Diet and prognosis of breast cancer.

The relationship between the occurrence of breast cancer and dietary intake, in particular a high-fat diet, has attracted much attention in recent years. In addition, the prognosis of breast cancer patients on the basis of dietary intake is also an interesting subject. The present study utilized breast cancer patients whose dietary intake was carefully assessed about one decade previously in a case-control study to determine whether dietary intake was indeed related to the patients' prognosis. The study included 212 patients who underwent a surgical operation between 1975 and 1978. They were followed-up until 1987, and a total of 47 breast cancer deaths were certified. The 5- and 10-year relative survival rates were 78.5% and 75.3%, respectively. The older patients tended to ingest smaller amounts of all nutrients, except animal fat from fish. Height was significantly correlated with total animal protein intake, whereas there was no significant correlation between body mass index and intake of any nutrient. Although the age-adjusted mean values of the nutrient intakes, other than vegetable fat, decreased with advancing stage, the differences were statistically insignificant. The results of multivariate analyses, in which some confounding factors (e.g., clinical stage) were adjusted using a proportional hazards model, showed that all hazards ratios in each nutrient were close to unity, and no dose-response relationship was seen. The present investigation did not provide any support for the hypothesis that a high-fat diet is a survival determinant for breast cancer patients.(ABSTRACT TRUNCATED AT 250 WORDS)     

Diet and breast cancer

Obesity, overweight, and a sedentary lifestyle-all common conditions in breast cancer patients-are likely to be associated with poor survival and poor quality of life in women with breast cancer. Diet-related factors are thought to account for about 30% of cancers in developed countries. Most studies of diet and healthcare have focused on the role of single nutrients, foods, or food groups in disease prevention or promotion. Recent cancer guidelines on nutrition and physical activity emphasize diets that promote maintenance of a healthy body weight and a prudent dietary pattern that is low in red and processed meats and high in a variety of vegetables, fruits, and whole grains. Except for dietary fat, few nutritional factors in adult life have been associated with breast cancer. Extensive data from animal model research, international correlations linking fat intake and breast cancer rates, and case-control studies support the hypothesis that a high-fat diet is conducive to the development of breast cancer in postmenopausal women. Conflicting findings from cohort studies, however, have created uncertainty over the role of dietary fat in breast cancer growth and recurrence. Results from large-scale nutritional intervention trials are expected to resolve such issues. As new and improved data on dietary factors and patterns accumulate, dietary guidelines for cancer risk reduction will become more focused.     

Diet, hormones, genes, and breast cancer

The review describes on-going studies at the Unit of cancer epidemiology of the National Cancer Institute in Milan-Breast carcinogenesis is reviewed addressing: 1) Hormones and breast cancer 2) Diet and breast cancer 3) Diet and hormones 4) Potentiality of dietary prevention in women at high genetic risk.     

Diet and breast cancer: a review.

Diet may promote or inhibit human breast cancer through its effects on hormonal systems. In this paper, risk factors with potential dietary components, geographic variations related to diet, experimental studies on diet and mammary tumors, and hormonal hypotheses are reviewed. The associations of early menarche with higher risk, and of early first pregnancy with lower risk suggest that events during teenage years may be determinants of breast cancer. Although data on the association between obesity and mammary cancer are not entirely consistent, it does seem clear that body fatness at menarche and during postmenopausal years may influence hormonal synthesis and metabolism. Published reports based on the Food and Agricultural Organization's food availability data or frequencies of individual foods are inadequate for associating diet with breast cancer incidence or mortality. Also, diets and susceptibility to breast cancer vary among species, and therefore results from rodent experiments should not be extrapolated to humans. Circumstantial evidence suggests that patterns of hormone metabolism in early years of life may be determinants of breast cancer risk. Research concerning the relationship of androgens, prolactin, estrogens, and possibly other hormones to risk factors should be continued. Further, there is a need for data relating dietary factors to hormone synthesis and metabolism. Epidemiological studies among young women in low- and high-risk countries are recommended. Comparisons of diet, body fatness, and hormonal levels could provide further insight about the relationship of diet to breast cancer risk. These same factors should be measured in case-controls studies, along with qualitative estimates of previous diet and possibly weight and height during adolescence. Dietary indices associated with early menarche may be the same as those related to breast cancer. Results of these investigations may provide valuable leads for preventive health programs.     

Diet, mammographic features of breast tissue, and breast cancer risk

This case-control study was designed to reevaluate the association of the morphology of breast tissue seen on mammograms with breast cancer risk and to assess the relation of diet, especially intake of fat and vitamin A, to the high-risk mammographic images. The cases included 290 patients with newly diagnosed breast cancer who were first treated in Quebec in 1982-1984. The controls included 645 women who participated in the Canadian National Breast Screening Study. Risk of breast cancer was higher among women with the P2 or DY parenchymal pattern (relative risk (RR) = 3.7, 95% confidence interval (Cl) 2.0-7.0) than it was among those with the N1 pattern. Moreover, risk increased regularly with the extent of nodular and homogeneous densities on the mammogram. Relative risk was 5.5 (95% Cl 2.3-13.2) for women in whom 60% or more of the volume of the breast showed either nodular or homogeneous densities compared with women without such densities. Among controls, increase in energy-adjusted saturated fat intake was associated with an increase in extent of high-risk mammographic features. Energy-adjusted polyunsaturated fat or cholesterol intake did not, however, appear to influence the morphology of breast tissue seen on the mammogram. Increasing carotenoid and fiber intakes were associated with a reduction of the extent of densities on the mammogram, but retinol intake seemed to have little or no effect on mammographic features. These data suggest that elevation in saturated fat intake and reduction in carotenoid and fiber intakes may be related to an increase in breast cancer risk through effects of these nutrients on breast tissue morphology.     

Diet, serum, breast fluid growth hormone, and prolactin levels in normal premenopausal Finnish and American women

A food frequency questionnaire was used to estimate and compare the dietary fat and fiber consumption of 94 premenopausal women in Kuopio (rural Finland, where there is a relatively low risk of breast cancer) and 61 American women in New York (where there is a high risk of breast cancer). In keeping with previous reports concerning middle-aged men, both groups had high fat intakes, but the Finnish women had considerably higher fiber intakes (24 +/- 11 vs. 16 +/- 6 g). Serum and breast fluid growth hormone and prolactin levels were compared in 29 of these American women and 24 of the Finnish women. All were healthy and had regular menstrual cycles. Serum growth hormone levels, which were measured by radioimmunoassay, were higher in the Finnish women; all but three of their breast fluids contained detectable growth hormone, frequently at extremely high concentration. In contrast, only 2 of the 29 breast fluids from American women had detectable amounts of growth hormone. Of the Finnish samples, 10 were also measured by an immunoradiometric assay with high specificity for the 22,000-dalton growth hormone molecule; all but 3 had values less than 3.0 ng/ml. Serum and breast fluid prolactin concentrations, which were determined by radioimmunoassay, were no different in the two groups; both groups frequently had considerably higher levels in breast fluid compared with the corresponding serum.(ABSTRACT TRUNCATED AT 250 WORDS)     

Diet quality indices and postmenopausal breast cancer survival

Research on diet in breast cancer survival has been focused on single nutrients or foods, particularly dietary fat, fruits, vegetables, fiber, and alcohol. We hypothesized that diet quality indices decrease the risk of total and non-breast-cancer-related deaths in women diagnosed with breast cancer. We evaluated 4 dietary quality scores: Alternate Healthy Eating Index (AHEI), Diet Quality Index-Revised (DQIR), Recommended Food Score (RFS), and the alternate Mediterranean Diet Score (aMED), among 2,729 women from the Nurses' Health Study with invasive Stage 1-3 breast cancer diagnosed between 1978 and 1998 with follow-up through 2004. In multivariate adjusted analyses, no association was found between diet quality indices and either total or non-breast-cancer-related deaths. However, a higher aMED score was associated with a lower risk of non-breast-cancer death in women with low physical activity; the RR comparing the highest to lowest tertile was 0.39 (95% CI, 0.20-0.75, P trend = 0.0004). Our results suggest that a higher-quality diet after breast cancer diagnosis does not considerably change the risk of death from breast cancer. However, healthy dietary choices may be important because women are at risk of death from non-breast-cancer-related causes affected by diet.     

Relationship of blood prolactin levels and the risk of subsequent breast cancer.

Between 1968 and 1976 a total of 5162 women volunteers were enrolled into a prospective study conducted on the Island of Guernsey. Up to February 1990 145 women subsequently developed breast cancer. Blood samples were taken at the time of enrollment and prolactin levels were known for 85% of the volunteers. In calculating the relationship between blood prolactin levels and subsequent breast cancer risk, women were excluded if they had a hysterectomy or an oophorectomy or had cancer at any site before enrollment. The final analysis was based on 2596 premenopausal and 1180 naturally postmenopausal women and, of these respectively, there were 71 and 40 volunteers who subsequently developed breast cancer. The total follow-up for these two groups was 49,941 and 22,360 woman-years, respectively. In assessing the relationship between blood prolactin levels and risk of subsequent breast cancer the cohort was divided into quintiles according to prolactin concentration and relative risks (RR) were estimated. In calculating these values possible confounding by age at entry, age at menarche, parity, age at first birth, years since menopause, body build, history of benign breast disease and family history of breast cancer were taken into consideration. There was no significant relation between risk of breast cancer and prolactin in either pre- or postmenopausal women. Hence prolactin appears not to be an important determinant of breast cancer risk.     

Diet among breast cancer survivors and healthy women. The Norwegian Women and Cancer Study

OBJECTIVE: To compare the diet and lifestyle in breast cancer survivors and healthy women. DESIGN: Cross-sectional study in the population-based Norwegian Women and Cancer cohort study, using a postal questionnaire on diet, lifestyle and health. SETTING: Nation-wide, population-based study. SUBJECTS: Women aged 41-70 years. Prevalent breast cancer cases (314 short-term with 1-5 years since diagnosis, 352 long-term with >5 years since diagnosis) were identified by linkage to the Norwegian Cancer Registry. The comparison group consisted of 54,314 women. INTERVENTIONS: Analyses of variance, with post hoc Bonferroni tests when significant differences were found. RESULTS: Overall there were few differences in the diet of the three groups. Short-term survivors ate more fruits and vegetables than healthy women (P<0.0001), and consumed more of nutrients associated with fruit and vegetables (fibre, mono- and disaccharides, folate, vitamin C and potassium). Short-term breast cancer survivors also had a higher use of dietary supplements and a lower level of physical activity, but did not differ from healthy women on other lifestyle factors. The long-time survivors did not differ from any of the other groups. CONCLUSION: Diet and lifestyle is generally similar between breast cancer survivors and healthy women, especially more than 5 years after diagnosis.     

Family history of breast cancer, mammographic features of breast tissue, and breast cancer risk.

I reexamined the relations of family history of breast cancer in first-degree relatives, mammographic features of breast tissue, and breast cancer risk, using data from three case-control studies. Subjects included 1,047 cases with newly diagnosed breast cancer and 2,329 controls. Family history of breast cancer showed only a weak relation to mammographic features. In addition, while family history and mammographic features were each related to breast cancer risk, associations of these two factors with risk appeared additive. In contrast to previous reports, these data suggest that, to a large extent, family history and mammographic features have independent effects on breast cancer development.     

Diet and histologic types of benign breast disease defined by subsequent risk of breast cancer

The authors investigated the relation between diet and histologic types of benign breast disease defined by subsequent risk of breast cancer in a case-control study of volunteers who entered the Vancouver Center of the Canadian National Breast Screening Study between 1983 and 1985. Proliferative benign breast disease (n = 124) was inversely associated with vitamin A supplementation (vitamin A user vs. nonuser, odds ratio (OR) = 0.5) and frequent green vegetable consumption (frequent vs. rare consumption, OR = 0.3), whereas severe atypias and borderline carcinoma in situ (n = 32) were directly associated with frequent meat fats consumption (frequent vs. rare consumption, OR = 3.2) with no association with vitamin A or vegetable consumption. No dietary relations were found for histologic types of benign breast disease at no increased risk for subsequent breast cancer (n = 274). The implications of these findings in relation to the etiology of breast cancer are discussed.     

Diet and cancer

The effect of diet on cancers of the lung, esophagus, stomach, colon, breast, and cervix is reviewed, based on a series of studies in Japan. Individual and community cancer plans are discussed with special reference to diet. It is our hope to develop an effective and essential community cancer plan with an emphasis on lifestyle improvement. This includes proper management of problems of smoking, drinking, diet, and nutrition and the sound growth of supporting industries for each of these items. It is believed that these are the real bases of an individual cancer plan.