culated in the upper three deciles compared with the lower seven deciles the significant difference was attenuated. A population-based case–control study of women ages 25 to 74 years in Canada compared vitamin D and calcium intake from food alone or from food and supplements. When intake above 400 IU of vitamin D per day was compared with no intake, a reduced risk was found. Calcium supplement intake alone, however, did not correlate with reduced risk, although a significant inverse trend was identified (Anderson et al., 2010). Two studies were identified that examined associations between dairy intake and risk of breast cancer. Shin et al. (2002) analyzed data from the NHS 1980 cohort for dairy intake and incident breast cancer. Over 16 years of follow-up, a significant inverse association was found for premenopausal women consuming low-fat dairy products and breast cancer risk. No association was found for calcium and vitamin D intake and postmenopausal breast cancer risk. Supplemental calcium intake had no linear association and supplemental vitamin D intake a weak but non-significant association with breast cancer risk in both premenopausal and postmenopausal women. Using a similar study design, McCullough et al. (2005), in an analysis of participants from the Cancer Prevention Study II Nutrition Cohort, found that two or more daily servings of dairy products were inversely associated with breast cancer risk; however, no association was found for either calcium or vitamin D supplementation. Women with dietary calcium intakes above 1,250 mg/day had lower breast cancer risk than women with intakes at or below 500 mg/day. Altogether, these observational studies were of lower quality and thus not considered as strong support for an association between vitamin D and risk for breast cancer, and they were not well supported by randomized trial evidence.

Concluding statement In summary, although experimental studies are suggestive of a role for vitamin D in breast biology, a review of the available evidence from both RCTs and observational studies of associations between vitamin D and calcium and risk of breast cancer shows a lack of consistency between study outcomes and insufficiently strong evidence to support DRI development. Both retrospective and prospective studies do not show consistent associations between estimated vitamin D intake or 25OHD status and breast cancer risk. A paucity of RCTs of vitamin D, calcium, or both with breast cancer as a primary outcome further limited the strength of the evidence.

Foods, nutrients, and physical activity all interact in a complex array of mechanisms to influence colorectal cancer risk. There is convincing evidence that physical activity protects against colorectal cancer, whereas