colon, lung, and prostate cancer among Asian, Black, Hispanic, and White residents of the San Francisco Bay Area, 1988-92 (United States). Cancer Causes Control. 1999 Dec;10(6):525–537. [PubMed]
  • Baquet CR, Commiskey P. Socioeconomic factors and breast carcinoma in multicultural women. Cancer. 2000 Mar 1;88(5 Suppl):1256–1264. [PubMed]
  • Nilunger Louise, Diderichsen Finn, Burström Bo, Ostlin Piroska. Using risk analysis in Health Impact Assessment: the impact of different relative risks for men and women in different socio-economic groups. Health Policy. 2004 Feb;67(2):215–224. [PubMed]
  • Gordon Nahida H. Socioeconomic factors and breast cancer in black and white Americans. Cancer Metastasis Rev. 2003 Mar;22(1):55–65. [PubMed]
  • Guirgis HA, Lynch HT, Harris RE, Vandevoorde JP. Carcinoembryonic antigen (CEA) in the cancer family syndrome. Cancer. 1978 Sep;42(3 Suppl):1574–1578. [PubMed]
  • Karagas Margaret R, Park Sunyeong, Warren Amy, Hamilton Joshua, Nelson Heather H, Mott Leila A, Kelsey Karl T. Gender, smoking, glutathione-S-transferase variants and bladder cancer incidence: a population-based study. Cancer Lett. 2005 Feb 28;219(1):63–69. [PubMed]
  • Johnson Kenneth C. Accumulating evidence on passive and active smoking and breast cancer risk. Int J Cancer. 2005 Nov 20;117(4):619–628. [PubMed]
  • Pan Sai Yi, Ugnat Anne-Marie, Mao Yang, Wen Shi Wu, Johnson Kenneth C. Association of cigarette smoking with the risk of ovarian cancer. Int J Cancer. 2004 Aug 10;111(1):124–130. [PubMed]
  • Hu Jinfu, Ugnat Anne-Marie. Active and passive smoking and risk of renal cell carcinoma in Canada. Eur J Cancer. 2005 Mar;41(5):770–778. [PubMed]
  • Bell NH, Jackson GJ. Role of vitamin D in the pathogenesis and treatment of osteoporosis. Endocr Pract. 1995 Jan-Feb;1(1):44–47. [PubMed]
  • Tuohimaa Pentti, Tenkanen Leena, Ahonen Merja, Lumme Sonja, Jellum Egil, Hallmans Göran, Stattin Pär, Harvei Sverre, Hakulinen Timo, Luostarinen Tapio, et al. Both high and low levels of blood vitamin D are associated with a higher prostate cancer risk: a longitudinal, nested case-control study in the Nordic countries. Int J Cancer. 2004 Jan 1;108(1):104–108. [PubMed]
  • Grant William B. Geographic variation of prostate cancer mortality rates in the United States: Implications for prostate cancer risk related to vitamin D. Int J Cancer. 2004 Sep 1;111(3):470–472. [PubMed]
  • Tuohimaa P, Golovko O, Kalueff A, Nazarova N, Qiao S, Syvälä H, Talonpoika R, Lou Y-R. Calcidiol and prostate cancer. J Steroid Biochem Mol Biol. 2005 Feb;93(2-5):183–190. [PubMed]
  • Grant William B, Garland Cedric F. A critical review of studies on vitamin D in relation to colorectal cancer. Nutr Cancer. 2004;48(2):115–123. [PubMed]
  • Heaney Robert P. Long-latency deficiency disease: insights from calcium and vitamin D. Am J Clin Nutr. 2003 Nov;78(5):912–919. [PubMed]
  • Holick Michael F. Vitamin D: A millenium perspective. J Cell Biochem. 2003 Feb 1;88(2):296–307. [PubMed]
  • Holick Michael F. Vitamin D: importance in the prevention of cancers, type 1 diabetes, heart disease, and osteoporosis. Am J Clin Nutr. 2004 Mar;79(3):362–371. [PubMed]
  • Dusso Adriana S, Brown Alex J, Slatopolsky Eduardo. Vitamin D. Am J Physiol Renal Physiol. 2005 Jul;289(1):F8–28. [PubMed]
  • Mosekilde Leif. Vitamin D and the elderly. Clin Endocrinol (Oxf) 2005 Mar;62(3):265–281. [PubMed]
  • Peterlik M, Cross HS. Vitamin D and calcium deficits predispose for multiple chronic diseases. Eur J Clin Invest. 2005 May;35(5):290–304. [PubMed]
  • Ponsonby A-L, Lucas RM, van der Mei IAF. UVR, vitamin D and three autoimmune diseases--multiple sclerosis, type 1 diabetes, rheumatoid arthritis. Photochem Photobiol. 2005 Nov-Dec;81(6):1267–1275. [PubMed]
  • John Esther M, Schwartz Gary G, Koo Jocelyn, Van Den Berg David, Ingles Sue A. Sun exposure, vitamin D receptor gene polymorphisms, and risk of advanced prostate cancer. Cancer Res. 2005 Jun 15;65(12):5470–5479. [PubMed]
  • Schwartz Gary G. Vitamin D and the epidemiology of prostate cancer. Semin Dial. 2005 Jul-Aug;18(4):276–289. [PubMed]
  • Bertone-Johnson Elizabeth R, Chen Wendy Y, Holick Michael F, Hollis Bruce W, Colditz Graham A, Willett Walter C, Hankinson Susan E. Plasma 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D and risk of breast cancer. Cancer Epidemiol Biomarkers Prev. 2005 Aug;14(8):1991–1997. [PubMed]
  • Holick Michael F. Vitamin D: important for prevention of osteoporosis, cardiovascular heart disease, type 1 diabetes, autoimmune diseases, and some cancers. South Med J. 2005 Oct;98(10):1024–1027. [PubMed]
  • Gorham Edward D, Garland Cedric F, Garland Frank C, Grant William B, Mohr Sharif B, Lipkin Martin, Newmark Harold L, Giovannucci Edward, Wei Melissa, Holick Michael F. Vitamin D and prevention of colorectal cancer. J Steroid Biochem Mol Biol. 2005 Oct;97(1-2):179–194. [PubMed]
  • Moon Samuel J, Fryer Anthony A, Strange Richard C. Ultraviolet radiation, vitamin D and risk of prostate cancer and other diseases. Photochem Photobiol. 2005 Nov-Dec;81(6):1252–1260. [PubMed]
  • Giovannucci Edward. The epidemiology of vitamin D and colorectal cancer: recent findings. Curr Opin Gastroenterol. 2006 Jan;22(1):24–29. [PubMed]
  • Garland Cedric F, Garland Frank C, Gorham Edward D, Lipkin Martin, Newmark Harold, Mohr Sharif B, Holick Michael F. The role of vitamin D in cancer prevention. Am J Public Health. 2006 Feb;96(2):252–261. [PubMed]

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