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

Rowan T Chlebowski; Aaron K Aragaki; Garnet L Anderson; Kathy Pan; Marian L Neuhouser; JoAnn E Manson; Cynthia A Thomson; Yasmin Mossavar-Rahmani; Dorothy S Lane; Karen C Johnson; Jean Wactawski-Wende; Linda Snetselaar; Thomas E Rohan; Juhua Luo; Ana Barac; Ross L Prentice

doi:10.1200/JCO.19.00435

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

Journal article

Open access

Peer reviewed

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

Rowan T Chlebowski, Aaron K Aragaki, Garnet L Anderson, Kathy Pan, Marian L Neuhouser, JoAnn E Manson, Cynthia A Thomson, Yasmin Mossavar-Rahmani, Dorothy S Lane, Karen C Johnson, …

Journal of clinical oncology, Vol.38(13), pp.1419-1428

05/01/2020

DOI: 10.1200/JCO.19.00435

PMCID: PMC7193750

PMID: 32031879

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7193750View

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Abstract

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. 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. 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%] 652 [0.14%] deaths; hazard ratio [HR], 0.85; 95% CI, 0.74 to 0.96; = .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] 251 [0.047%] deaths, respectively; HR, 0.79; 95% CI, 0.64 to 0.97; = .02). 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.

Outcome Assessment, Health Care - statistics & numerical data

Follow-Up Studies

Humans

Middle Aged

Risk Factors

Kaplan-Meier Estimate

Proportional Hazards Models

Survival Rate

Incidence

Breast Neoplasms - diet therapy

Diet, Fat-Restricted

Dietary Fats - administration & dosage

Outcome Assessment, Health Care - methods

Women's Health - statistics & numerical data

Postmenopause

Breast Neoplasms - mortality

Female

Aged

Breast Neoplasms - epidemiology

Details

Title: Subtitle: Dietary Modification and Breast Cancer Mortality: Long-Term Follow-Up of the Women's Health Initiative Randomized Trial
Creators: Rowan T Chlebowski - Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
Aaron K Aragaki - Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
Garnet L Anderson - Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
Kathy Pan - Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
Marian L Neuhouser - Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
JoAnn E Manson - Brigham and Women's Hospital, Harvard Medical School, Boston, MA
Cynthia A Thomson - Department of Nutritional Sciences, University of Arizona, Tucson, AZ
Yasmin Mossavar-Rahmani - Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
Dorothy S Lane - Department of Family, Population and Preventive Medicine, Stony Brook University School of Medicine, Stony Brook, NY
Karen C Johnson - Departments of Preventive Medicine and Medicine, University of Tennessee, Memphis, TN
Jean Wactawski-Wende - Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY
Linda Snetselaar - College of Public Health, University of Iowa, Iowa City, IA
Thomas E Rohan - Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
Juhua Luo - Department of Epidemiology and Biostatistics, Indiana University, Bloomington, IN
Ana Barac - MedStar Heart and Vascular Institute, Georgetown University, Washington, DC
Ross L Prentice - Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
Resource Type: Journal article
Publication Details: Journal of clinical oncology, Vol.38(13), pp.1419-1428
Publisher: United States
DOI: 10.1200/JCO.19.00435
PMID: 32031879
PMCID: PMC7193750
ISSN: 0732-183X
eISSN: 1527-7755
Grant note: N01WH22110 / WHI NIH HHS
Language: English
Date published: 05/01/2020
Academic Unit: Epidemiology; Fraternal Order of Eagles Diabetes Research Center; Internal Medicine
Record Identifier: 9984066348002771

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