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I agree with the authors’ conclusions that cancer survival in the UK might be linked to austerity, staff shortages, the GP’s gate keeper function and other factors (1). However, the humble supplement of vitamin D appears to be ignored, despite the fact that the UK has significantly lower serum 25(OH)D levels than for instance the US or Canada, where population wide food supplementation has provided vitamin D for decades.
Recent research results, at long last, confirm our clinical impressions in general practice that better supply with vitamin D helps cancer survival (2,3). The UK does have a problem with widespread vitamin D deficiency, worst in Scotland, noticeable in general practice through the many patients who improved their vague osteomalacia symptoms (tiredness, muscle pains, depressed feelings and frequent infections) with sufficient vitamin D supplements. Others have pointed to this tip of the iceberg (4), to the potential cost savings to the NHS (5) and called for food fortification (6,7). Finland has started vitamin D food fortification in the past 10 years (8)
(1) UK’s poor performance on cancer survival. BMJ 2019;367:l6122
(2) Samji V, Haykal T, Zayed Y. et al. Role of vitamin D supplementation for primary prevention of cancer: Meta-analysis of randomized controlled trials. Journal of Clinical Oncology 2019 37:15_suppl, 1534-1534
(3) Manson JAE, Bassuk SS, Buring JE. et al. Principal Results of the VITamin D and OmegA-3 TriaL (VITAL) and Updated Meta-analyses of Relevant Vitamin D Trials. The Journal of Steroid Biochemistry and Molecular Biology, 2019
(4) Uday S, Högler W. Spot the silent sufferers: A call for clinical diagnostic criteria for solar and nutritional osteomalacia. J Steroid Biochem Mol Biol. 2019 Apr;188:141-146
(5) Aguiar, M., Andronis, L., Pallan, M. et al. The economic case for prevention of population vitamin D deficiency: a modelling study using data from England and Wales. Eur J Clin Nutr (2019)
(6) Roth DE, Abrams SA, Aloia J. et al. Global prevalence and disease burden of vitamin D deficiency: a roadmap for action in low- and middle-income countries. Ann. N.Y. Acad. Sci. 2018 Oct;1430(1):44-79
(7) Pilz S, März W, Cashman KD. et al. Rationale and Plan for Vitamin D Food Fortification: A Review and Guidance Paper. Front. Endocrinol., 17 July 2018
(8) Raulio S, Erlund I, Männistö S. et al. Successful nutrition policy: improvement of vitamin D intake and status in Finnish adults over the last decade. European Journal of Public Health, Volume 27, Issue 2, April 2017, Pages 268–273,
Competing interests:
No competing interests
19 November 2019
Helga M Rhein
retired general practitioner
previously Sighthill Health Centre Edinburgh
previously Sighthill Health Centre, 380 Calder Road, Edinburgh EH11 4AU
The authors correctly indicate that international comparisons of cancer survival should be interpreted with caution because of difference in the way data is collected and recorded. They highlight a recent study that suggests that cancer survival in England may be truly worse than in other countries.
However, early diagnosis and a better cancer survival rate does not necessarily equate to better healthcare. Early cancer diagnosis would definitely benefit some patients but could harm others due to the risk of overdiagnosis as many of these stage 1 cancers may never have been destined to cause problems in that patient's lifetime. However, since the latter patients have an excellent prognosis, they could significantly improve the overall cancer survival rates.
Early diagnosis is more likely to be beneficial if there is a reduction in the number of patients presenting with higher stage disease or reduction in the population cancer mortality rate. The latter would be multifactorial as it would be influenced by prevention, early diagnosis and better treatment, but would reflect a truly better healthcare system.
Re: UK’s poor performance on cancer survival ... might be improved with sufficient vitamin D
I agree with the authors’ conclusions that cancer survival in the UK might be linked to austerity, staff shortages, the GP’s gate keeper function and other factors (1). However, the humble supplement of vitamin D appears to be ignored, despite the fact that the UK has significantly lower serum 25(OH)D levels than for instance the US or Canada, where population wide food supplementation has provided vitamin D for decades.
Recent research results, at long last, confirm our clinical impressions in general practice that better supply with vitamin D helps cancer survival (2,3). The UK does have a problem with widespread vitamin D deficiency, worst in Scotland, noticeable in general practice through the many patients who improved their vague osteomalacia symptoms (tiredness, muscle pains, depressed feelings and frequent infections) with sufficient vitamin D supplements. Others have pointed to this tip of the iceberg (4), to the potential cost savings to the NHS (5) and called for food fortification (6,7). Finland has started vitamin D food fortification in the past 10 years (8)
(1) UK’s poor performance on cancer survival. BMJ 2019;367:l6122
(2) Samji V, Haykal T, Zayed Y. et al. Role of vitamin D supplementation for primary prevention of cancer: Meta-analysis of randomized controlled trials. Journal of Clinical Oncology 2019 37:15_suppl, 1534-1534
(3) Manson JAE, Bassuk SS, Buring JE. et al. Principal Results of the VITamin D and OmegA-3 TriaL (VITAL) and Updated Meta-analyses of Relevant Vitamin D Trials. The Journal of Steroid Biochemistry and Molecular Biology, 2019
(4) Uday S, Högler W. Spot the silent sufferers: A call for clinical diagnostic criteria for solar and nutritional osteomalacia. J Steroid Biochem Mol Biol. 2019 Apr;188:141-146
(5) Aguiar, M., Andronis, L., Pallan, M. et al. The economic case for prevention of population vitamin D deficiency: a modelling study using data from England and Wales. Eur J Clin Nutr (2019)
(6) Roth DE, Abrams SA, Aloia J. et al. Global prevalence and disease burden of vitamin D deficiency: a roadmap for action in low- and middle-income countries. Ann. N.Y. Acad. Sci. 2018 Oct;1430(1):44-79
(7) Pilz S, März W, Cashman KD. et al. Rationale and Plan for Vitamin D Food Fortification: A Review and Guidance Paper. Front. Endocrinol., 17 July 2018
(8) Raulio S, Erlund I, Männistö S. et al. Successful nutrition policy: improvement of vitamin D intake and status in Finnish adults over the last decade. European Journal of Public Health, Volume 27, Issue 2, April 2017, Pages 268–273,
Competing interests: No competing interests