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To the Editor: In the European Prospective Investigation Into Cancer and Nutrition (EPIC) cohort study, Dr van Gils and colleagues found no association between the consumption of fruits or vegetables and breast cancer risk.¹ The authors note that their results are compatible with those from a pooled analysis of cohort studies² and argue that the findings from case-control studies pointing to a protective effect of intake of fruits and vegetables against breast cancer³ are likely to be due to recall bias or selection bias. Although this is possible, alternative explanations need to be considered before the findings from case-control studies are discounted.

High consumers of fruits and vegetables are generally health conscious women who are also likely to be more frequently tested with mammography or breast examination.⁴ Occult cases of breast cancer do occur and their frequency of detection increases sharply with mammography.⁵ The joint operation of these factors could . . . [Full Text of this Article]

Pagona Lagiou, MD
Department of Hygiene and Epidemiology
University of Athens Medical School
Athens, Greece

Jorn Olsen, MD
The Danish Epidemiology Science Centre
University of Aarhus
Aarhus, Denmark

Dimitrios Trichopoulos, MD
dtrichop@hsph.harvard.edu
Department of Epidemiology
Harvard School of Public Health
Boston, Mass

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