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Consumption of Vegetables and Fruits and Risk of Breast Cancer
Carla H. van Gils, PhD;
Petra H. M. Peeters, MD, PhD;
H. Bas Bueno-de-Mesquita, MD, MPH, PhD;
Hendriek C. Boshuizen, PhD;
Petra H. Lahmann, PhD;
Françoise Clavel-Chapelon, PhD;
Anne Thiébaut, PhD;
Emmanuelle Kesse, PhD;
Sabina Sieri, PhD;
Domenico Palli, MD;
Rosario Tumino, MD, MSc;
Salvatore Panico, MD, MSc;
Paolo Vineis, MD;
Carlos A. Gonzalez, MD, MPH, PhD;
Eva Ardanaz, PhD;
Maria-José Sánchez, MD, PhD;
Pilar Amiano, MS;
Carmen Navarro, MD, PhD, MSc;
José R. Quirós, MD;
Timothy J. Key, DPhil;
Naomi Allen, DPhil;
Kay-Tee Khaw, MBBChir, FRCP;
Sheila A. Bingham, PhD;
Theodora Psaltopoulou, MD;
Maria Koliva, PhN;
Antonia Trichopoulou, MD;
Gabriële Nagel, MPH;
Jakob Linseisen, PhD;
Heiner Boeing, PhD;
Göran Berglund, MD, PhD;
Elisabet Wirfält, MPH, PhD;
Göran Hallmans, MD, PhD;
Per Lenner, MD, PhD;
Kim Overvad, MD, PhD;
Anne Tjønneland, MD, PhD;
Anja Olsen, PhD, MSc;
Eiliv Lund, MD, PhD;
Dagrun Engeset, MSc;
Elin Alsaker, MSc;
Teresa Norat, PhD;
Rudolf Kaaks, PhD;
Nadia Slimani, MSc, PhD;
Elio Riboli, MD, MPH, ScM
JAMA. 2005;293:183-193.
Context The intake of vegetables and fruits has been thought to protect against breast cancer. Most of the evidence comes from case-control studies, but a recent pooled analysis of the relatively few published cohort studies suggests no significantly reduced breast cancer risk is associated with vegetable and fruit consumption.
Objective To examine the relation between total and specific vegetable and fruit intake and the incidence of breast cancer.
Design, Setting, and Participants Prospective study of 285 526 women between the ages of 25 and 70 years, participating in the European Prospective Investigation Into Cancer and Nutrition (EPIC) study, recruited from 8 of the 10 participating European countries. Participants completed a dietary questionnaire in 1992-1998 and were followed up for incidence of cancer until 2002.
Main Outcome Measures Relative risks for breast cancer by total and specific vegetable and fruit intake. Analyses were stratified by age at recruitment and study center. Relative risks were adjusted for established breast cancer risk factors.
Results During 1 486 402 person-years (median duration of follow-up, 5.4 years), 3659 invasive incident breast cancer cases were reported. No significant associations between vegetable or fruit intake and breast cancer risk were observed. Relative risks for the highest vs the lowest quintile were 0.98 (95% confidence interval [CI], 0.84-1.14) for total vegetables, 1.09 (95% CI , 0.94-1.25) for total fruit, and 1.05 (95% CI , 0.92-1.20) for fruit and vegetable juices. For 6 specific vegetable subgroups no associations with breast cancer risk were observed either.
Conclusion Although the period of follow-up is limited for now, the results suggest that total or specific vegetable and fruit intake is not associated with risk for breast cancer.
Author Affiliations: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (Drs van Gils and Peeters); Center for Nutrition and Health, National Institute for Public Health and the Environment, Bilthoven, the Netherlands (Dr Bueno-de-Mesquita); Center for Information Technology and Methodology, National Institute for Public Health and the Environment, Bilthoven, the Netherlands (Dr Boshuizen); German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany (Drs Lahmann and Boeing); INSERM, Institut Gustave Roussy, Equipe Nutrition, Hormones et Cancer, Villejuif, France (Drs Clavel-Chapelon, Thiébaut, and Kesse); Epidemiology Unit, Istituto Tumori, Milan, Italy (Dr Sieri); Molecular and Nutritional Epidemiology Unit, CSPO, Scientific Institute of Tuscany, Florence, Italy (Dr Palli); Cancer Registry, Azienda Ospedaliera "Civile - M. P. Arezzo," Ragusa, Italy (Dr Tumino); Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy (Dr Panico); University of Torino, Italy and Imperial College, London, England (Dr Vineis); Department of Epidemiology, Catalan Institute of Oncology, Barcelona, Spain (Dr Gonzalez); Public Health Institute, Navarra, Spain (Dr Ardanaz); Andalusian School of Public Health, Granada, Spain (Dr Sánchez); Public Health Division of Gipuzkoa, Health Department of the Basque Country, San Sebastian, Spain (Ms Amiano); Epidemiology Department, Murcia Health Council, Murcia, Spain (Dr Navarro); Health Information Unit, Public Health and Planning Directorate, Health and Health Services Council, Principality of Asturias, Oviedo, Spain (Dr Quirós); Cancer Research UK Epidemiology Unit, University of Oxford, England (Drs Key and Allen); Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, England (Dr Khaw); MRC Dunn Human Nutrition Unit, Cambridge, England (Dr Bingham); Department of Hygiene and Epidemiology, School of Medicine, University of Athens, Greece (Drs Psaltopoulou and Trichopoulou and Ms Koliva); Division of Clinical Epidemiology, Deutsches Krebsforschungszentrum, Heidelberg, Germany (Ms Nagel and Dr Linseisen); Department of Medicine, Lund University, Malmö University Hospital, Malmö, Sweden (Drs Berglund and Wirfält); Units of Nutritional Research and Oncology (Dr Hallmans) and Department of Radiation Sciences, Oncology (Dr Lenner), University of Umeå, Sweden; Department of Clinical Epidemiology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark (Dr Overvad); Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark (Drs Tjønneland and Olsen); Institute of Community Medicine, University of Tromsø, Tromsø, Norway (Dr Lund and Mss Engeset and Alsaker); and International Agency for Research on Cancer (IARC-WHO), Lyon, France (Drs Norat, Kaaks, Slimani, and Riboli).
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