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Calcium, Vitamin D, and Risk Reduction of Colorectal Cancer

The results of two controlled intervention studies in older women using dietary supplements of calcium and vitamin D, as part of the Women’s Health Initiative (WHI) studies, were reported in major medical journals, regarded as authoritative by the general public (1,2). One of these reports dealt with the effects of these dietary supplements on the risk of colorectal cancer (1). The public news media generally reported negative results as summarized in the abstracts of these articles and in the associated press releases. However, the full text of the articles contained a great deal of qualifying data, including high basal dietary intake of calcium in the subjects involved (nearly twice the U.S. average intake), vitamin D intake at close to recommended levels (at least twofold the U.S. average), low compliance with intervention (only about 70% of subjects reported more than 50% compliance), probably inadequate duration of intervention, low intervention dosage of vitamin D, and a significant 2.5-fold increase in risk of colorectal cancer in the lowest 25-hydroxy vitamin D quartile. These “qualifiers” in the authors’ text were generally omitted from the journal abstracts and the media coverage. An exception was The Wall Street Journal, which issued a detailed and critical analysis of the publications of the WHI studies (3), and Jane Brody’s article in The New York Times, whose message was “Read the fine print. Stay the course.” This review is intended to clarify, for readers of this journal who are concerned with the relation between diet and cancer, some of the design flaws and qualifying data of the WHI study report of the trial of calcium and vitamin D supplementation and colorectal cancer risk (1). Some detailed comments: