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Endocrine Oncology outcomes, 67–69 people should try to reach those levels through a combination of moderate solar UVB irradiance and vitamin D supplementation. Considerable variation exists in serum 25(OH) D concentration for any oral vitamin D intake, 70 so people can either take 1,000–4,000  IU of vitamin D per day 69–70 or have serum 25(OH) D concentration measured before starting to increase 25(OH)D concentrations, then again after several months. For reference, US mean population serum 25(OH)D concentrations in the early 2000s were 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 54 Garland CF, Garland FC, Do sunlight and vitamin D reduce the likelihood of colon cancer?, Int J Epidemiol, 1980;9(3):227–31. Grant WB, An estimate of premature cancer mortality in the U.S. due to inadequate doses of solar ultraviolet-B radiation, Cancer, 2002;94(6):1867–75. Grant WB, Garland CF, The association of solar ultraviolet B (UVB) with reducing risk of cancer: multifactorial ecologic analysis of geographic variation in age-adjusted cancer mortality rates, Anticancer Res, 2006;26(4A):2687–99. Lin SW, Wheeler DC, Park Y, et al., Prospective study of ultraviolet radiation exposure and risk of cancer in the U.S, Int J Cancer, 2012;131(6):E1015–23. Nelson DE, Jarman DW, Rehm J, et al., Alcohol-attributable cancer deaths and years of potential life lost in the United States, Am J Public Health, 2013;103(4):641–8. Grant WB, Ecological studies of the UVB–vitamin D–cancer hypothesis; review, Anticancer Res, 2012;32(1):223–36. Grant WB, Role of solar UV irradiance and smoking in cancer as inferred from cancer incidence rates by occupation in Nordic countries, Dermatoendocrinol, 2012;4(2):203–11. Tuohimaa P, Pukkala E, Scelo G, et al., Does solar exposure, as indicated by the non-melanoma skin cancers, protect from solid cancers: Vitamin D as a possible explanation, Eur J Cancer, 2007;43:1701–1712. Mondul AM, Weinstein SJ, Männistö S, et al., Serum vitamin D and risk of bladder cancer, Cancer Res, 2010;70 9218–23. Peiris AN, Bailey BA, Manning T, Relationship of vitamin D monitoring and status to bladder cancer survival in veterans, South Med J, 2013;106(2):126–30. Grant WB, Relation between prediagnostic serum 25-hydroxyvitamin D level and incidence of breast, colorectal, and other cancers, J Photochem Photobiol B, 2010;101(2):130–36. Yang L, Veierod MB, Lof M, et al., Prospective study of UV exposure and cancer incidence among Swedish women, Cancer Epidemiol Biomarkers Prev, 2011;20(7);1358–67. Tretli S, Schwartz GG, Torjesen PA, Robsahm TE, Serum levels of 25-hydroxyvitamin D and survival in Norwegian patients with cancer of breast, colon, lung, and lymphoma: a population-based study, Cancer Causes Control, 2012;23(2):363–70. Epstein E, Lindqvist PG, Geppert B, Olsson H, A population-based cohort study on sun habits and endometrial cancer, Br J Cancer, 2009;101(3):537–40. Tran B, Lucas R, Kimlin M, et al., Association between ambient ultraviolet radiation and risk of esophageal cancer, Am J Gastroenterol, 2012;107:1803–13. Ren C, Qiu MZ, Wang DS, et al., Prognostic effects of 25-hydroxyvitamin D levels in gastric cancer, J Transl Med, 2012;10(1):16. Cheng TY, Neuhouser ML, Serum 25-hydroxyvitamin D, vitamin A, and lung cancer mortality in the US population: a potential nutrient-nutrient interaction, Cancer Causes Control, 2012;23(9):1557–65. Toriola AT, Surcel HM, Calypse A, et al., Independent and joint effects of serum 25-hydroxyvitamin D and calcium on ovarian cancer risk: A prospective nested case-control study, Eur J Cancer, 2010;46(15):2799–805. Tran B, Jordan SJ, Lucas RM, et al., Association between ambient ultraviolet radiation and risk of epithelial ovarian cancer, Cancer Prev Res (Phila), 2012;5(11):1330–36. Wolpin BM, Ng K, Bao Y, et al., Plasma 25-hydroxyvitamin D and risk of pancreatic cancer, Cancer Epidemiol Biomarkers Prev, 2012;21(1):82–91. Gilbert R, Metcalfe C, Fraser WD, et al., Associations of circulating 25-hydroxyvitamin D with prostate cancer diagnosis, stage and grade, Int J Cancer, 2012;131(5):1187–96. Salehin D, Haugk C, Thill M, et al., Serum 25-hydroxyvitamin D levels in patients with vulvar cancer, Anticancer Res, 2012;32 265–70. Pukkala E, Martinsen JI, Lynge E, et al., Occupation and cancer – follow-up of 15 million people in five Nordic countries, Acta Oncol, 2009;48:646–790. Garland CF, Garland FC, Gorham ED, Epidemiologic evidence for different roles of ultraviolet A and B radiation in melanoma mortality rates, Ann Epidemiol, 2003;13(6):395–404. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45. 46. 47. 16  ng/ml for black Americans, 21  ng/ml for Hispanic Americans, and 26  ng/ml for white Americans. 42 Thus, about two-thirds of Americans had suboptimal serum 25(OH)D concentrations then, and with the rising prevalence of obesity, the fraction is probably higher now. Serum 25(OH) D concentrations above 30–40  ng/ml confer many health benefits, along with virtually no substantiated health risks below 100 ng/ml. And vitamin D supplements are inexpensive. Therefore, implementing these recommendations makes good public-health sense. n Lin JS, Eder M, Weinmann S, et al., Behavioral counseling to prevent skin cancer: Systematic evidence review to update the 2003 U.S. Preventive Services Task Force Recommendation [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2011 Feb. Chang YM, Barrett JH, Bishop DT, et al., Sun exposure and melanoma risk at different latitudes: a pooled analysis of 5700 cases and 7216 controls, Int J Epidemiol, 2009;38(3):814–30. Grant WB, An ecologic study of cancer mortality rates in Spain with respect to indices of solar UV irradiance and smoking, Int J Cancer, 2007;120(5):1123-7. Grant WB, An ecological study of cancer mortality rates in California, 1950–64, with respect to solar UVB and smoking indices, Dermatoendocrinol, 2012;4(2):176–82. Hill AB, The environment and disease: Association or causation?, Proc R Soc Med, 1965;58:295–300. Biesalski HK, Aggett PJ, Anton R, et al., 26th Hohenheim Consensus Conference, September 11, 2010 Scientific substantiation of health claims: evidence-based nutrition, Nutrition, 2011;27(10 Suppl.):S1–20. Grant WB, How strong is the evidence that solar ultraviolet B and vitamin D reduce the risk of cancer? An examination using Hill’s criteria for causality, Dermatoendocrinol, 2009;1(1):17–24. Mohr SB, Gorham ED, Alcaraz JE, et al., Does the evidence for an inverse relationship between serum vitamin D status and breast cancer risk satisfy the Hill criteria?, Dermatoendocrin, 2012;4(2):152–7. Pike JW, Meyer MB, The vitamin D receptor: new paradigms for the regulation of gene expression by 1,25-dihydroxyvitamin D3, Rheum Dis Clin North Am, 2012;38(1):13–27. Pilz S, Vitamin D and cancer: current evidence and future perspective, Anticancer Agents Med Chem, 2013;13(1):2–3. Grant WB, A review of the evidence regarding the solar ultraviolet-B–vitamin D–cancer hypothesis, Standardy Medyczne/ Pediatria, 2012;9:610–19. Bakhru A, Mallinger JB, Buckanovich RJ, Griggs JJ, Casting light on 25-hydroxyvitamin D deficiency in ovarian cancer: A study from the NHANES, Gynecol Oncol, 2010;119(2):314–18. Grant WB, Effect of interval between serum draw and follow-up period on relative risk of cancer incidence with respect to 25-hydroxyvitamin D level; implications for meta-analyses and setting vitamin D guidelines, Dermatoendocrinol, 2011;3(3):199– 204. Zehnder D, Bland R, Williams MC, et al., Extrarenal expression of 25-hydroxyvitamin d(3)-1 alpha-hydroxylase, J Clin Endocrinol Metab, 2001;86(2):888–94. Oh EY, Ansell C, Nawaz H, et al., Global breast cancer seasonality, Breast Cancer Res Treat, 2010;123(1):233–43. Helzlsouer KJ, For the VDPP Steering Committee. Overview of the Cohort Consortium Vitamin D Pooling Project of Rarer Cancers, Am J Epi, 2010;172:4–9. Grant WB, An ecological study of cancer mortality rates in the United States with respect to solar ultraviolet-B doses, smoking, alcohol consumption, and urban/rural residence, Dermatoendocrinol, 2010;2(2):68–76. Ginde AA, Liu MC, Camargo CA Jr, Demographic differences and trends of vitamin D insufficiency in the US population, 1988–2004, Arch Intern Med, 2009;169(6):626–32. Grant WB, Peiris AN, Differences in vitamin D status may account for unexplained disparities in cancer survival rates between African and White Americans, Dermatoendocrinol, 2012;4(2):85–94. Grant WB, Effect of follow-up time on the relation between prediagnostic serum 25-hydroxyitamin D and all-cause mortality rate, Dermatoendocrinol, 2012;4(2):198–202. Fleet JC, Desmet M, Johnson R, Li Y, Vitamin D and cancer: a review of molecular mechanisms, Biochem J, 2012;441(1):61–76. Lappe JM, Travers-Gustafson D, Davies KM, et al., Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial, Am J Clin Nutr, 2007;85(6):1586–91. Bolland MJ, Grey A, Gamble GD, Reid IR, Calcium and vitamin D supplements and health outcomes: a reanalysis of the Women’s Health Initiative (WHI) limited-access data set, Am J Clin Nutr, 2011;94(4):1144–9. 48. 49. 50. 51. 52. 53. 54. 55. 56. 57. 58. 59. 60. 61. 62. 63. 64. 65. 66. 67. 68. 69. 70. Lappe JM, Heaney RP, Why randomized controlled trials of calcium and vitamin D sometimes fail, Dermatoendocrin, 2012;4(2):95–100. Peterlik M, Grant WB, Cross HS, Calcium, vitamin D and cancer, Anticancer Res, 2009;29(9):3687–98. Garland CF, Gorham ED, Mohr SB, Garland FC, Vitamin D for cancer prevention: Global perspective, Ann Epi, 2009;19(7): 468–83. Mocellin S, Vitamin D and cancer: Deciphering the truth, Biochim Biophys Acta, 2011;1816(2):172–8. Krishnan AV, Trump DL, Johnson CS, Feldman D, The role of vitamin D in cancer prevention and treatment, Rheum Dis Clin North Am, 2012;38(1):161–78. Ross AC, Manson JE, Abrams SA, et al., The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know, J Clin Endocrinol Metab, 2011;96(1):53–8. Grant WB, Benefits of ultraviolet-B irradiance and vitamin D in youth, J Steroid Biochem Molec Bio, 2012; Epub ahead of print. Armstrong B, Doll R, Environmental factors and cancer incidence and mortality in different countries, with special reference to dietary practices, Int J Cancer, 1975;15(4):617–31. Cho E, Chen WY, Hunter DJ, et al. Red meat intake and risk of breast cancer among premenopausal women, Arch Intern Med, 2006;166(20):2253–9. Friedland RP, Nandi S, A modest proposal for a longitudinal study of dementia prevention (with apologies to Jonathan Swift, 1729), J Alzheimers Dis, 2013;33(2):313–15. Grant WB, In defense of the sun: An estimate of changes in mortality rates in the United States if mean serum 25-hydroxyvitamin D levels were raised to 45 ng/mL by solar ultraviolet-B irradiance. Dermatoendocrinol, 2009;1(4):207–14. Jablonski NG, Chaplin G. Colloquium paper: human skin pigmentation as an adaptation to UV radiation, Proc Natl Acad Sci U S A, 2010;107 Suppl 2:8962–8. Durup D, Jørgensen HL, Christensen J, et al., A reverse J-shaped association of all-cause mortality with serum 25-hydroxyvitamin D in general practice, the CopD Study, J Clin Endocrinol Metab, 2012;97(8):2644–52. Ensrud KE, Ewing SK, Fredman L, et al., Circulating 25-hydroxyvitamin D levels and frailty status in older women, J Clin Endocrinol Metab, 2010;95(12):5266–73. Ensrud KE, Blackwell TL, Cauley JA, et al., Circulating 25-hydroxyvitamin D levels and frailty in older men: the osteoporotic fractures in men study, J Am Geriatr Soc, 2011;59(1):101–6. Zittermann A, Iodice S, Pilz S, et al., Vitamin D deficiency and mortality risk in the general population: A meta-analysis of prospective cohort studies, Am J Clin Nutr, 2012;95(1):91–100. Anderson JL, May HT, Horne BD, et al., Relation of vitamin D deficiency to cardiovascular risk factors, disease status, and incident events in a general healthcare population, Am J Cardiol, 2010;106(7):963–8. Vacek JL, Vanga SR, Good M, et al., Vitamin D deficiency and supplementation and relation to cardiovascular health, Am J Cardiol, 2012;109(3):359–63. Afzal S, Bojesen SE, Nordestgaard BG, Low 25-hydroxyvitamin D and risk of type 2 diabetes: A prospective cohort study and meta- analysis, Clin Chem, 2013;59(2):381–91 Souberbielle JC, Body JJ, Lappe JM, et al., Vitamin D and musculoskeletal health, cardiovascular disease, autoimmunity and cancer: Recommendations for clinical practice, Autoimmun Rev, 2010;9(11):709–15. Grant WB, An estimate of the global reduction in mortality rates through doubling vitamin D levels, Eur J Clin Nutr, 2011;65(9):1016–26. Holick MF, Binkley NC, Bischoff-Ferrari HA, et al., Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society Clinical Practice Guideline, J Clin Endocrinol Metab, 2011;96(7):1911–30. Garland CF, French CB, Baggerly LL, Heaney RP, Vitamin D supplement doses and serum 25-hydroxyvitamin D in the range associated with cancer prevention, Anticancer Res, 2011;31:617–22. US E ndocrinology