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Dietary change and reduced breast cancer events among women without hot flashes after treatment of early-stage breast cancer: subgroup analysis of the Women's Healthy Eating and Living Study^1,2,3,4

¹ From the Moores UCSD Cancer Center, University of California, San Diego, La Jolla, CA (JPP, LN, SWF, SK, VAN, CLR, MP, NS, and BP); the Division of Research, Kaiser Permanente Northern California, Oakland, CA (BJC); the Department of Public Health Sciences, University of California, Davis, Davis, CA (EBG); the University of Texas M D Anderson Cancer Center, The University of Texas, Houston, TX (RAH); the Stanford Prevention Research Center, Stanford University, Stanford, CA (MLS); and the Arizona Cancer Center, Department of Nutritional Sciences, University of Arizona, Tucson, AZ (CAT).

² Presented at the symposium, "Fifth International Congress on Vegetarian Nutrition," held in Loma Linda, CA, March 4–6, 2008.

³ The Women's Healthy Eating and Living Study was initiated with the support of the Walton Family Foundation and continued with funding from NCI grant CA 69375. Some of the data were collected from General Clinical Research Centers, NIH grants M01-RR00070, M01-RR00079, and M01-RR00827.

⁴ Reprints not available. Address correspondence to JP Pierce, Cancer Prevention and Control Program, Moores UCSD Cancer Center, 3855 Health Sciences Drive, #0901, La Jolla, CA 92093-0901. E-mail: jppierce{at}ucsd.edu.

for the Women's Healthy Eating and Living Study Group

Background: A diet high in vegetables, fruit, and fiber and low in fat decreased additional risk of secondary breast cancer events in women without hot flashes (HF–) compared with that in women with hot flashes (HF+), possibly through lowered concentrations of circulating estrogens.

Objective: The objective was to investigate the intervention effect by baseline quartiles of dietary pattern among breast cancer survivors in the HF– subgroup of the Women's Healthy Eating and Living Study.

Design: A randomized controlled trial compared a putative cancer prevention diet with a diet of 5 servings of vegetables and fruit daily in early-stage breast cancer survivors. Participants did not experience hot flashes at baseline (n = 896). We confirmed cancer status for 96% of participants 7.3 y after enrollment.

Results: The study intervention achieved a large between-group difference in dietary pattern that, at 4 y, was not significantly different across baseline quartiles of dietary pattern. The intervention group experienced fewer breast cancer events than did the comparison group for all of the baseline quartiles. This difference was significant only in upper baseline quartiles of intake of vegetables, fruit, and fiber and in the lowest quartile of fat. A significant trend for fewer breast cancer events was observed across quartiles of vegetable-fruit and fiber consumption.

Conclusions: The secondary analysis showing the decreased risk in the HF– subgroup was not explained by amount of change in dietary pattern achieved. The difference was strongest in the quartile with the most putatively cancer-preventive dietary pattern at baseline.

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