Scientific Evidence Confirms The Influence of Diet on Breast Cancer Risk

Commentary by: Commentary by Lise Alschuler, ND, FABNO

Reference: Brennan S, Cantwell M, Cardwell C, Velentzis L, Woodside J. Dietary patterns and breast cancer risk: a systemic review and meta-analysis. Am J Clin Nutr. 2010;91(5):1294-1302. [Epub ahead of print.]

Design: MEDLINE and EMBASE were searched for relevant articles that identified common dietary patterns published up to November 2009. Multivariable-adjusted odds ratios comparing highest to lowest categories of dietary pattern and multivariable adjusted ORs for a 20th percentile increase in dietary pattern scores were combined using random-effects meta-analyses.

Number of Studies: Case-control and cohort studies that identified prudent/healthy diet (N=18), Western/unhealthy diet (N=17), and drinker (N=4) dietary patterns. In total, 18 studies met the inclusion criteria and were included in the analyses.

Key Findings: This meta-analysis resulted in evidence of a decrease in the risk of breast cancer in the highest compared to the lowest categories of prudent/healthy dietary patterns (OR=0.89; 95% CI: 0.82, 0.99; P=0.02) in all studies and in pooled cohort studies alone. An increase in the risk of breast cancer was shown for the highest compared to the lowest categories of a drinker dietary pattern (OR=1.21; 95% CI: 1.04, 1.41; P=0.01). There was no evidence of a difference in the risk of breast cancer between the highest and the lowest categories of Western/unhealthy dietary patterns (OR=1.09; 95% CI:0.98, 1.22; P=0.12). A Western/unhealthy dietary pattern tended to have high quantities of red and/or processed meats, refined grains, potatoes, sweets, and high-fat dairy. Prudent/healthy diets tended to have high quantities of fruit, vegetables, poultry, fish, low-fat dairy, and whole grains.

Practice Implications: This study supports the long-held contention that diet provides breast cancer prevention. The data on this topic are mixed with some trials, such as the widely publicized randomized controlled Women’s Healthy Eating and Living (WHEL) trial on women with recently diagnosed early-stage breast cancer, which failed to show a benefit from diet in reducing breast cancer recurrence risk.¹ Other trials have shown benefit, and follow-up analyses of the WHEL trial indicate that subgroups may experience benefit.² The current meta-analysis provides a comprehensive opportunity to review the cumulative findings of trials on this association.

One important aspect of this meta-analysis is that the inclusion criteria studies are based on dietary patterns rather than on diets focused on single nutrients. This supports the hypothesis that nutrients in food have complex synergistic interactions and that their effects are best studied in a whole-foods context. Of interest is the lack of a difference in risk from Western/unhealthy diets in the highest compared to the lowest category. One interpretation of this, in light of the observed benefit from the prudent/healthy diets, is that the absence of fruit, vegetables, poultry, fish, low-fat dairy, and whole grains is more impactful than the presence of deleterious foods. This makes sense when one considers the plentitude of DNA reparative, anti-inflammatory, antiproliferative and proapoptotic compounds found in healthy diets. When one is ingesting these compounds in sufficient quantity, one gains their protective effect, regardless of other components in the diet. While the risk reduction from healthy diets is small, namely a 7% risk reduction in cohort studies (OR=0.93; 95% CI: 0.88, 0.98; P=0.01), this is significant as both a cumulative factor and in association with other lifestyle parameters such as exercise. Another important conclusion from this meta-analysis is the once again clearly defined link between alcoholic beverage consumption (greater than 2 drinks daily) and increased breast cancer risk—above and beyond the underlying diet. Alcohol is thought to raise estrogen levels because of decreased hepatic clearance, to increase cellular susceptibility to carcinogens and to impair DNA repair enzymes.

References

1. Pierce JP, Natarajan L, Caan BJ, et al. 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. JAMA. 2007;298(3):289-298.
2. Gold EB, Pierce JP, Natarajan L, et al. Dietary pattern influences breast cancer prognosis in women without hot flashes: the women’s healthy eating and living trial. J Clin Oncol. 2009 Jan 20;27(3):352-359.

About Lise Alschuler, ND, FABNO
Lise Alschuler, ND, FABNO, is a naturopathic physician with board certification in naturopathic oncology and a graduate of Bastyr University where she received her naturopathic doctorate. Dr. Alschuler has been in practice for over 15 years. She is the immediate past-President of the American Association of Naturopathic Physicians and member of the American Board of Naturopathic Oncology Board of Medical Examiners. Dr. Alschuler is the Vice President of Quality and Education at Emerson Ecologics, a supplement distribution company based in Bedford NH. She also provides naturopathic oncology at Naturopathic Specialists, based out of Scottsdale AZ. Previous to this, she was Director of naturopathic medicine at Cancer Treatment Centers of America, a JCAHO accredited regional hospital specializing in comprehensive integrative cancer located north of Chicago. Dr. Alschuler co-authored The Definitive Guide to Cancer: An Integrative Approach to Prevention, Treatment and Healing (Third Edition 2010). She has presented at numerous professional conferences, and continues to give presentations for lay and professional audiences. For more information visit www.drlise.net.

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