Low-fat dietary pattern and risk of invasive breast cancer: The Women's Health Initiative randomized controlled dietary modification trial

Ross L. Prentice, Bette Caan, Rowan T. Chlebowski, Ruth Patterson, Lewis H. Kuller, Judith K. Ockene, Karen L. Margolis, Marian C. Limacher, Jo Ann E. Manson, Linda M. Parker, Electra Paskett, Lawrence Phillips, John Robbins, Jacques E. Rossouw, Gloria E. Sarto, James M. Shikany, Marcia L. Stefanick, Cynthia A. Thomson, Linda Van Horn, Mara Z. VitolinsJean Wactawski-Wende, Robert B. Wallace, Sylvia Wassertheil-Smoller, Evelyn Whitlock, Katsuhiko Yano, Lucile Adams-Campbell, Garnet L. Anderson, Annlouise R. Assaf, Shirley A.A. Beresford, Henry R. Black, Robert L. Brunner, Robert G. Brzyski, Leslie Ford, Margery Gass, Jennifer Hays-Grudo, David Heber, Gerardo Heiss, Susan L. Hendrix, Judith Hsia, F. Allan Hubbell, Rebecca D. Jackson, Karen C. Johnson, Jane Morley Kotchen, Andrea Z. LaCroix, Dorothy S. Lane, Robert D. Langer, Norman L. Lasser, Maureen M. Henderson

Research output: Contribution to journalArticle

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Abstract

Context: The hypothesis that a low-fat dietary pattern can reduce breast cancer risk has existed for decades but has never been tested in a controlled intervention trial. Objective: To assess the effects of undertaking a low-fat dietary pattern on breast cancer incidence. Design and Setting: A randomized, controlled, primary prevention trial conducted at 40 US clinical centers from 1993 to 2005. Participants: A total of 48 835 postmenopausal women, aged 50 to 79 years, without prior breast cancer, including 18.6% of minority race/ethnicity, were enrolled. Interventions: Women were randomly assigned to the dietary modification intervention group (40% [n = 19 541]) or the comparison group (60% [n = 29 294]). The intervention was designed to promote dietary change with the goals of reducing intake of total fat to 20% of energy and increasing consumption of vegetables and fruit to at least 5 servings daily and grains to at least 6 servings daily. Comparison group participants were not asked to make dietary changes. Main Outcome Measure: Invasive breast cancer incidence. Results: Dietary fat intake was significantly lower in the dietary modification intervention group compared with the comparison group. The difference between groups in change from baseline for percentage of energy from fat varied from 10.7% at year 1 to 8.1% at year 6. Vegetable and fruit consumption was higher in the intervention group by at least 1 serving per day and a smaller, more transient difference was found for grain consumption. The number of women who developed invasive breast cancer (annualized incidence rate) over the 8.1-year average follow-up period was 655 (0.42%) in the intervention group and 1072 (0.45%) in the comparison group (hazard ratio, 0.91; 95% confidence interval, 0.83-1.01 for the comparison between the 2 groups). Secondary analyses suggest a lower hazard ratio among adherent women, provide greater evidence of risk reduction among women having a high-fat diet at baseline, and suggest a dietary effect that varies by hormone receptor characteristics of the tumor. Conclusions: Among postmenopausal women, a low-fat dietary pattern did not result in a statistically significant reduction in invasive breast cancer risk over an 8.1-year average follow-up period. However, the nonsignificant trends observed suggesting reduced risk associated with a low-fat dietary pattern indicate that longer, planned, nonintervention follow-up may yield a more definitive comparison.

Original languageEnglish
Pages (from-to)629-642
Number of pages14
JournalJournal of the American Medical Association
Volume295
Issue number6
DOIs
StatePublished - 8 Feb 2006

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Diet Therapy
Dietary Fats
Women's Health
Breast Neoplasms
Vegetables
Fruit
Incidence
Fats
High Fat Diet
Risk Reduction Behavior
Primary Prevention
Outcome Assessment (Health Care)
Hormones
Confidence Intervals
Neoplasms

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Prentice, Ross L. ; Caan, Bette ; Chlebowski, Rowan T. ; Patterson, Ruth ; Kuller, Lewis H. ; Ockene, Judith K. ; Margolis, Karen L. ; Limacher, Marian C. ; Manson, Jo Ann E. ; Parker, Linda M. ; Paskett, Electra ; Phillips, Lawrence ; Robbins, John ; Rossouw, Jacques E. ; Sarto, Gloria E. ; Shikany, James M. ; Stefanick, Marcia L. ; Thomson, Cynthia A. ; Van Horn, Linda ; Vitolins, Mara Z. ; Wactawski-Wende, Jean ; Wallace, Robert B. ; Wassertheil-Smoller, Sylvia ; Whitlock, Evelyn ; Yano, Katsuhiko ; Adams-Campbell, Lucile ; Anderson, Garnet L. ; Assaf, Annlouise R. ; Beresford, Shirley A.A. ; Black, Henry R. ; Brunner, Robert L. ; Brzyski, Robert G. ; Ford, Leslie ; Gass, Margery ; Hays-Grudo, Jennifer ; Heber, David ; Heiss, Gerardo ; Hendrix, Susan L. ; Hsia, Judith ; Hubbell, F. Allan ; Jackson, Rebecca D. ; Johnson, Karen C. ; Kotchen, Jane Morley ; LaCroix, Andrea Z. ; Lane, Dorothy S. ; Langer, Robert D. ; Lasser, Norman L. ; Henderson, Maureen M. / Low-fat dietary pattern and risk of invasive breast cancer : The Women's Health Initiative randomized controlled dietary modification trial. In: Journal of the American Medical Association. 2006 ; Vol. 295, No. 6. pp. 629-642.
@article{ad4287dc029b47b08f57d19f018c09fc,
title = "Low-fat dietary pattern and risk of invasive breast cancer: The Women's Health Initiative randomized controlled dietary modification trial",
abstract = "Context: The hypothesis that a low-fat dietary pattern can reduce breast cancer risk has existed for decades but has never been tested in a controlled intervention trial. Objective: To assess the effects of undertaking a low-fat dietary pattern on breast cancer incidence. Design and Setting: A randomized, controlled, primary prevention trial conducted at 40 US clinical centers from 1993 to 2005. Participants: A total of 48 835 postmenopausal women, aged 50 to 79 years, without prior breast cancer, including 18.6{\%} of minority race/ethnicity, were enrolled. Interventions: Women were randomly assigned to the dietary modification intervention group (40{\%} [n = 19 541]) or the comparison group (60{\%} [n = 29 294]). The intervention was designed to promote dietary change with the goals of reducing intake of total fat to 20{\%} of energy and increasing consumption of vegetables and fruit to at least 5 servings daily and grains to at least 6 servings daily. Comparison group participants were not asked to make dietary changes. Main Outcome Measure: Invasive breast cancer incidence. Results: Dietary fat intake was significantly lower in the dietary modification intervention group compared with the comparison group. The difference between groups in change from baseline for percentage of energy from fat varied from 10.7{\%} at year 1 to 8.1{\%} at year 6. Vegetable and fruit consumption was higher in the intervention group by at least 1 serving per day and a smaller, more transient difference was found for grain consumption. The number of women who developed invasive breast cancer (annualized incidence rate) over the 8.1-year average follow-up period was 655 (0.42{\%}) in the intervention group and 1072 (0.45{\%}) in the comparison group (hazard ratio, 0.91; 95{\%} confidence interval, 0.83-1.01 for the comparison between the 2 groups). Secondary analyses suggest a lower hazard ratio among adherent women, provide greater evidence of risk reduction among women having a high-fat diet at baseline, and suggest a dietary effect that varies by hormone receptor characteristics of the tumor. Conclusions: Among postmenopausal women, a low-fat dietary pattern did not result in a statistically significant reduction in invasive breast cancer risk over an 8.1-year average follow-up period. However, the nonsignificant trends observed suggesting reduced risk associated with a low-fat dietary pattern indicate that longer, planned, nonintervention follow-up may yield a more definitive comparison.",
author = "Prentice, {Ross L.} and Bette Caan and Chlebowski, {Rowan T.} and Ruth Patterson and Kuller, {Lewis H.} and Ockene, {Judith K.} and Margolis, {Karen L.} and Limacher, {Marian C.} and Manson, {Jo Ann E.} and Parker, {Linda M.} and Electra Paskett and Lawrence Phillips and John Robbins and Rossouw, {Jacques E.} and Sarto, {Gloria E.} and Shikany, {James M.} and Stefanick, {Marcia L.} and Thomson, {Cynthia A.} and {Van Horn}, Linda and Vitolins, {Mara Z.} and Jean Wactawski-Wende and Wallace, {Robert B.} and Sylvia Wassertheil-Smoller and Evelyn Whitlock and Katsuhiko Yano and Lucile Adams-Campbell and Anderson, {Garnet L.} and Assaf, {Annlouise R.} and Beresford, {Shirley A.A.} and Black, {Henry R.} and Brunner, {Robert L.} and Brzyski, {Robert G.} and Leslie Ford and Margery Gass and Jennifer Hays-Grudo and David Heber and Gerardo Heiss and Hendrix, {Susan L.} and Judith Hsia and Hubbell, {F. Allan} and Jackson, {Rebecca D.} and Johnson, {Karen C.} and Kotchen, {Jane Morley} and LaCroix, {Andrea Z.} and Lane, {Dorothy S.} and Langer, {Robert D.} and Lasser, {Norman L.} and Henderson, {Maureen M.}",
year = "2006",
month = "2",
day = "8",
doi = "10.1001/jama.295.6.629",
language = "English",
volume = "295",
pages = "629--642",
journal = "Journal of the American Medical Association",
issn = "0098-7484",
publisher = "American Medical Association",
number = "6",

}

Prentice, RL, Caan, B, Chlebowski, RT, Patterson, R, Kuller, LH, Ockene, JK, Margolis, KL, Limacher, MC, Manson, JAE, Parker, LM, Paskett, E, Phillips, L, Robbins, J, Rossouw, JE, Sarto, GE, Shikany, JM, Stefanick, ML, Thomson, CA, Van Horn, L, Vitolins, MZ, Wactawski-Wende, J, Wallace, RB, Wassertheil-Smoller, S, Whitlock, E, Yano, K, Adams-Campbell, L, Anderson, GL, Assaf, AR, Beresford, SAA, Black, HR, Brunner, RL, Brzyski, RG, Ford, L, Gass, M, Hays-Grudo, J, Heber, D, Heiss, G, Hendrix, SL, Hsia, J, Hubbell, FA, Jackson, RD, Johnson, KC, Kotchen, JM, LaCroix, AZ, Lane, DS, Langer, RD, Lasser, NL & Henderson, MM 2006, 'Low-fat dietary pattern and risk of invasive breast cancer: The Women's Health Initiative randomized controlled dietary modification trial', Journal of the American Medical Association, vol. 295, no. 6, pp. 629-642. https://doi.org/10.1001/jama.295.6.629

Low-fat dietary pattern and risk of invasive breast cancer : The Women's Health Initiative randomized controlled dietary modification trial. / Prentice, Ross L.; Caan, Bette; Chlebowski, Rowan T.; Patterson, Ruth; Kuller, Lewis H.; Ockene, Judith K.; Margolis, Karen L.; Limacher, Marian C.; Manson, Jo Ann E.; Parker, Linda M.; Paskett, Electra; Phillips, Lawrence; Robbins, John; Rossouw, Jacques E.; Sarto, Gloria E.; Shikany, James M.; Stefanick, Marcia L.; Thomson, Cynthia A.; Van Horn, Linda; Vitolins, Mara Z.; Wactawski-Wende, Jean; Wallace, Robert B.; Wassertheil-Smoller, Sylvia; Whitlock, Evelyn; Yano, Katsuhiko; Adams-Campbell, Lucile; Anderson, Garnet L.; Assaf, Annlouise R.; Beresford, Shirley A.A.; Black, Henry R.; Brunner, Robert L.; Brzyski, Robert G.; Ford, Leslie; Gass, Margery; Hays-Grudo, Jennifer; Heber, David; Heiss, Gerardo; Hendrix, Susan L.; Hsia, Judith; Hubbell, F. Allan; Jackson, Rebecca D.; Johnson, Karen C.; Kotchen, Jane Morley; LaCroix, Andrea Z.; Lane, Dorothy S.; Langer, Robert D.; Lasser, Norman L.; Henderson, Maureen M.

In: Journal of the American Medical Association, Vol. 295, No. 6, 08.02.2006, p. 629-642.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Low-fat dietary pattern and risk of invasive breast cancer

T2 - The Women's Health Initiative randomized controlled dietary modification trial

AU - Prentice, Ross L.

AU - Caan, Bette

AU - Chlebowski, Rowan T.

AU - Patterson, Ruth

AU - Kuller, Lewis H.

AU - Ockene, Judith K.

AU - Margolis, Karen L.

AU - Limacher, Marian C.

AU - Manson, Jo Ann E.

AU - Parker, Linda M.

AU - Paskett, Electra

AU - Phillips, Lawrence

AU - Robbins, John

AU - Rossouw, Jacques E.

AU - Sarto, Gloria E.

AU - Shikany, James M.

AU - Stefanick, Marcia L.

AU - Thomson, Cynthia A.

AU - Van Horn, Linda

AU - Vitolins, Mara Z.

AU - Wactawski-Wende, Jean

AU - Wallace, Robert B.

AU - Wassertheil-Smoller, Sylvia

AU - Whitlock, Evelyn

AU - Yano, Katsuhiko

AU - Adams-Campbell, Lucile

AU - Anderson, Garnet L.

AU - Assaf, Annlouise R.

AU - Beresford, Shirley A.A.

AU - Black, Henry R.

AU - Brunner, Robert L.

AU - Brzyski, Robert G.

AU - Ford, Leslie

AU - Gass, Margery

AU - Hays-Grudo, Jennifer

AU - Heber, David

AU - Heiss, Gerardo

AU - Hendrix, Susan L.

AU - Hsia, Judith

AU - Hubbell, F. Allan

AU - Jackson, Rebecca D.

AU - Johnson, Karen C.

AU - Kotchen, Jane Morley

AU - LaCroix, Andrea Z.

AU - Lane, Dorothy S.

AU - Langer, Robert D.

AU - Lasser, Norman L.

AU - Henderson, Maureen M.

PY - 2006/2/8

Y1 - 2006/2/8

N2 - Context: The hypothesis that a low-fat dietary pattern can reduce breast cancer risk has existed for decades but has never been tested in a controlled intervention trial. Objective: To assess the effects of undertaking a low-fat dietary pattern on breast cancer incidence. Design and Setting: A randomized, controlled, primary prevention trial conducted at 40 US clinical centers from 1993 to 2005. Participants: A total of 48 835 postmenopausal women, aged 50 to 79 years, without prior breast cancer, including 18.6% of minority race/ethnicity, were enrolled. Interventions: Women were randomly assigned to the dietary modification intervention group (40% [n = 19 541]) or the comparison group (60% [n = 29 294]). The intervention was designed to promote dietary change with the goals of reducing intake of total fat to 20% of energy and increasing consumption of vegetables and fruit to at least 5 servings daily and grains to at least 6 servings daily. Comparison group participants were not asked to make dietary changes. Main Outcome Measure: Invasive breast cancer incidence. Results: Dietary fat intake was significantly lower in the dietary modification intervention group compared with the comparison group. The difference between groups in change from baseline for percentage of energy from fat varied from 10.7% at year 1 to 8.1% at year 6. Vegetable and fruit consumption was higher in the intervention group by at least 1 serving per day and a smaller, more transient difference was found for grain consumption. The number of women who developed invasive breast cancer (annualized incidence rate) over the 8.1-year average follow-up period was 655 (0.42%) in the intervention group and 1072 (0.45%) in the comparison group (hazard ratio, 0.91; 95% confidence interval, 0.83-1.01 for the comparison between the 2 groups). Secondary analyses suggest a lower hazard ratio among adherent women, provide greater evidence of risk reduction among women having a high-fat diet at baseline, and suggest a dietary effect that varies by hormone receptor characteristics of the tumor. Conclusions: Among postmenopausal women, a low-fat dietary pattern did not result in a statistically significant reduction in invasive breast cancer risk over an 8.1-year average follow-up period. However, the nonsignificant trends observed suggesting reduced risk associated with a low-fat dietary pattern indicate that longer, planned, nonintervention follow-up may yield a more definitive comparison.

AB - Context: The hypothesis that a low-fat dietary pattern can reduce breast cancer risk has existed for decades but has never been tested in a controlled intervention trial. Objective: To assess the effects of undertaking a low-fat dietary pattern on breast cancer incidence. Design and Setting: A randomized, controlled, primary prevention trial conducted at 40 US clinical centers from 1993 to 2005. Participants: A total of 48 835 postmenopausal women, aged 50 to 79 years, without prior breast cancer, including 18.6% of minority race/ethnicity, were enrolled. Interventions: Women were randomly assigned to the dietary modification intervention group (40% [n = 19 541]) or the comparison group (60% [n = 29 294]). The intervention was designed to promote dietary change with the goals of reducing intake of total fat to 20% of energy and increasing consumption of vegetables and fruit to at least 5 servings daily and grains to at least 6 servings daily. Comparison group participants were not asked to make dietary changes. Main Outcome Measure: Invasive breast cancer incidence. Results: Dietary fat intake was significantly lower in the dietary modification intervention group compared with the comparison group. The difference between groups in change from baseline for percentage of energy from fat varied from 10.7% at year 1 to 8.1% at year 6. Vegetable and fruit consumption was higher in the intervention group by at least 1 serving per day and a smaller, more transient difference was found for grain consumption. The number of women who developed invasive breast cancer (annualized incidence rate) over the 8.1-year average follow-up period was 655 (0.42%) in the intervention group and 1072 (0.45%) in the comparison group (hazard ratio, 0.91; 95% confidence interval, 0.83-1.01 for the comparison between the 2 groups). Secondary analyses suggest a lower hazard ratio among adherent women, provide greater evidence of risk reduction among women having a high-fat diet at baseline, and suggest a dietary effect that varies by hormone receptor characteristics of the tumor. Conclusions: Among postmenopausal women, a low-fat dietary pattern did not result in a statistically significant reduction in invasive breast cancer risk over an 8.1-year average follow-up period. However, the nonsignificant trends observed suggesting reduced risk associated with a low-fat dietary pattern indicate that longer, planned, nonintervention follow-up may yield a more definitive comparison.

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U2 - 10.1001/jama.295.6.629

DO - 10.1001/jama.295.6.629

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AN - SCOPUS:32144441493

VL - 295

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JO - Journal of the American Medical Association

JF - Journal of the American Medical Association

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