Originally published as JCO Early Release 10.1200/JCO.2008.16.1067 on December 15 2008

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Dietary Pattern Influences Breast Cancer Prognosis in Women Without Hot Flashes: The Women's Healthy Eating and Living Trial

Ellen B. Gold, John P. Pierce, Loki Natarajan, Marcia L. Stefanick, Gail A. Laughlin, Bette J. Caan, Shirley W. Flatt, Jennifer A. Emond, Nazmus Saquib, Lisa Madlensky, Sheila Kealey, Linda Wasserman, Cynthia A. Thomson, Cheryl L. Rock, Barbara A. Parker, Njeri Karanja, Vicky Jones, Richard A. Hajek, Minya Pu, Joanne E. Mortimer

From the Department of Public Health Sciences, University of California, Davis, Davis; Moores Cancer Center and Department of Family and Preventive Medicine, Division of Biostatistics, University of California, San Diego, La Jolla; Stanford Prevention Research Center, Stanford University, Stanford; Kaiser Permanente Northern California, Division of Research, Oakland; City of Hope Comprehensive Cancer Center, Duarte, CA; Department of Nutritional Sciences, Arizona Cancer Center, University of Arizona, Tucson, AZ; Center for Health Research, Portland, OR; Yakama Valley Memorial Hospital, Yakima, WA; and Department of Health Disparities Research, The University of Texas M.D. Anderson Cancer Center, Houston, TX

Corresponding author: John P. Pierce, PhD, Cancer Prevention and Control Program, Moores Cancer Center, University of California, San Diego, 3855 Health Sciences Drive, #0901 La Jolla, CA 92093-0901; e-mail: jppierce{at}ucsd.edu

Purpose To determine whether a low-fat diet high in vegetables, fruit, and fiber differentially affects prognosis in breast cancer survivors with hot flashes (HF) or without HF after treatment.

Patients and Methods A secondary analysis was conducted on 2,967 breast cancer survivors, age 18 to 70 years, who were randomly assigned between 1995 and 2000 in a multicenter, controlled trial of a dietary intervention to prevent additional breast cancer events and observed through June 1, 2006. We compared the dietary intervention group with a group who received five-a-day dietary guidelines.

Results Independent of HF status, a substantial between-group difference among those who did and did not receive dietary guidelines was achieved and maintained at 4 years in intake of vegetable/fruit servings per day (54% higher; 10 v 6.5 servings/d, respectively), fiber (31% higher; 25.5 v 19.4 g/d, respectively), and percent energy from fat (14% lower; 26.9% v 31.3%, respectively). Adjusting for tumor characteristics and antiestrogen treatment, HF-negative women assigned to the intervention had 31% fewer events than HF-negative women assigned to the comparison group (hazard ratio [HR] = 0.69; 95% CI, 0.51 to 0.93; P = .02). The intervention did not affect prognosis in the women with baseline HFs. Furthermore, compared with HF-negative women assigned to the comparison group, HF-positive women had significantly fewer events in both the intervention (HR = 0.77; 95% CI, 0.59 to 1.00; P = .05) and comparison groups (HR = 0.65; 95% CI, 0.49 to 0.85; P = .002).

Conclusion A diet with higher vegetable, fruit, and fiber and lower fat intakes than the five-a-day diet may reduce risk of additional events in HF-negative breast cancer survivors. This suggestive finding needs confirmation in a trial in which it is the primary hypothesis.

published online ahead of print at www.jco.org on December 15, 2008.

Supported by the Walton Family Foundation and National Cancer Institute Grant No. CA 69375. Some of the data were collected from General Clinical Research Centers supported by National Institutes of Health Grant Nos. M01-RR00070, M01-RR00079, and M01-RR00827.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

Clinical trial information can be found for the following: NCT00003787 [ClinicalTrials.gov]

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