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To the Editor: In the Women's Healthy Eating and Living (WHEL) randomized trial, Dr Pierce and colleagues¹ evaluated the effect of increased dietary fruits and vegetables on breast cancer recurrence. We agree with the authors that the differences they report in between-group fat intake for participants in this trial may not have been sufficient to adequately test the dietary fat hypothesis that was raised by the interim results of the Women's Intervention Study (WINS).²

In the WHEL study, while there was a significant difference between groups in fat intake, the long-term reduction in fat from baseline entry in the intervention group was minimal. The reported percentage energy from fat was 28.5% at baseline, 27.1% at 48 months, and 28.9% at 72 months; there were no weight differences between groups. In WINS, patients were entered only up to 1 year after diagnosis (mean, 7.4 months) while the patients in the WHEL . . . [Full Text of this Article]

Rowan T. Chlebowski, MD, PhD
rchlebowski@gmail.com
Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center
Torrance, California

George L. Blackburn, MD, PhD
Beth Israel Deaconess Medical Center
Boston, Massachusetts

RELATED LETTER

Diet and Breast Cancer Recurrence—Reply
John P. Pierce, Bette J. Caan, Cheryl Ritenbaugh, Cheryl L. Rock, and Loki Natarajan
JAMA. 2007;298(18):2135-2136.
EXTRACT | FULL TEXT  

RELATED ARTICLE

Influence of a Diet Very High in Vegetables, Fruit, and Fiber and Low in Fat on Prognosis Following Treatment for Breast Cancer: The Women's Healthy Eating and Living (WHEL) Randomized Trial
John P. Pierce, Loki Natarajan, Bette J. Caan, Barbara A. Parker, E. Robert Greenberg, Shirley W. Flatt, Cheryl L. Rock, Sheila Kealey, Wael K. Al-Delaimy, Wayne A. Bardwell, Robert W. Carlson, Jennifer A. Emond, Susan Faerber, Ellen B. Gold, Richard A. Hajek, Kathryn Hollenbach, Lovell A. Jones, Njeri Karanja, Lisa Madlensky, James Marshall, Vicky A. Newman, Cheryl Ritenbaugh, Cynthia A. Thomson, Linda Wasserman, and Marcia L. Stefanick
JAMA. 2007;298(3):289-298.
ABSTRACT | FULL TEXT