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Yang J, Shen H, Mi M, Qin Y. Isoflavone Consumption and Risk of Breast Cancer: An Updated Systematic Review with Meta-Analysis of Observational Studies. Nutrients 2023; 15:2402. [PMID: 37242286 PMCID: PMC10224089 DOI: 10.3390/nu15102402] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 05/12/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
RATIONALE Epidemiological studies that focus on the relationship between dietary isoflavone intake and the risk of breast cancer still lead to inconsistent conclusions. Herein, we conducted a meta-analysis of the latest studies to explore this issue. METHOD We performed a systematic search using Web of Science, PubMed, and Embase from inception to August 2021. The robust error meta-regression (REMR) model and generalized least squares trend (GLST) model were used to establish dose-response relationships between isoflavones and breast cancer risk. RESULTS Seven cohort studies and 17 case-control studies were included in the meta-analysis, and the summary OR for breast cancer was 0.71 (95% CI 0.72-0.81) when comparing the highest to the lowest isoflavone intake. A subgroup analysis further showed that neither menopausal status nor ER status has a significant influence on the association between isoflavone intake and breast cancer risk, while the isoflavone intake doses and study design does. When the isoflavones exposure was less than 10 mg/day, no effects on breast cancer risk were detected. The inverse association was significant in the case-control studies but not in the cohort studies. In the dose-response meta-analysis of the cohort studies, we observed an inverse association between isoflavone intake and breast cancer: a 10 mg/day increase in isoflavone intake was related to reductions of 6.8% (OR = 0.932, 95% CI 0.90-0.96) and 3.2% (OR = 0.968, 95% CI 0.94-0.99) in breast cancer risk when using REMR and GLST, respectively. In the dose-response meta-analysis of the case-control studies, the inverse association for every 10 mg/day isoflavone intake was associated with breast cancer risk reductions by 11.7%. CONCLUSION present evidence demonstrated that taking in dietary isoflavone is helpful in reducing the breast cancer risk.
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Affiliation(s)
- Jining Yang
- Research Center for Nutrition and Food Safety, Institute of Military Preventive Medicine, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Hui Shen
- Research Center for Nutrition and Food Safety, Institute of Military Preventive Medicine, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Mantian Mi
- Chongqing Medical Nutrition Research Center, Chongqing 400038, China
| | - Yu Qin
- Research Center for Nutrition and Food Safety, Institute of Military Preventive Medicine, Third Military Medical University (Army Medical University), Chongqing 400038, China
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2
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Sim EJ, Ko KP, Ahn C, Park SM, Surh YJ, An S, Kim SW, Lee MH, Lee JW, Lee JE, Kim KS, Yom CK, Kim HA, Park SK. Isoflavone intake on the risk of overall breast cancer and molecular subtypes in women at high risk for hereditary breast cancer. Breast Cancer Res Treat 2020; 184:615-626. [DOI: 10.1007/s10549-020-05875-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 08/10/2020] [Indexed: 01/10/2023]
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3
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Association between flavonoids, flavonoid subclasses intake and breast cancer risk: a case-control study in China. Eur J Cancer Prev 2019; 29:493-500. [DOI: 10.1097/cej.0000000000000561] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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4
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Hanpaibool C, Chakcharoensap T, Arifin, Hijikata Y, Irle S, Wolschann P, Kungwan N, Pongsawasdi P, Ounjai P, Rungrotmongkol T. Theoretical analysis of orientations and tautomerization of genistein in β-cyclodextrin. J Mol Liq 2018. [DOI: 10.1016/j.molliq.2018.05.109] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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5
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The inclusion complexation of daidzein with β-cyclodextrin and 2,6-dimethyl-β-cyclodextrin: a theoretical and experimental study. MONATSHEFTE FUR CHEMIE 2018. [DOI: 10.1007/s00706-018-2209-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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6
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Sak K. Intake of Individual Flavonoids and Risk of Carcinogenesis: Overview of Epidemiological Evidence. Nutr Cancer 2017; 69:1119-1150. [PMID: 29083244 DOI: 10.1080/01635581.2017.1367934] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Several epidemiological findings have demonstrated that specific flavonoids can be responsible for reduction of the risk of certain cancer types. However, these results are still rather limited, inconclusive and controversial. Therefore, in this comprehensive review article the findings reported to date about the associations between dietary intake of individual flavonoid compounds and cancer incidence are compiled and analyzed. Also, the possible reasons for inconsistencies are brought forth and discussed. As diet is a potentially modifiable factor in our behavioral choices, further large-scale prospective studies with longer follow-up times, different populations, various doses and exposure timing as well as diverse well-controlled confounders are highly needed to confirm or disprove the current epidemiological knowledge about the role of flavonoids on cancer risk. Regarding the promising data to date, more research on bioavailability, metabolism and biological action mechanisms of these plant secondary metabolites is also encouraged.
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Affiliation(s)
- Katrin Sak
- a NGO Praeventio , Näituse 22-3, Tartu , Estonia
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7
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Sak K. Epidemiological Evidences on Dietary Flavonoids and Breast Cancer Risk: A Narrative Review. Asian Pac J Cancer Prev 2017; 18:2309-2328. [PMID: 28950673 PMCID: PMC5720631 DOI: 10.22034/apjcp.2017.18.9.2309] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Epidemiological studies on associations between intake of flavonoids and breast cancer risk are highly needed to assess the actual effects of flavonoids in humans. Experimental investigations in vitro conditions cannot detect and model the real action of these phytochemicals due to the limitations to consider absorption and metabolic biotransformation as well as several complex interactions. Therefore, the data about association findings between intake of flavonoids and breast cancer risk are compiled and analyzed in the current review by evaluating both the results obtained using food composition databases as well as different biomarkers. Although several case-control studies demonstrate some reduction in breast cancer risk related to high consumption of flavones and flavonols, large-scale prospective cohort studies with follow-up times of many years do not confirm these findings. Intake of isoflavones can be associated with a decrease in breast tumorigenesis only in Asian countries where the consumption of soy foods is high but not among Western women with significantly lower ingestion amounts, suggesting the presence of so-called threshold level of effect. Besides doses, the timing of exposure to isoflavones seems also to be a significant factor as childhood and prepubertal age can be critical periods. Although women may need to consume high amounts of isoflavones typical to Asian diets to gain beneficial effects and protection against mammary carcinogenesis, it is still too early to give any specific recommendations to prevent breast tumors by diet rich in certain flavonoids.
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Affiliation(s)
- Katrin Sak
- NGO Praeventio, Näituse 22-3, Tartu 50407, Estonia.
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Gray JM, Rasanayagam S, Engel C, Rizzo J. State of the evidence 2017: an update on the connection between breast cancer and the environment. Environ Health 2017; 16:94. [PMID: 28865460 PMCID: PMC5581466 DOI: 10.1186/s12940-017-0287-4] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 07/17/2017] [Indexed: 05/23/2023]
Abstract
BACKGROUND In this review, we examine the continually expanding and increasingly compelling data linking radiation and various chemicals in our environment to the current high incidence of breast cancer. Singly and in combination, these toxicants may have contributed significantly to the increasing rates of breast cancer observed over the past several decades. Exposures early in development from gestation through adolescence and early adulthood are particularly of concern as they re-shape the program of genetic, epigenetic and physiological processes in the developing mammary system, leading to an increased risk for developing breast cancer. In the 8 years since we last published a comprehensive review of the relevant literature, hundreds of new papers have appeared supporting this link, and in this update, the evidence on this topic is more extensive and of better quality than that previously available. CONCLUSION Increasing evidence from epidemiological studies, as well as a better understanding of mechanisms linking toxicants with development of breast cancer, all reinforce the conclusion that exposures to these substances - many of which are found in common, everyday products and byproducts - may lead to increased risk of developing breast cancer. Moving forward, attention to methodological limitations, especially in relevant epidemiological and animal models, will need to be addressed to allow clearer and more direct connections to be evaluated.
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Affiliation(s)
- Janet M. Gray
- Department of Psychology and Program in Science, Technology, and Society, Vassar College, 124 Raymond Avenue, Poughkeepsie, NY 12604-0246 USA
| | - Sharima Rasanayagam
- Breast Cancer Prevention Partners, 1388 Sutter St., Suite 400, San Francisco, CA 94109-5400 USA
| | - Connie Engel
- Breast Cancer Prevention Partners, 1388 Sutter St., Suite 400, San Francisco, CA 94109-5400 USA
| | - Jeanne Rizzo
- Breast Cancer Prevention Partners, 1388 Sutter St., Suite 400, San Francisco, CA 94109-5400 USA
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DUSP1 promoter methylation in peripheral blood leukocyte is associated with triple-negative breast cancer risk. Sci Rep 2017; 7:43011. [PMID: 28220843 PMCID: PMC5318948 DOI: 10.1038/srep43011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 01/18/2017] [Indexed: 12/13/2022] Open
Abstract
DNA methylation is one of the most common epigenetic alterations, providing important information regarding cancer risk and prognosis. A case-control study (423 breast cancer cases, 509 controls) and a case-only study (326 cases) were conducted to evaluate the association of DUSP1 promoter methylation with breast cancer risk and clinicopathological characteristics. No significant association between DUSP1 methylation in peripheral blood leukocyte (PBL) DNA and breast cancer risk was observed. DUSP1 methylation was significantly associated with ER/PR-negative status; in particular, triple-negative breast cancer patients showed the highest frequency of DUSP1 methylation in both tumour DNA and PBL DNA. Soybean intake was significantly correlated with methylated DUSP1 only in ER-negative (OR 2.978; 95% CI 1.245-7.124) and PR negative (OR 2.735; 95% CI 1.315-5.692) patients. Irregular menstruation was significantly associated with methylated DUSP1 only in ER-positive (OR 3.564; 95% CI 1.691-7.511) and PR-positive (OR 3.902, 95% CI 1.656-9.194) patients. Thus, DUSP1 methylation is a cancer-associated hypermethylation event that is closely linked with triple-negative status. Further investigations are warranted to confirm the association of environmental factors, including fruit and soybean intake, irregular menstruation, and ER/PR status, with DUSP1 methylation in breast tumour DNA.
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Baglia ML, Zheng W, Li H, Yang G, Gao J, Gao YT, Shu XO. The association of soy food consumption with the risk of subtype of breast cancers defined by hormone receptor and HER2 status. Int J Cancer 2016; 139:742-8. [PMID: 27038352 DOI: 10.1002/ijc.30117] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 03/18/2016] [Indexed: 01/15/2023]
Abstract
Soy food intake has previously been associated with reduced breast cancer risk. Epidemiological evidence for subgroups of breast cancer, particularly by menopausal and hormone receptor status, is less consistent. To evaluate the role of hormone receptor and menopausal status on the association between soy food intake and breast cancer risk, we measured usual soy food intake in adolescence and adulthood via food frequency questionnaire in 70,578 Chinese women, aged 40-70 years, recruited to the Shanghai Women's Health Study (1996-2000). After a median follow-up of 13.2 years (range: 0.01-15.0), 1,034 incident breast cancer cases were identified. Using Cox models, we found that adult soy intake was inversely associated with breast cancer risk [hazard ratio (HR) for fifth versus first quintile soy protein intake = 0.78; 95% confidence interval (CI):0.63-0.97]. The association was predominantly seen in premenopausal women (HR = 0.46; 95% CI:0.29-0.74). Analyses further stratified by hormone receptor status showed that adult soy intake was associated with significantly decreased risk of estrogen receptor (ER)+/progesterone receptor (PR)+ breast cancer in postmenopausal women (HR = 0.72; 95% CI:0.53-0.96) and decreased risk of ER-/PR- breast cancer in premenopausal women (HR = 0.46; 95% CI:0.22-0.97). The soy association did not vary by human epidermal growth factor-2 (HER2) status. Furthermore, we found that high soy intake during adulthood and adolescence was associated with reduced premenopausal breast cancer risk (HR = 0.53; 95% CI: 0.32-0.88; comparing third vs. first tertile) while high adulthood soy intake was associated with postmenopausal breast cancer only when adolescent intake was low (HR = 0.63; 95% CI: 0.43-0.91). Our study suggests that hormonal status, menopausal status and time window of exposure are important factors influencing the soy-breast cancer association.
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Affiliation(s)
- Michelle L Baglia
- Division of Epidemiology, Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN
| | - Wei Zheng
- Division of Epidemiology, Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN
| | - Honglan Li
- Department of Epidemiology, Shanghai Cancer Institute, Shanghai, People's Republic of China
| | - Gong Yang
- Division of Epidemiology, Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN
| | - Jing Gao
- Department of Epidemiology, Shanghai Cancer Institute, Shanghai, People's Republic of China
| | - Yu-Tang Gao
- Department of Epidemiology, Shanghai Cancer Institute, Shanghai, People's Republic of China
| | - Xiao-Ou Shu
- Division of Epidemiology, Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN
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11
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Abstract
Isoflavones have been suggested to have protective effects on certain cancers. However, the association of soya foods or dietary isoflavones with the risk of myelodysplastic syndromes (MDS) has not been examined. Thus, the aim of this hospital-based case-control study undertaken in China in 2012-2013 was to investigate the association between dietary isoflavone intake and MDS risk. The analysis included 208 cases aged 19-85 years with MDS and 208 controls individually matched to the cases by sex, birth quinquennium and residential locality. Information on habitual food intakes, including nine items of soya foods, was sought from in-person interviews using a validated 107-item FFQ. Dietary intakes of daidzein, genistein, glycitein and total isoflavones were estimated using the 2008 US Department of Agriculture Isoflavone Database. OR were calculated from conditional logistic regression after adjustment for potential confounding by demographics, lifestyle and dietary factors. The mean daily intake of total isoflavones was 19·0 mg in cases and 23·0 mg in controls. Dietary intake of isoflavones was inversely associated with the risk of MDS. The adjusted OR in the highest tertile compared with the lowest tertile of intake were 0·43 (95 % CI 0·21, 0·85) for daidzein, 0·36 (95 % CI 0·18, 0·74) for genistein, 0·49 (95 % CI 0·25, 0·97) for glycitein and 0·40 (95 % CI 0·20, 0·81) for total isoflavones. The findings suggest that higher dietary intake of isoflavones is associated with a reduced risk of MDS in a Chinese population.
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12
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Kiyabu GY, Inoue M, Saito E, Abe SK, Sawada N, Ishihara J, Iwasaki M, Yamaji T, Shimazu T, Sasazuki S, Shibuya K, Tsugane S. Fish, n - 3 polyunsaturated fatty acids and n - 6 polyunsaturated fatty acids intake and breast cancer risk: The Japan Public Health Center-based prospective study. Int J Cancer 2015; 137:2915-26. [PMID: 26147326 DOI: 10.1002/ijc.29672] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 06/25/2015] [Indexed: 12/15/2022]
Abstract
Limited and inconsistent studies exist on the association between the intake of fish, n - 3 polyunsaturated fatty acids (PUFA) and n - 6 PUFA and breast cancer. Fish and n - 3 PUFA support various body functions and are thought to reduce the carcinogenesis risk while n - 6 PUFA may have a positive association with cancer risk. We examined the association between intake of fish, n - 3 PUFA [including eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), docosapentaenoic acid (DPA) and alpha-linolenic acid (ALA)] and n - 6 PUFA and breast cancer with subanalyses on estrogen (ER) and progesterone receptor (PR) status. We investigated 38,234 Japanese women aged 45-74 years from the Japan Public Health Center-based prospective study (JPHC study), and during 14.1 years of follow-up time, 556 breast cancer cases were newly diagnosed. Breast cancer risk was not associated with the intake of total fish, n - 3 PUFA and n - 6 PUFA when analyzed in totality through multivariable Cox proportional hazards regression models with age as the time scale. Intake of total n - 6 was positively associated with the development of ER+PR+ tumors [multivariable-adjusted HR Q4 vs. Q1 = 2.94 (95% CI: 1.26-6.89; ptrend = 0.02)]. Intake of EPA was associated with a decreased breast cancer risk for ER+PR+ tumors [multivariable-adjusted HR Q2 vs. Q1 = 0.47 (95% CI: 0.25-0.89; ptrend =0.47)]. While the overall association between the intake of total fish, n - 3 PUFA and n - 6 PUFA and breast cancer risk is null, for ER+PR+ tumors, a positive association was seen between n - 6 intake and breast cancer, and a marginally significant inverse association was observed for EPA intake.
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Affiliation(s)
- Grace Y Kiyabu
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Manami Inoue
- AXA Department of Health and Human Security, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Epidemiology and Prevention Group, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan
| | - Eiko Saito
- AXA Department of Health and Human Security, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Epidemiology and Prevention Group, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan
| | - Sarah K Abe
- AXA Department of Health and Human Security, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Norie Sawada
- Epidemiology and Prevention Group, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan
| | - Junko Ishihara
- Department of Nutrition Management, Sagami Women's University, Kanagawa Prefecture, Japan
| | - Motoki Iwasaki
- Epidemiology and Prevention Group, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan
| | - Taiki Yamaji
- Epidemiology and Prevention Group, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan
| | - Taichi Shimazu
- Epidemiology and Prevention Group, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan
| | - Shizuka Sasazuki
- Epidemiology and Prevention Group, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan
| | - Kenji Shibuya
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shoichiro Tsugane
- Epidemiology and Prevention Group, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan
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Li L, Zhang M, Holman CDJ. Hospital outpatients are satisfactory for case-control studies on cancer and diet in China: a comparison of population versus hospital controls. Asian Pac J Cancer Prev 2015; 14:2723-9. [PMID: 23803022 DOI: 10.7314/apjcp.2013.14.5.2723] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND To investigate the internal validity of a food-frequency questionnaire (FFQ) developed for use in Chinese women and to compare habitual dietary intakes between population and hospital controls measured by the FFQ. MATERIALS AND METHODS A quantitative FFQ and a short food habit questionnaire (SFHQ) were developed and adapted for cancer and nutritional studies. Habitual dietary intakes were assessed in 814 Chinese women aged 18-81 years (407 outpatients and 407 population controls) by face-to-face interview using the FFQ in Shenyang, Northeast China in 2009-2010. The Goldberg formula (ratio of energy intake to basal metabolic rate, EI/BMR) was used to assess the validity of the FFQ. Correlation analyses compared the SFHQ variables with those of the quantitative FFQ. Differences in dietary intakes between hospital and population controls were investigated. Odds ratios (ORs) and 95% confidence intervals (CIs) were obtained using conditional logistic regression analyses. RESULTS The partial correlation coefficients were moderate to high (0.42 to 0.80; all p<0.05) for preserved food intake, fat consumption and tea drinking variables between the SFHQ and the FFQ. The average EI/BMR was 1.93 with 88.5% of subjects exceeding the Goldberg cut-off value of 1.35. Hospital controls were comparable to population controls in consumption of 17 measured food groups and mean daily intakes of energy and selected nutrients. CONCLUSIONS The FFQ had reasonable validity to measure habitual dietary intakes of Chinese women. Hospital outpatients provide a satisfactory control group for food consumption and intakes of energy and nutrients measured by the FFQ in a Chinese hospital setting.
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Affiliation(s)
- Lin Li
- School of Population Health, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia , Perth, Australia.
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Morimoto Y, Maskarinec G, Park SY, Ettienne R, Matsuno RK, Long C, Steffen AD, Henderson BE, Kolonel LN, Le Marchand L, Wilkens LR. Dietary isoflavone intake is not statistically significantly associated with breast cancer risk in the Multiethnic Cohort. Br J Nutr 2014; 112:976-83. [PMID: 25201305 PMCID: PMC4237401 DOI: 10.1017/s0007114514001780] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Given the high intake levels of soya and low incidence rates of breast cancer in Asian countries, isoflavones, substances with an oestrogen-like structure occurring principally in soyabeans, are postulated to be cancer protective. In the present study, we examined the association of dietary isoflavone intake with breast cancer risk in 84,450 women (896 in situ and 3873 invasive cases) who were part of the Multiethnic Cohort (Japanese Americans, whites, Latinos, African Americans and Native Hawaiians) with a wide range of soya intake levels. The absolute levels of dietary isoflavone intake estimated from a baseline FFQ were categorised into quartiles, with the highest quartile being further subdivided to assess high dietary intake. The respective intake values for the quartiles (Q1, Q2, Q3, and lower and upper Q4) were 0-< 3·2, 3·2-< 6·7, 6·7-< 12·9, 12·9-< 20·3, and 20·3-178·7 mg/d. After a mean follow-up period of 13 years, hazard ratios (HR) and 95% CI were calculated using Cox regression models stratified by age and adjusted for known confounders. Linear trends were tested by modelling continuous variables of interest assigned the median value within the corresponding quartile. No statistically significant association was observed between dietary isoflavone intake and overall breast cancer risk (HR for upper Q4 v. Q1: 0·96 (95% CI 0·85, 1·08); P trend = 0·40). While the test for interaction was not significant (P=0·14), stratified analyses suggested possible ethnic/racial differences in risk estimates, indicating that higher isoflavone intakes may be protective in Latina, African American and Japanese American women. These results are in agreement with those of previous meta-analyses showing no protection of isoflavones at low intake levels, but suggesting inverse associations in populations consuming high amounts of soya.
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Affiliation(s)
| | | | - Song-Yi Park
- University of Hawaii Cancer Center, Honolulu, HI
| | - Reynolette Ettienne
- College of Tropical Agriculture and Human Resources, University of Hawaii, Honolulu, HI
| | | | - Camonia Long
- Department of Public Health Sciences, University of Hawaii, Honolulu, HI
| | - Alana D. Steffen
- College of Nursing, University of Illinois at Chicago, Chicago, IL
| | - Brian E. Henderson
- Keck School of Medicine, University of Southern California, Los Angeles, CA
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Mourouti N, Kontogianni MD, Papavagelis C, Panagiotakos DB. Diet and breast cancer: a systematic review. Int J Food Sci Nutr 2014; 66:1-42. [DOI: 10.3109/09637486.2014.950207] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Chen M, Rao Y, Zheng Y, Wei S, Li Y, Guo T, Yin P. Association between soy isoflavone intake and breast cancer risk for pre- and post-menopausal women: a meta-analysis of epidemiological studies. PLoS One 2014; 9:e89288. [PMID: 24586662 PMCID: PMC3930722 DOI: 10.1371/journal.pone.0089288] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 01/19/2014] [Indexed: 12/17/2022] Open
Abstract
Background Conclusions drawn from meta-analyses on the association between soy isoflavone intake and breast cancer risk for pre- and post-menopausal women are not fully consistent. These meta-analyses did not explore the influence of different study designs on the pooled results on the basis of distinguishing between pre- and post-menopausal women. Methodology and Principal Findings We performed a meta-analysis of 35 studies which reported results of association between soy isoflavone intake and breast cancer risk for pre- and/or post-menopausal women, calculated pooled odds ratios and their 95% confidence intervals of pre- and post-menopausal women respectively, and further explored soy isoflavone-breast cancer association on the basis of considering different study regions and designs. Summary results suggested that soy isoflavone intake has a protective effect against breast cancer for both pre- and post-menopausal women. However, they are influenced by study design and region. Pooled ORs of studies carried out in Asian countries suggested that soy isoflavone’s protective effect exist in both pre- and post-menopausal women (OR = 0.59, 95%CI: 0.48–0.69 for premenopausal women; OR = 0.59, 95%CI: 0.44–0.74 for postmenopausal women). However, there are some differences between the results pooled from different study designs for women in Asian countries (test for consistency, P = 0.04). Pooled OR of studies on postmenopausal women in Western countries suggested that soy isoflavone intake has a marginally significant protective effect (OR = 0.92; 95%CI: 0.83∼1.00), but further analyses stratifying by study design found no statistically significant association. Conclusions We meta-analyzed more and newer research results, and separated women according to menopausal status to explore soy isoflavone-breast cancer association. We founded that soy isoflavone intake could lower the risk of breast cancer for both pre- and post-menopausal women in Asian countries. However, for women in Western countries, pre- or post-menopausal, there is no evidence to suggest an association between intake of soy isoflavone and breast cancer.
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Affiliation(s)
- Meinan Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yanhua Rao
- Jiangxia Maternal and Child Health Hospital, Wuhan, China
| | - Yi Zheng
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shiqing Wei
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ye Li
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tong Guo
- WuXiPRA Clinical Research (Shanghai) Co., Ltd, Shanghai, China
| | - Ping Yin
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- * E-mail:
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Fritz H, Seely D, Flower G, Skidmore B, Fernandes R, Vadeboncoeur S, Kennedy D, Cooley K, Wong R, Sagar S, Sabri E, Fergusson D. Soy, red clover, and isoflavones and breast cancer: a systematic review. PLoS One 2013; 8:e81968. [PMID: 24312387 PMCID: PMC3842968 DOI: 10.1371/journal.pone.0081968] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 10/18/2013] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Soy and red clover isoflavones are controversial due to purported estrogenic activity and possible effects on breast cancer. We conducted a systematic review of soy and red clover for efficacy in improving menopausal symptoms in women with breast cancer, and for potential impact on risk of breast cancer incidence or recurrence. METHODS We searched MEDLINE, Embase, the Cochrane Library, and AMED from inception to March 2013 for human interventional or observational data pertaining to the safety and efficacy of soy and red clover isoflavones in patients with or at risk of breast cancer. RESULTS Of 4179 records, we included a total of 131 articles: 40 RCTs, 11 uncontrolled trials, and 80 observational studies. Five RCTs reported on the efficacy of soy for hot flashes, showing no significant reductions in hot flashes compared to placebo. There is lack of evidence showing harm from use of soy with respect to risk of breast cancer or recurrence, based on long term observational data. Soy intake consistent with that of a traditional Japanese diet (2-3 servings daily, containing 25-50mg isoflavones) may be protective against breast cancer and recurrence. Human trials show that soy does not increase circulating estradiol or affect estrogen-responsive target tissues. Prospective data of soy use in women taking tamoxifen does not indicate increased risk of recurrence. Evidence on red clover is limited, however existing studies suggest that it may not possess breast cancer-promoting effects. CONCLUSION Soy consumption may be associated with reduced risk of breast cancer incidence, recurrence, and mortality. Soy does not have estrogenic effects in humans. Soy intake consistent with a traditional Japanese diet appears safe for breast cancer survivors. While there is no clear evidence of harm, better evidence confirming safety is required before use of high dose (≥ 100 mg) isoflavones can be recommended for breast cancer patients.
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Affiliation(s)
- Heidi Fritz
- Department of Research & Clinical Epidemiology, Canadian College of Naturopathic Medicine, Toronto, Ontario, Canada
| | - Dugald Seely
- Department of Research & Clinical Epidemiology, Canadian College of Naturopathic Medicine, Toronto, Ontario, Canada
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Ottawa Integrative Cancer Center, Ottawa, Ontario, Canada
| | - Gillian Flower
- Department of Research & Clinical Epidemiology, Canadian College of Naturopathic Medicine, Toronto, Ontario, Canada
| | - Becky Skidmore
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Rochelle Fernandes
- Department of Research & Clinical Epidemiology, Canadian College of Naturopathic Medicine, Toronto, Ontario, Canada
- Laboratory Medicine and Pathobiology (LMP), University of Toronto, Toronto, Ontario, Canada
| | - Sarah Vadeboncoeur
- Department of Research & Clinical Epidemiology, Canadian College of Naturopathic Medicine, Toronto, Ontario, Canada
| | - Deborah Kennedy
- Department of Research & Clinical Epidemiology, Canadian College of Naturopathic Medicine, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Kieran Cooley
- Department of Research & Clinical Epidemiology, Canadian College of Naturopathic Medicine, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Raimond Wong
- Juravinski Cancer Centre and Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Stephen Sagar
- Juravinski Cancer Centre and Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Elham Sabri
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Dean Fergusson
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Anderson LN, Cotterchio M, Boucher BA, Kreiger N. Phytoestrogen intake from foods, during adolescence and adulthood, and risk of breast cancer by estrogen and progesterone receptor tumor subgroup among Ontario women. Int J Cancer 2012; 132:1683-92. [DOI: 10.1002/ijc.27788] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 07/31/2012] [Indexed: 12/15/2022]
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Zhang M, Holman CDJ. Low-to-moderate alcohol intake and breast cancer risk in Chinese women. Br J Cancer 2011; 105:1089-95. [PMID: 21829196 PMCID: PMC3185931 DOI: 10.1038/bjc.2011.302] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Despite extensive investigation of the association between alcohol consumption and breast cancer risk, effect of low-to-moderate alcohol intake on breast cancer incidence has been inconsistent. METHODS A case-control study was conducted in China, 2004-2005 to examine the association by menopausal status, oestrogen (ER) and progesterone receptor (PR) status of the tumour. There were 1009 incident cases with histologically confirmed breast cancer and 1009 age-matched controls recruited. We assessed alcohol consumption by face-to-face interview using a validated questionnaire and obtained tumour ER and PR status from pathology reports. RESULTS Low-to-moderate alcohol consumption was inversely associated with breast cancer risk. Compared with nondrinkers, the adjusted odds ratios (ORs) for alcohol <5 g per day were 0.41 (95% confidence interval 0.27-0.62) and 0.62 (0.48-0.79) in postmenopausal and premenopausal women, respectively. The inverse association was consistent for alcohol <15 g per day across hormone receptor status groups with ORs of 0.36-0.56 in postmenopausal women and 0.57-0.64 in premenopausal women. An exception was that alcohol ≥15 g per day appeared to increase the risk of breast cancers with discordant receptor status in postmenopausal women, that is, ER+/PR- or ER-/PR+ (4.27, 1.57-11.65). CONCLUSION We found that low-to-moderate alcohol intake was not associated with increased risk of breast cancer in pre- or postmenopausal Chinese women. Future studies are required to understand differences in effect of alcohol on breast cancers by tumour hormone receptor status.
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Affiliation(s)
- M Zhang
- School of Population Health, The University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western Australia 6009, Australia.
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Agurs-Collins T, Dunn BK, Browne D, Johnson KA, Lubet R. Epidemiology of Health Disparities in Relation to the Biology of Estrogen Receptor–Negative Breast Cancer. Semin Oncol 2010; 37:384-401. [DOI: 10.1053/j.seminoncol.2010.05.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Cho YA, Kim J, Park KS, Lim SY, Shin A, Sung MK, Ro J. Effect of dietary soy intake on breast cancer risk according to menopause and hormone receptor status. Eur J Clin Nutr 2010; 64:924-32. [PMID: 20571498 DOI: 10.1038/ejcn.2010.95] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Although high soy consumption may be associated with lower breast cancer risk in Asian populations, findings from epidemiological studies have been inconsistent. OBJECTIVE We investigated the effects of soy intake on breast cancer risk among Korean women according to their menopausal and hormone receptor status. METHODS We conducted a case-control study with 358 incident breast cancer patients and 360 age-matched controls with no history of malignant neoplasm. Dietary consumption of soy products was examined using a 103-item food frequency questionnaire. RESULTS The estimated mean intakes of total soy and isoflavones from this study population were 76.5 g per day and 15.0 mg per day, respectively. Using a multivariate logistic regression model, we found a significant inverse association between soy intake and breast cancer risk, with a dose-response relationship (odds ratios (OR) (95% confidence interval (CI)) for the highest vs the lowest intake quartile: 0.36 (0.20-0.64)). When the data were stratified by menopausal status, the protective effect was observed only among postmenopausal women (OR (95% CI) for the highest vs the lowest intake quartile: 0.08 (0.03-0.22)). The association between soy and breast cancer risk did not differ according to estrogen receptor (ER)/progesterone receptor (PR) status, but the estimated intake of soy isoflavones showed an inverse association only among postmenopausal women with ER+/PR+ tumors. CONCLUSIONS Our findings suggest that high consumption of soy might be related to lower risk of breast cancer and that the effect of soy intake could vary depending on several factors.
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Affiliation(s)
- Y A Cho
- Cancer Epidemiology Branch, Division of Cancer Epidemiology and Management, Research Institute, National Cancer Center, Gyeonggi-do, South Korea
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Health disparities in breast cancer: biology meets socioeconomic status. Breast Cancer Res Treat 2010; 121:281-92. [DOI: 10.1007/s10549-010-0827-x] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Accepted: 02/26/2010] [Indexed: 01/30/2023]
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Zhang C, Ho SC, Lin F, Cheng S, Fu J, Chen Y. Soy product and isoflavone intake and breast cancer risk defined by hormone receptor status. Cancer Sci 2010; 101:501-7. [PMID: 19860847 PMCID: PMC11158760 DOI: 10.1111/j.1349-7006.2009.01376.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The association between soy food consumption and breast cancer risk has been inconsistent. A hospital-based case-control study was conducted to assess the relationship between soy food intake and breast cancer risk according to the estrogen receptor (ER) and/or progesterone receptor (PR) status of breast cancer in Chinese women residing in Guangdong province from June 2007 to August 2008. A total of 438 consecutively recruited cases with primary breast cancer were frequency matched to 438 controls by age (5-year interval) and residence (rural/urban). Dietary intake was assessed by face-to-face interviews using a validated food frequency questionnaire. Odds ratios (OR) and 95% confidence intervals (CI) were obtained by using multiple unconditional logistic regression adjusted for the potential confounders. We observed a statistically significant inverse association between soy isoflavone and soy protein intake with breast cancer risk. The multivariate ORs (95% CIs) of breast cancer risk for the highest quartile compared with the lowest quartile were 0.54 (0.34-0.84) for soy isoflavone and 0.62 (0.40-0.96) for soy protein, respectively. A preventive effect of soy food was found for all subtypes of ER and/or PR status of breast cancer. The inverse association was more evident among premenopausal women. This study suggests that consumption of soy food, soy isoflavone, is inversely associated with the risk of breast cancer. The protective effects of soy did not seem to differ by ER and PR breast cancer status.
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Affiliation(s)
- Caixia Zhang
- Centre of Research and Promotion of Women's Health, School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
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