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Chlebowski RT, Aragaki AK, Anderson GL, Pan K, Neuhouser ML, Manson JE, Thomson CA, Mossavar-Rahmani Y, Lane DS, Johnson KC, Wactawski-Wende J, Snetselaar L, Rohan TE, Luo J, Barac A, Prentice RL. Dietary Modification and Breast Cancer Mortality: Long-Term Follow-Up of the Women's Health Initiative Randomized Trial. J Clin Oncol 2020; 38:1419-1428. [PMID: 32031879 PMCID: PMC7193750 DOI: 10.1200/jco.19.00435] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2019] [Indexed: 01/13/2023] Open
Abstract
PURPOSE Observational studies of dietary fat intake and breast cancer have reported inconsistent findings. This topic was addressed in additional analyses of the Women's Health Initiative (WHI) Dietary Modification (DM) clinical trial that evaluated a low-fat dietary pattern influence on breast cancer incidence. METHODS In the WHI DM trial, 48,835 postmenopausal women, ages 50-79 years, with no prior breast cancer, and a dietary fat intake of ≥ 32% of energy were randomly assigned at 40 US centers to a usual diet comparison group (60%) or dietary intervention group (40%). The goals were to reduce fat intake to 20% of energy and increase vegetable, fruit, and grain intake. Breast cancers were confirmed after central medical record review and serial National Death Index linkages to enhance mortality findings. RESULTS During 8.5 years of dietary intervention, breast cancer incidence and deaths as a result of breast cancer were nonsignificantly lower in the intervention group, while deaths after breast cancer were statistically significantly lower both during intervention and through a 16.1-year (median) follow-up. Now, after a long-term, cumulative 19.6-year (median) follow-up, the significant reduction in deaths after breast cancer persists (359 [0.12%] v 652 [0.14%] deaths; hazard ratio [HR], 0.85; 95% CI, 0.74 to 0.96; P = .01), and a statistically significant reduction in deaths as a result of breast cancer (breast cancer followed by death attributed to the breast cancer) emerged (132 [0.037%, annualized risk] v 251 [0.047%] deaths, respectively; HR, 0.79; 95% CI, 0.64 to 0.97; P = .02). CONCLUSION Adoption of a low-fat dietary pattern associated with increased vegetable, fruit, and grain intake, demonstrably achievable by many, may reduce the risk of death as a result of breast cancer in postmenopausal women.
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Affiliation(s)
- Rowan T. Chlebowski
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
| | - Aaron K. Aragaki
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Garnet L. Anderson
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Kathy Pan
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
| | - Marian L. Neuhouser
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - JoAnn E. Manson
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | | | - Yasmin Mossavar-Rahmani
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Dorothy S. Lane
- Department of Family, Population and Preventive Medicine, Stony Brook University School of Medicine, Stony Brook, NY
| | - Karen C. Johnson
- Departments of Preventive Medicine and Medicine, University of Tennessee, Memphis, TN
| | - Jean Wactawski-Wende
- Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY
| | | | - Thomas E. Rohan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Juhua Luo
- Department of Epidemiology and Biostatistics, Indiana University, Bloomington, IN
| | - Ana Barac
- MedStar Heart and Vascular Institute, Georgetown University, Washington, DC
| | - Ross L. Prentice
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - on behalf of the Women’s Health Initiative
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Department of Nutritional Sciences, University of Arizona, Tucson, AZ
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
- Department of Family, Population and Preventive Medicine, Stony Brook University School of Medicine, Stony Brook, NY
- Departments of Preventive Medicine and Medicine, University of Tennessee, Memphis, TN
- Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY
- Department of Epidemiology and Biostatistics, Indiana University, Bloomington, IN
- College of Public Health, University of Iowa, Iowa City, IA
- MedStar Heart and Vascular Institute, Georgetown University, Washington, DC
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