First published November 25, 2015, doi: 10.3945/ajcn.114.101436
Am J Clin Nutr
Vegetable and fruit consumption and the risk of hormone receptor–defined breast cancer in the EPIC cohort 1,2
Marleen J Emaus3, Petra HM Peeters3,4, Marije F Bakker3, Kim Overvad5, Anne Tjønneland6, Anja Olsen6, Isabelle Romieu7, Pietro Ferrari7, Laure Dossus8,9,10, Marie Christine Boutron-Ruault8,9,10, Laura Baglietto11,12, Renée T Fortner13, Rudolf Kaaks13, Heiner Boeing14, Antonia Trichopoulou15,16,17, Pagona Lagiou16,17,18, Dimitrios Trichopoulos15,17,18, Giovanna Masala19, Valeria Pala20, Salvatore Panico21, Rosario Tumino22, Silvia Polidoro23, Guri Skeie24, Eiliv Lund24, Elisabete Weiderpass24,25,26,27, J Ramón Quirós28, Noémie Travier29, María-José Sánchez30,31, Maria-Dolores Chirlaque31,32, Eva Ardanaz31,33, Miren Dorronsoro34, Anna Winkvist35,36, Maria Wennberg36, H Bas Bueno-de-Mesquita4,37–39, Kay-Tee Khaw40, Ruth C Travis41, Timothy J Key41, Dagfinn Aune4, Marc Gunter4, Elio Riboli4, and Carla H van Gils3,*
3Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands;
4Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom;
5Section of Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark;
6Danish Cancer Society Research Center, Copenhagen, Denmark;
7International Agency for Research on Cancer, Lyon, France;
8INSERM, Center for Research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones, and Women’s Health Team, Villejuif, France;
9University Paris Sud, UMRS 1018, Villejuif, France;
10Gustave Roussy Institute, Villejuif, France;
11Cancer Epidemiology Centre, Cancer Council of Victoria, Melbourne, Australia;
12Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Australia;
13Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany;
14Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany;
15Hellenic Health Foundation, Athens, Greece;
16Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Goudi, Athens, Greece;
17Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece;
18Department of Epidemiology, Harvard School of Public Health, Boston, MA;
19Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute–ISPO, Florence, Italy;
20Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy;
21Dipartimento Di Medicina Clinica E Chirurgia, Federico II University, Naples, Italy;
22Cancer Registry and Histopathology Unit, Civic–M.P. Arezzo Hospital, ASP Ragusa, Italy;
23Human Genetic Foundation (HuGeF), Turin, Italy;
24Department of Community Medicine, School of Health Sciences, University of Tromso, The Arctic University of Norway, Tromso, Norway;
25Department of Research, The Cancer Registry of Norway, Oslo, Norway;
26Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden;
27Folkhälsan Research Center, Samfundet Folkhälsan, Helsinki, Finland;
28Public Health Directorate, Asturias, Spain;
29Unit of Nutrition, Environment, and Cancer, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain;
30Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs.GRANADA, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain;
31CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain;
32Epidemiology Department, Regional Health Council, Murcia, Spain;
33Navarre Public Health Institute, Pamplona, Spain;
34Public Health Direction and Biodonostia-Ciberesp Basque Regional Health Department, San Sebastian, Spain;
35Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;
36Department of Public Health and Clinical Medicine, Nutritional Research, Umeå University, Umeå, Sweden;
37Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands;
38Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, Netherlands;
39Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia;
40University of Cambridge, Cambridge, United Kingdom; and
41Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
↵1 Supported by the Netherlands Organization for Health Research and Development (grant ZONMW-200320002-UMCU; to MJE); Associazione Italiana per la Ricerca sul Cancro–Italy (GM); Public Health Programme of the European Union (2005328); Europe against Cancer Programme of the European Commission (SANCO); French League against Cancer (LNCC); National Institute for Health and Medical Research (INSERM), France; Mutuelle Generale de l’Education Nationale, France; 3M Co., France; Gustave Roussy Institute, France; General Councils of France; German Cancer Aid; German Cancer Research Center; German Federal Ministry of Education and Research; Danish Cancer Society; Health Research Fund (FIS) of the Spanish Ministry of Health (Exp P10710130); Regional Governments of Andalucía, Asturias, Basque Country, Murcia (6236), Navarra, and the Catalan Institute of Oncology, La Caixa (BM 06-130), RTICC-RD06/0020 (Spain); Cancer Research UK; Medical Research Council UK; the Hellenic Health Foundation, Greece; the Italian Association for Research on Cancer; the Italian National Research Council; Fondazione-Istituto Banco Napoli, Italy; Compagnia di San Paolo; Dutch Ministry of Public Health, Welfare, and Sports; Dutch Prevention Funds; LK Research Funds; Dutch ZON (Zorg Onderzoek Nederland); World Cancer Research Fund; Statistics Netherlands; Swedish Cancer Society; Swedish Scientific Council; Regional Government of Skane, Sweden; and the Nordforsk Center of Excellence Program in Food, Nutrition and Health (Helga), Norway.
↵2 Supplemental Figures 1–5 and Supplemental Tables 1 and 2 are available from the “Online Supporting Material” link in the online posting of the article and from the same link in the online table of contents at http://ajcn.nutrition.org.
↵*To whom correspondence should be addressed. E-mail: email@example.com.
Background: The recent literature indicates that a high vegetable intake and not a high fruit intake could be associated with decreased steroid hormone receptor–negative breast cancer risk.
Objective: This study aimed to investigate the association between vegetable and fruit intake and steroid hormone receptor–defined breast cancer risk.
Design: A total of 335,054 female participants in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort were included in this study (mean ± SD age: 50.8 ± 9.8 y). Vegetable and fruit intake was measured by country-specific questionnaires filled out at recruitment between 1992 and 2000 with the use of standardized procedures. Cox proportional hazards models were stratified by age at recruitment and study center and were adjusted for breast cancer risk factors.
Results: After a median follow-up of 11.5 y (IQR: 10.1–12.3 y), 10,197 incident invasive breast cancers were diagnosed [3479 estrogen and progesterone receptor positive (ER+PR+); 1021 ER and PR negative (ER−PR−)]. Compared with the lowest quintile, the highest quintile of vegetable intake was associated with a lower risk of overall breast cancer (HRquintile 5–quintile 1: 0.87; 95% CI: 0.80, 0.94). Although the inverse association was most apparent for ER−PR− breast cancer (ER−PR−: HRquintile 5–quintile 1: 0.74; 95% CI: 0.57, 0.96; P-trend = 0.03; ER+PR+: HRquintile 5–quintile 1: 0.91; 95% CI: 0.79, 1.05; P-trend = 0.14), the test for heterogeneity by hormone receptor status was not significant (P-heterogeneity = 0.09). Fruit intake was not significantly associated with total and hormone receptor–defined breast cancer risk.
Conclusion: This study supports evidence that a high vegetable intake is associated with lower (mainly hormone receptor–negative) breast cancer risk.
See other articles about Cancer: Breast, Nutrition is Medicine, Nutrition: Vegetarianism