Vasomotor Symptoms, Adoption of a Low-Fat Dietary Pattern, and Risk of Invasive Breast Cancer: A Secondary Analysis of the Women's Health Initiative Randomized Controlled Dietary Modification Trial

Purpose To assess whether the effect of a low-fat dietary pattern on breast cancer incidence varied by report of baseline vasomotor symptoms. Methods Postmenopausal women age 50 to 79 years enrolled onto the Women's Health Initiative (WHI) Dietary Modification trial from 1993 to 1998 were randomly assigned to a low-fat dietary intervention (n = 19,541) or comparison (n = 29,294). Presence of vasomotor symptoms at baseline was ascertained from a 34-item self-report symptom inventory. Women were queried semi-annually for a new diagnosis of breast cancer. Each case report was verified by medical record and pathology report review by centrally trained WHI physician adjudicators. Results Among participants who reported hot flashes (HFs) at baseline (n = 3,375), those assigned to the low-fat diet had a breast cancer rate of 0.27 compared with their counterparts in the control group who had a rate of 0.41 (hazard ratio [HR] = 0.65; 95% CI, 0.42 to 1.01). Among women reporting no HFs (n = 45,160), the breast cancer rate was 0.42 in those assigned to the low-fat diet compared with 0.46 in the control group (HR = 0.93; 95% CI, 0.84 to 1.03; P for interaction = .12 by HF status). Furthermore, the dietary benefits observed seemed to be specific to estrogen receptor (ER) –positive/progesterone receptor (PR) –positive tumors (ER positive/PR positive v other, P for risk = .03). Although women with and without HFs differed with regard to breast cancer risk factors, the effect of the diet intervention on breast cancer incidence by HF status was consistent across risk factor strata. Conclusion The results of this trial, which are hypothesis generating, suggest that HFs may identify a subgroup of postmenopausal women whose risk of invasive breast cancer might be reduced with the adoption of a low-fat eating pattern.

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Low-fat dietary pattern and breast cancer mortality by metabolic syndrome components: a secondary analysis of the Women’s Health Initiative (WHI) randomised trial

British Journal of Cancer ◽

10.1038/s41416-021-01379-w ◽

2021 ◽

Author(s):

Kathy Pan ◽

Aaron K. Aragaki ◽

Marian L. Neuhouser ◽

Michael S. Simon ◽

Juhua Luo ◽

...

Keyword(s):

Breast Cancer ◽

Metabolic Syndrome ◽

Cancer Mortality ◽

Dietary Pattern ◽

Breast Cancer Mortality ◽

Randomised Trial ◽

Secondary Analysis ◽

Low Fat ◽

Health Initiative ◽

Metabolic Syndrome Components

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Breast cancer rate after oophorectomy: A Prospective Danish Cohort Study

International Journal of Cancer ◽

10.1002/ijc.33563 ◽

2021 ◽

Author(s):

Trine Koch ◽

Jeanette Therming Jørgensen ◽

Jane Christensen ◽

Christian Dehlendorff ◽

Lærke Priskorn ◽

...

Keyword(s):

Breast Cancer ◽

Cohort Study ◽

Cancer Rate ◽

Breast Cancer Rate ◽

Danish Cohort

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Increase in Distant Stage Breast Cancer Incidence Rates in US Women Aged 25–49 Years, 2000–2011: The Stage Migration Hypothesis

Journal of Cancer Epidemiology ◽

10.1155/2015/710106 ◽

2015 ◽

Vol 2015 ◽

pp. 1-7 ◽

Cited By ~ 6

Author(s):

Anthony P. Polednak

Keyword(s):

Breast Cancer ◽

Breast Cancer Incidence ◽

Relative Survival ◽

Distant Metastases ◽

Incidence Rates ◽

Stage Migration ◽

Relative Survival Rate ◽

Regional Stage ◽

Er Positive ◽

Using Data

Background.Unexplained increases have been reported in incidence rates for breast cancer diagnosed at distant stage in younger U.S. women, using data from the Surveillance, Epidemiology and End Results (SEER) Program.Methods.This report focused on recent SEER trends (2000–2011) in age-standardized incidence rates of invasive breast cancer at ages 25–39 and 40–49 years and the hypothesis that stage migration may have resulted from advances in detecting distant metastases at diagnosis.Results.Increases in the rates for distant stage were roughly equal to decreases in the rates for the most advanced stage subgroups within regional stage; this was evident for estrogen receptor (ER) negative cancers, associated with poorer prognosis, but not for ER positive cancers. The 3-year relative survival rate increased over time for distant stage (especially in the ER positive subgroup) and regional stage but not for localized stage; these trends do not contradict the stage-migration hypothesis.Conclusions.Findings provide some support for stage migration as one explanation for the recent increase in incidence of distant stage breast cancer, but additional studies are needed using other databases.

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Dietary Modification and Breast Cancer Mortality: Long-Term Follow-Up of the Women’s Health Initiative Randomized Trial

Journal of Clinical Oncology ◽

10.1200/jco.19.00435 ◽

2020 ◽

Vol 38 (13) ◽

pp. 1419-1428 ◽

Cited By ~ 10

Author(s):

Rowan T. Chlebowski ◽

Aaron K. Aragaki ◽

Garnet L. Anderson ◽

Kathy Pan ◽

Marian L. Neuhouser ◽

...

Keyword(s):

Breast Cancer ◽

Dietary Fat ◽

Dietary Intervention ◽

Breast Cancer Incidence ◽

Intervention Group ◽

Dietary Modification ◽

Fat Intake ◽

Health Initiative

PURPOSE Observational studies of dietary fat intake and breast cancer have reported inconsistent findings. This topic was addressed in additional analyses of the Women’s Health Initiative (WHI) Dietary Modification (DM) clinical trial that evaluated a low-fat dietary pattern influence on breast cancer incidence. METHODS In the WHI DM trial, 48,835 postmenopausal women, ages 50-79 years, with no prior breast cancer, and a dietary fat intake of ≥ 32% of energy were randomly assigned at 40 US centers to a usual diet comparison group (60%) or dietary intervention group (40%). The goals were to reduce fat intake to 20% of energy and increase vegetable, fruit, and grain intake. Breast cancers were confirmed after central medical record review and serial National Death Index linkages to enhance mortality findings. RESULTS During 8.5 years of dietary intervention, breast cancer incidence and deaths as a result of breast cancer were nonsignificantly lower in the intervention group, while deaths after breast cancer were statistically significantly lower both during intervention and through a 16.1-year (median) follow-up. Now, after a long-term, cumulative 19.6-year (median) follow-up, the significant reduction in deaths after breast cancer persists (359 [0.12%] v 652 [0.14%] deaths; hazard ratio [HR], 0.85; 95% CI, 0.74 to 0.96; P = .01), and a statistically significant reduction in deaths as a result of breast cancer (breast cancer followed by death attributed to the breast cancer) emerged (132 [0.037%, annualized risk] v 251 [0.047%] deaths, respectively; HR, 0.79; 95% CI, 0.64 to 0.97; P = .02). CONCLUSION Adoption of a low-fat dietary pattern associated with increased vegetable, fruit, and grain intake, demonstrably achievable by many, may reduce the risk of death as a result of breast cancer in postmenopausal women.

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Insulin resistance and breast cancer incidence and mortality in postmenopausal women in the Women’s Health Initiative

Cancer ◽

10.1002/cncr.33002 ◽

2020 ◽

Vol 126 (16) ◽

pp. 3638-3647

Author(s):

Kathy Pan ◽

Rowan T. Chlebowski ◽

Joanne E. Mortimer ◽

Marc J. Gunther ◽

Thomas Rohan ◽

...

Keyword(s):

Breast Cancer ◽

Insulin Resistance ◽

Women's Health ◽

Postmenopausal Women ◽

Cancer Incidence ◽

Breast Cancer Incidence ◽

Women's Health Initiative ◽

Health Initiative ◽

Incidence And Mortality ◽

The Women’S Health Initiative

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Molecular Mechanism for Breast Cancer Incidence in the Women's Health Initiative

Cancer Prevention Research ◽

10.1158/1940-6207.capr-20-0082 ◽

2020 ◽

Vol 13 (10) ◽

pp. 807-816 ◽

Cited By ~ 4

Author(s):

V. Craig Jordan

Keyword(s):

Breast Cancer ◽

Women’S Health ◽

Women's Health ◽

Molecular Mechanism ◽

Cancer Incidence ◽

Breast Cancer Incidence ◽

Women's Health Initiative ◽

Women’S Health Initiative ◽

Health Initiative ◽

The Women’S Health Initiative

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Association of Menopausal Hormone Therapy With Breast Cancer Incidence and Mortality During Long-term Follow-up of the Women’s Health Initiative Randomized Clinical Trials

JAMA ◽

10.1001/jama.2020.9482 ◽

2020 ◽

Vol 324 (4) ◽

pp. 369 ◽

Cited By ~ 16

Author(s):

Rowan T. Chlebowski ◽

Garnet L. Anderson ◽

Aaron K. Aragaki ◽

JoAnn E. Manson ◽

Marcia L. Stefanick ◽

...

Keyword(s):

Breast Cancer ◽

Clinical Trials ◽

Cancer Incidence ◽

Randomized Clinical Trials ◽

Breast Cancer Incidence ◽

Health Initiative ◽

Incidence And Mortality ◽

Long Term Follow Up

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Metformin and breast cancer incidence in postmenopausal diabetic women in the Women’s Health Initiative (WHI).

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.15_suppl.1503 ◽

2011 ◽

Vol 29 (15_suppl) ◽

pp. 1503-1503 ◽

Cited By ~ 6

Author(s):

R. T. Chlebowski ◽

A. McTiernan ◽

A. K. Aragaki ◽

T. Rohan ◽

J. Wactawski-Wende ◽

...

Keyword(s):

Breast Cancer ◽

Women’S Health ◽

Women's Health ◽

Cancer Incidence ◽

Breast Cancer Incidence ◽

Women's Health Initiative ◽

Women’S Health Initiative ◽

Health Initiative ◽

The Women’S Health Initiative

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Low-fat dietary pattern and long-term breast cancer incidence and mortality: The Women’s Health Initiative randomized clinical trial.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.520 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. 520-520 ◽

Cited By ~ 1

Author(s):

Rowan T. Chlebowski ◽

Aaron K Aragaki ◽

Garnet L Anderson ◽

Kathy Pan ◽

Marian L Neuhouser ◽

...

Keyword(s):

Breast Cancer ◽

Clinical Trial ◽

Dietary Pattern ◽

Dietary Intervention ◽

Breast Cancer Incidence ◽

Intervention Group ◽

Fat Intake ◽

Breast Cancers ◽

Low Fat ◽

Cancer Breast

520 Background: Observational studies of dietary fat intake and breast cancer have inconsistent findings. To address this issue, the Women’s Health Initiative (WHI) Dietary Modification (DM) clinical trial assessed a low-fat dietary pattern influence on breast cancer incidence and outcome. Methods: The WHI DM trial is a randomized, controlled clinical trial conducted at 40 US centers, where 48,835 postmenopausal women, aged 50-79 years, with no previous breast cancer and dietary fat intake ≥32% of total energy, were randomly assigned, from 1993-1998, to a usual diet comparison group (60%) or dietary intervention group (40%) with goals to reduce fat intake to 20% of energy and increase vegetables, fruit, and grain intake. This study is registered as: NCT00000611. Results: The dietary intervention significantly reduced fat intake; increased fruit, vegetable and grain intake with modest weight loss (3%) (all P< 0.001). During 8.5 years of dietary intervention, there were 8% fewer breast cancers and deaths from breast cancer were somewhat lower in the intervention group but the rates were not significantly different. However, deaths after breast cancer (breast cancer followed by death from any cause) were significantly reduced in the intervention group, both during intervention (hazard ratio [HR] 0·65 95% confidence interval [CI] 0·45-0·95) and through 16.1 year (median) cumulative follow-up. Now, after long- term, cumulative 19.6 year (median) follow-up, with 3,374 incident breast cancers, the significant reduction in deaths after breast cancer continued (with 1,011 deaths, HR 0·85 95% CI 0·74-0·96) and a significant reduction in deaths from breast cancer (breast cancer followed by death attributed to the breast cancer) emerged (with 383 deaths, HR 0·79 95% CI 0·64-0·97). Conclusions: Adoption of a low-fat dietary pattern associated with increased vegetable, fruit, and grain intake, demonstrably achievable by many, significantly reduced the risk of death from breast cancer in postmenopausal women. To our review, these findings provide the first randomized clinical trial evidence that a dietary change can reduce a postmenopausal woman’s risk of dying from breast cancer. Clinical trial information: NCT00000611.

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