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In Reply: We agree with Dr Laigou and colleagues that high consumers of fruits and vegetables are generally health conscious women who are more likely to be tested with breast examination. If, for this reason, more breast tumors are detected in high consumers than in low consumers this may conceal an inverse association between breast cancer and intake of vegetables or fruits. However, the higher frequency of detection of breast cancer in mammography-screened populations is largely due to the increased detection of ductal carcinoma in situ,¹ and our study only included invasive breast tumors. One might argue that the number of invasive cancers will be relatively lower in regularly screened populations than in unscreened populations because in screened populations tumors will be detected in an earlier stage. This would, however, lead to a relative overestimation of any protective effects. We therefore think that confounding by screening participation cannot explain . . . [Full Text of this Article]

Carla H. van Gils, PhD; Petra H. M. Peeters, MD, PhD
P.H.M.Peeters@umcutrecht.nl
Julius Center for Health Sciences and Primary Care
University Medical Center Utrecht
Utrecht, the Netherlands

Elio Riboli, MD, MPH, ScM
International Agency for Research on Cancer
Lyon, France

For the Investigators of the European Prospective Investigation Into Cancer and Nutrition

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