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To the Editor: Baseline differences in serum estradiol, relatively few participants who met the dietary target of 20% or less energy from fat, and the exclusion of an exercise intervention from the dietary modification group of the WHI trial all made it less likely that an experimental difference in breast cancer outcomes would be obtained in the study by Dr Prentice and colleagues.¹ Observational studies have consistently found serum estradiol levels in postmenopausal women to be associated with breast cancer risk.² A meta-analysis of 13 short-term low-fat dietary intervention trials showed significant declines in serum estradiol levels, particularly when coupled with physical activity interventions and when the dietary target of energy from fat was 20% or less.³ Other evidence suggests that adherence to diets lower in fat and higher in fruits and vegetables are facilitated by exercise.^4-5

Despite the attenuated magnitude of the dietary fat reduction achieved in the WHI . . . [Full Text of this Article]

William J. McCarthy, PhD
wmccarth@ucla.edu
School of Public Health
Department of Health Services

Tony Kuo, MD, MSHS
Geffen School of Medicine
Department of Family Practice
University of California, Los Angeles

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