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

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 520-520 ◽  
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.

scholarly journals Low-Fat Dietary Pattern and Breast Cancer Mortality in the Women’s Health Initiative Randomized Controlled Trial

2017 ◽  
Vol 35 (25) ◽  
pp. 2919-2926 ◽  
Author(s):  
Rowan T. Chlebowski ◽  
Aaron K. Aragaki ◽  
Garnet L. Anderson ◽  
Cynthia A. Thomson ◽  
JoAnn E. Manson ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Dietary Pattern ◽  
Dietary Intervention ◽  
Dietary Group ◽  
Fat Intake ◽  
Breast Cancers ◽  
Low Fat ◽  
Health Initiative ◽  
Usual Diet

Purpose Earlier Women’s Health Initiative Dietary Modification trial findings suggested that a low-fat eating pattern may reduce breast cancers with greater mortality. Therefore, as a primary outcome-related analysis from a randomized prevention trial, we examined the long-term influence of this intervention on deaths as a result of and after breast cancer during 8.5 years (median) of dietary intervention and cumulatively for all breast cancers diagnosed during 16.1 years (median) of follow-up. Patients and Methods The trial randomly assigned 48,835 postmenopausal women with normal mammograms and without prior breast cancer from 1993 to 1998 at 40 US clinical centers to a dietary intervention with goals of a reduction of fat intake to 20% of energy and an increased intake of fruits, vegetables, and grains (40%; n = 19,541) or to a usual diet comparison (60%; n = 29,294). Results In the dietary group, fat intake and body weight decreased (all P < .001). During the 8.5-year dietary intervention, with 1,764 incident breast cancers, fewer deaths occurred as a result of breast cancer in the dietary group, which was not statistically significant (27 deaths [0.016% per year] v 61 deaths [0.024% per year]; hazard ratio [HR], 0.67; 95% CI, 0.43 to 1.06; P = .08). During the same period, deaths after breast cancer (n = 134) were significantly reduced (40 deaths [0.025% per year] v 94 deaths [0.038% per year]; HR, 0.65; 95% CI, 0.45 to 0.94; P = .02) by the dietary intervention. During the 16.1-year follow-up, with 3,030 incident breast cancers, deaths after breast cancer also were significantly reduced (234 deaths [0.085% per year] v 443 deaths [0.11% per year]; HR, 0.82; 95% CI, 0.70 to 0.96; P = .01) in the dietary group. Conclusion Compared with a usual diet comparison group, a low-fat dietary pattern led to a lower incidence of deaths after breast cancer.

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

2020 ◽  
Vol 38 (13) ◽  
pp. 1419-1428 ◽  
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.

scholarly journals Low-Fat Dietary Pattern and Cancer Mortality in the Women’s Health Initiative (WHI) Randomized Controlled Trial

2018 ◽  
Vol 2 (4) ◽  
Author(s):  
Rowan T Chlebowski ◽  
Garnet L Anderson ◽  
JoAnn E Manson ◽  
Ross L Prentice ◽  
Aaron K Aragaki ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Women's Health ◽  
Cancer Mortality ◽  
Dietary Pattern ◽  
Dietary Intervention ◽  
Low Fat ◽  
Women's Health Initiative ◽  
Health Initiative ◽  
The Women’S Health Initiative

Abstract Background In the Women’s Health Initiative Dietary Modification trial, a low-fat dietary pattern reduced deaths after breast cancer. Mortality from other cancer sites has not been reported. Methods A low-fat dietary pattern influence on deaths from and after site-specific cancers was examined during 8.5 years (median) of dietary intervention and cumulatively during 17.7 years (median) of follow-up. A total 48 835 postmenopausal women, ages 50–79 years, were randomly assigned from 1993 to 1998 at 40 US clinical centers to dietary intervention (40%, n = 19 541 or a usual diet comparison group (60%, n = 29 294). Dietary intervention influence on mortality from protocol-specified cancers (breast, colon and rectum, endometrium and ovary), individually and as a composite, represented the primary analyses. Results During the dietary intervention period, a reduction in deaths after breast cancer (HR = 0.65 95% CI = 0.45 to 0.94, P = .02) was the only statistically significant cancer mortality finding. During intervention, the HRs for deaths after the protocol-specified cancer composite were 0.90 (95% CI = 0.73 to 1.10) and 0.95 (95% CI = 0.85 to 1.06) for deaths after all cancers. During 17.7 years of follow-up with 3867 deaths after all cancers, reduction in deaths after breast cancer continued in the dietary intervention group (HR = 0.85, 95% CI = 0.74 to 0.99, P = .03). However, no dietary intervention influence on deaths from or after any other cancer or cancer composite was seen. Conclusions A low-fat dietary pattern reduced deaths after breast cancer. No reduction in mortality from or after any other cancer or cancer composite was seen.

Abstract 19836: Lipid Metabolism is Modified by the Interaction Between Cholesteryl Ester Transfer Protein Gene Polymorphism and Mediterranean Diet in Patients in Secondary Prevention for Cardiovascular Disease

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Antonio Garcia Rios ◽  
Francisco Gomez-Delgado ◽  
Ana Isabel Perez Caballero ◽  
Andreea Corina-Baba ◽  
Vanesa Navarro-Martos ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Lipid Metabolism ◽  
Cholesteryl Ester ◽  
Mediterranean Diet ◽  
Cholesteryl Ester Transfer Protein ◽  
Dietary Intervention ◽  
Intervention Group ◽  
Low Fat ◽  
Transfer Protein ◽  
The Impact

Introduction: Cholesteryl ester transfer protein (CETP) gene has been implicated in lipid metabolism. However, little is known about the impact of this gene on coronary heart disease (CHD) patients and its interaction with diet. Hypothesis: To evaluate whether the chronic consumption of a Mediterranean diet enriched in olive oil, compared with a Low fat diet, interacts with the rs3764261 SNP at CETP locus in order to modify lipid metabolism among MetS patients from the CORDIOPREV clinical trial Methods: Plasma lipid concentrations and rs3764261 genotypes were determined in 424 MetS subjects participating in the CORDIOPREV clinical trial. Gene-diet interactions were analyzed after a year of dietary intervention (Mediterranean diet (35% fat, 22% MUFA) vs Low fat diet (28% fat, 12% MUFA)) Results: We found significant gene-diet interactions between rs3764261 SNP and the dietary pattern for HDL-C ( P=0.006 ) and triglyceride concentrations ( P=0.040 ). Specifically, after 12 months of Mediterranean diet intervention, subjects who were carriers of the minor T allele (TT+TG) displayed higher plasma HDL-C concentrations ( P=0.021 ) and lower triglycerides ( P=0.020 ) compared with homozygous for the major allele (GG). In contrast, in the Low fat intervention group no significant differences were found between CETP genotypes after 12 months of dietary treatment. Conclusions: Our data support the notion that a chronic consumption of a Mediterranean diet may play a contributing role in triggering lipid metabolism by interacting with the rs3764261 SNP at CETP gene locus in MetS patients

scholarly journals Low-Fat Dietary Pattern among Postmenopausal Women Influences Long-Term Cancer, Cardiovascular Disease, and Diabetes Outcomes

2019 ◽  
Vol 149 (9) ◽  
pp. 1565-1574 ◽  
Author(s):  
Ross L Prentice ◽  
Aaron K Aragaki ◽  
Barbara V Howard ◽  
Rowan T Chlebowski ◽  
Cynthia A Thomson ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Dietary Fat ◽  
Dietary Pattern ◽  
Cancer Colorectal ◽  
Comparison Group ◽  
Intervention Group ◽  
Intervention Period ◽  
Low Fat

ABSTRACT Background The preferred macronutrient dietary composition, and the health consequences of dietary fat reduction specifically, have been debated for decades. Here we provide a comprehensive overview of long-term health outcomes in the Women's Health Initiative Dietary Modification (DM) trial. Objective The DM trial aimed to examine whether a low-fat dietary pattern would reduce the risk of invasive breast cancer, colorectal cancer, and, secondarily, coronary heart disease (CHD), with various other health outcomes also considered. Methods The DM trial is a randomized controlled trial conducted at 40 centers in the US, among 48,835 postmenopausal women aged 50–79 y with baseline intake of ≥32% energy from fat. Participants were randomly assigned to a low-fat dietary pattern intervention group or to a usual-diet comparison group, during 1993–1998. Intervention goals were to reduce fat intake from ∼35% to 20% of total energy, in conjunction with increasing vegetables and fruit to 5 servings/d and grains to 6 servings/d. Results Over an 8.5-y (median) intervention period, intervention and comparison group differences included lower fat by 8–10%, and higher carbohydrate by 8–10%, of total energy, in conjunction with higher consumption of vegetables, fruit, and grains. Time-to-outcome analyses did not show significant differences between intervention and comparison groups for invasive breast cancer, colorectal cancer, or CHD, either over the intervention period or over longer-term cumulative follow-up. Additional analyses showed significant intervention group benefits related to breast cancer, CHD, and diabetes, without adverse effects. Over a 19.6-y (median) follow-up period, HRs (95% CIs) were 0.84 (0.74, 0.96) for breast cancer followed by death, and 0.87 (0.77, 0.98) for diabetes requiring insulin. Conclusions Reduction in dietary fat with corresponding increase in vegetables, fruit, and grains led to benefits related to breast cancer, CHD, and diabetes, without adverse effects, among healthy postmenopausal US women. This trial was registered at clinicaltrials.gov as NCT00000611.

Estrogen plus progestin (E+P) and breast cancer incidence and mortality.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 1501-1501
Author(s):  
Rowan T. Chlebowski ◽  
Garnet L Anderson ◽  
Lewis H Kuller ◽  
Aaron K Aragaki ◽  
JoAnn E Manson ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Clinical Trial ◽  
Cancer Incidence ◽  
Cancer Mortality ◽  
Breast Cancer Mortality ◽  
Breast Cancer Incidence ◽  
Cancer Prognosis ◽  
Breast Cancers ◽  
Incidence And Mortality ◽  
Mortality Table

1501 Background: In the WHI clinical trial, E+P increased both breast cancer incidence and breast cancer mortality (JAMA 2010;304:1684). In contrast, breast cancers associated with E+P use in most observational studies have a more favorable prognosis. To address differences, a cohort of WHI Observational Study participants with characteristics similar to the WHI clinical trial was identified to examine E+P association with invasive breast cancer incidence and outcome. Methods: 41,449 postmenopausal women with no prior hysterectomy and mammogram negative for breast cancer < 2 years before who either were not hormone users (25,328) or were using E+P (16,121) were identified. Breast cancers were verified by centralized medical record review. Adjusted Cox proportional hazard regression was used to calculate hazard ratios (HRs) with 95% confidence intervals (CI). Additional analyses adjusted for breast cancer screening, censoring participants for incidence analyses who had a > 2 year interval without a mammogram. Results: After a mean (SD) follow-up 11.3 (3.1) years, 2,236 breast cancers were diagnosed. Breast cancer incidence was higher in E+P users (0.60% vs 0.42%, annualized rate, respectively: HR 1.55, 95% CI 1.41-1.70, P<0.001). Screening adjusted analyses had stronger breast cancer association (0.63% vs 0.39%, HR 1.72, 95% CI 1.54-1.93; P<0.001). Survival following breast cancer, measured from diagnosis date, was similar in E+P users and non-users (HR 0.95, 95% CI 0.74-1.23). Breast cancer mortality, analyzed from cohort entry date, are shown in the table. Conclusions: E+P use is associated with increased breast cancer incidence. As breast cancer prognosis following diagnosis on E+P is similar to that of nonusers, the higher incidence with E+P leads to increased breast cancer mortality. [Table: see text]

Determinan Kejadian Ca Mammae Di Poli Rawat Jalan Bedah Rsud Dr. Achmad Mochtar

2018 ◽  
Vol 3 (3) ◽  
pp. 575
Author(s):  
Neila Sulung ◽  
Rizki Yananda ◽  
Adriani Adriani
Keyword(s):  
Breast Cancer ◽  
Breast Cancer Incidence ◽  
Hormonal Contraception ◽  
Sampling Technique ◽  
Case Control ◽  
Female Breast Cancer ◽  
Chi Square ◽  
Control Approach ◽  
Factors Associated ◽  
Cancer Breast

<p>Cancer is one of the leading causes of death worldwide. In Indonesia every year 1: 3 women per 1000 population are affected by breast cancer. Breast cancer is a cancer that attacks most women. The incidence of breast cancer is currently estimated at 39 per 100,000 population in 2008. The purpose of this study was to determine the factors associated with the risk of female breast cancer in surgical outpatient poly patients at Dr. Achmad Mochtar, Bukittinggi City. This study uses descriptive analytic method with a case control approach. The sampling technique in this study was accidental sampling. The sample in this study were all women diagnosed with breast cancer, amounting to 50 cases and 50 controls with data processing through computerization. The instrument used in this study is a questionnaire. Data analysis was performed using Chi-Square test (α = 0.05). The results showed that the factors associated with the incidence of breast cancer were genetic (p = 0.009), menarche (p = 0.014), menopause (p = 0.016), hormonal contraception (p = 0,045), obesity (p = 0,043), and high food fat (p = 0.028).  Conclusions of the study are factors related to the risk of breast cancer incidence are genetic, menarche, menopause, hormonal contraception, obesity and high-fat foods.<br /> </p><p>Penyakit kanker merupakan salah satu penyebab kematian utama di seluruh dunia. Di Indonesia setiap tahun 1:3 wanita per 1000 penduduk terserang kanker payudara. Kanker payudara merupakan kanker yang paling banyak menyerang perempuan. Angka kejadian kanker payudara saat ini diperkirakan 39 per 100.000 penduduk pada tahun 2008. Tujuan penelitian ini adalah untuk mengetahui faktor-faktor yang berhubungan dengan risiko kanker payudara wanita pada pasien poli rawat jalan bedah di RSUD Dr. Achmad Mochtar Kota Bukittinggi. Penelitian ini menggunakan metode <em>deskriptif analitik</em> dengan pendekatan <em>case control</em>. Teknik pengambilan sampel dalam penelitian ini adalah <em>accidental sampling.</em> Sampel dalam penelitian ini adalah semua wanita yang terdiagnosis kanker payudara, berjumlah 50 kasus dan 50 kontrol dengan pengolahan data melalui komputerisasi. Instrument yang digunakan dalam penelitian ini adalah lembar kuisioner. Analisis data dilakukan menggunakan uji <em>Chi-Square </em>(α=0,05). Hasil penelitian menunjukkan faktor yang berhubungan dengan kejadian kanker payudara adalah genetik (p=0,009), <em>menarche</em> (p=0,014;), <em>menopause</em> (p=0,016), kontrasepsi hormonal (p=0,045), <em>obesitas </em>(p=0,043), dan makanan tinggi lemak (p=0,028). Simpulan penelitian adalah faktor yang berhubungan dengan risiko kejadian kanker payudara adalah genetik, <em>menarche, menopause,</em> kontrasepsi hormonal, <em>obesitas</em> dan makanan tinggi lemak.</p>

scholarly journals The Effect of Health Literacy Counselling on Self-Care in Women after Mastectomy: a Randomized Clinical Trial

2020 ◽  
Vol 9 (1) ◽  
pp. 39-45
Author(s):  
Masoume Rastegar ◽  
Zohreh Mahmoodi ◽  
Sara Esmaelzadeh Saeieh ◽  
Nasibeh Sharifi ◽  
Kourosh Kabir
Keyword(s):  
Breast Cancer ◽  
Clinical Trial ◽  
Health Literacy ◽  
Intervention Group ◽  
Self Care ◽  
Essential Element ◽  
World Health ◽  
Control Group ◽  
Fars Province ◽  
The Mean

Introduction: Breast cancer has a high prevalence, constituting a major cause of mortality in women around the world. Health literacy has a vital role in the self-care of chronic diseases such as cancer and is an essential element in the ability of each person to engage with health promotion. The aim of this study was to determine effect of health literacy counselling on selfcare in women after mastectomy. Methods: This study is a randomized, controlled, clinical trial carried out on 72 women with breast cancer after mastectomy in Fars province. The eligible women entered the study using convenience sampling and were then divided into an intervention and a control group through randomized blocks of four. Health literacy questionnaire and self-care questionnaire were distributed among the participants before, immediately after and three weeks following the intervention. Data analysis was performed in SPSS ver.13. Results: The results showed no significant differences between the two groups in terms of their health literacy and self-care scores before the intervention (P=0.299 and 0.059). A comparison of the mean values showed a greater increase in the mean score of health literacy and score of selfcare immediately and three weeks after the intervention in the intervention group compared to the control group. Also, the mean score of the dimensions of self-care in chemotherapy increased over time in the intervention group. Conclusion: The findings of this study confirm the higher effectiveness of counseling with a health literacy approach on overall self-care in chemotherapy and all its dimensions.

scholarly journals Counteracting Chemoresistance with Metformin in Breast Cancers: Targeting Cancer Stem Cells

Cancers ◽  
2020 ◽  
Vol 12 (9) ◽  
pp. 2482
Author(s):  
Samson Mathews Samuel ◽  
Elizabeth Varghese ◽  
Lenka Koklesová ◽  
Alena Líšková ◽  
Peter Kubatka ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Stem Cells ◽  
Cancer Stem Cells ◽  
Molecular Mechanisms ◽  
Epithelial Mesenchymal Transition ◽  
Acquired Resistance ◽  
Breast Cancers ◽  
Intrinsic Resistance ◽  
Mesenchymal Transition ◽  
Cancer Breast

Despite the leaps and bounds in achieving success in the management and treatment of breast cancers through surgery, chemotherapy, and radiotherapy, breast cancer remains the most frequently occurring cancer in women and the most common cause of cancer-related deaths among women. Systemic therapeutic approaches, such as chemotherapy, although beneficial in treating and curing breast cancer subjects with localized breast tumors, tend to fail in metastatic cases of the disease due to (a) an acquired resistance to the chemotherapeutic drug and (b) the development of intrinsic resistance to therapy. The existence of cancer stem cells (CSCs) plays a crucial role in both acquired and intrinsic chemoresistance. CSCs are less abundant than terminally differentiated cancer cells and confer chemoresistance through a unique altered metabolism and capability to evade the immune response system. Furthermore, CSCs possess active DNA repair systems, transporters that support multidrug resistance (MDR), advanced detoxification processes, and the ability to self-renew and differentiate into tumor progenitor cells, thereby supporting cancer invasion, metastasis, and recurrence/relapse. Hence, current research is focusing on targeting CSCs to overcome resistance and improve the efficacy of the treatment and management of breast cancer. Studies revealed that metformin (1, 1-dimethylbiguanide), a widely used anti-hyperglycemic agent, sensitizes tumor response to various chemotherapeutic drugs. Metformin selectively targets CSCs and improves the hypoxic microenvironment, suppresses the tumor metastasis and inflammation, as well as regulates the metabolic programming, induces apoptosis, and reverses epithelial–mesenchymal transition and MDR. Here, we discuss cancer (breast cancer) and chemoresistance, the molecular mechanisms of chemoresistance in breast cancers, and metformin as a chemo-sensitizing/re-sensitizing agent, with a particular focus on breast CSCs as a critical contributing factor to acquired and intrinsic chemoresistance. The review outlines the prospects and directions for a better understanding and re-purposing of metformin as an anti-cancer/chemo-sensitizing drug in the treatment of breast cancer. It intends to provide a rationale for the use of metformin as a combinatory therapy in a clinical setting.

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