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Dietary flavonoid and lignan intake and breast cancer risk according to menopause and hormone receptor status in the European Prospective Investigation into Cancer and Nutrition (EPIC) Study

  • Epidemiology
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Abstract

Evidence on the association between dietary flavonoids and lignans and breast cancer (BC) risk is inconclusive, with the possible exception of isoflavones in Asian countries. Therefore, we investigated prospectively dietary total and subclasses of flavonoid and lignan intake and BC risk according to menopause and hormonal receptor status in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. The study included 334,850 women, mostly aged between 35 and 70 years from ten European countries. At baseline, country-specific validated dietary questionnaires were used. A flavonoid and lignan food composition database was developed from the US Department of Agriculture, the Phenol-Explorer and the UK Food Standards Agency databases. Cox regression models were used to analyse the association between dietary flavonoid/lignan intake and the risk of developing BC. During an average 11.5-year follow-up, 11,576 incident BC cases were identified. No association was observed between the intake of total flavonoids [hazard ratio comparing fifth to first quintile (HRQ5–Q1) 0.97, 95 % confidence interval (CI): 0.90–1.04; P trend = 0.591], isoflavones (HRQ5–Q1 1.00, 95 % CI: 0.91–1.10; P trend = 0.734), or total lignans (HRQ5–Q1 1.02, 95 % CI: 0.93–1.11; P trend = 0.469) and overall BC risk. The stratification of the results by menopausal status at recruitment or the differentiation of BC cases according to oestrogen and progesterone receptors did not affect the results. This study shows no associations between flavonoid and lignan intake and BC risk, overall or after taking into account menopausal status and BC hormone receptors.

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Abbreviations

BC:

Breast cancer

EPIC:

European prospective investigation into cancer and nutrition

ER:

Oestrogen receptor

PR:

Progesterone receptor

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Acknowledgements

This work was supported by the European Commission: Public Health and Consumer Protection Directorate 1993–2004; Research Directorate-General 2005; Ligue contre le Cancer, Institut Gustave Roussy, Mutuelle Générale de l’Education Nationale, Institut National de la Santé et de la Recherche Médicale (INSERM) (France); German Cancer Aid; German Cancer Research Center (DKFZ); German Federal Ministry of Education and Research; Danish Cancer Society: Health Research Fund (FIS) of the Spanish Ministry of Health (RTICC DR06/0020/0091); the participating regional governments from Asturias, Andalucía, Murcia, Navarra and Basque Country and the Catalan Institute of Oncology of Spain; Cancer Research UK; Medical Research Council, UK; Hellenic Health Foundation, Greece; Italian Association for Research on Cancer-AIRC-Milan, Italy; Compagnia San Paolo, Italy; Dutch Ministry of Public Health, Welfare and Sports; Dutch Ministry of Health; Dutch Prevention Funds; LK Research Funds; Dutch ZON (Zorg Onderzoek Nederland); World Cancer Research Fund (WCRF); Statistics Netherlands (The Netherlands); Swedish Cancer Society; Swedish Scientific Council; Regional Government of Skane, Sweden; and Nordforsk—Centre of Excellence programme. Some authors are partners of ECNIS, a network of excellence of the 6 Frame Program of the European Commission. R.Z.R. is thankful for a postdoctoral programme, Fondo de Investigación Sanitaria (FIS; No. CD09/00133), from the Spanish Ministry of Science and Innovation.

Conflict of interest

  The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Bellvitge Biomedical Research Institute (IDIBELL), Avda Gran Via 199-203, L’Hospitalet de Llobregat, 08907, Barcelona, Spain

    Raul Zamora-Ros, Carlos A. González & Noémie Travier

  2. Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC), Lyon, France

    Pietro Ferrari, Augustin Scalbert & Isabelle Romieu

  3. Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark

    Anne Tjønneland & Anja Olsen

  4. Technical University of Denmark, National Food Institute, Soeborg, Denmark

    Lea Bredsdorff

  5. Section for Epidemiology, Department of Public Health, Aarhus University, Århus, Denmark

    Kim Overvad

  6. Centre for Research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women’s Health Team, Inserm, 94805, Villejuif, France

    Marina Touillaud, Florence Perquier & Guy Fagherazzi

  7. Paris South University, UMRS 1018, Villejuif, France

    Marina Touillaud, Florence Perquier & Guy Fagherazzi

  8. Institut Gustave-Roussy (IGR), 94805, Villejuif, France

    Marina Touillaud, Florence Perquier & Guy Fagherazzi

  9. Department of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany

    Annekatrin Lukanova & Kaja Tikk

  10. Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany

    Krasimira Aleksandrova & Heiner Boeing

  11. Hellenic Health Foundation, Athens, Greece

    Antonia Trichopoulou, Dimitrios Trichopoulos & Vardis Dilis

  12. Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, WHO Collaborating Center for Food and Nutrition Policies, Athens, Greece

    Antonia Trichopoulou

  13. Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA

    Dimitrios Trichopoulos

  14. Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece

    Dimitrios Trichopoulos

  15. Molecular and Nutritional Epidemiology Unit, ISPO Cancer Prevention and Research Institute, Florence, Italy

    Giovanna Masala

  16. Nutritional Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

    Sabina Sieri

  17. Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy

    Amalia Mattiello

  18. Cancer Registry and Histopathology Unit, “Civile M.P. Arezzo” Hospital, Ragusa, Italy

    Rosario Tumino

  19. School of Public Health, Imperial College, London, UK

    Elio Riboli

  20. Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands

    H. Bas Bueno-de-Mesquita

  21. Department of Gastroenterology and Hepatology, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands

    H. Bas Bueno-de-Mesquita

  22. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands

    Petra H. M. Peeters

  23. Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College, London, UK

    Petra H. M. Peeters & Heather A. Ward

  24. Department of Community Medicine, University of Tromsø, Tromsö, Norway

    Elisabete Weiderpass, Guri Skeie & Dagrun Engeset

  25. Cancer Registry of Norway, Oslo, Norway

    Elisabete Weiderpass

  26. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden

    Elisabete Weiderpass

  27. Samfundet Folkhälsan, Helsinki, Finland

    Elisabete Weiderpass

  28. Public Health Directorate, Asturias, Spain

    Virginia Menéndez

  29. Andalusian School of Public Health, Granada, Spain

    Esther Molina-Montes

  30. CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain

    Esther Molina-Montes, Pilar Amiano, Maria-Dolores Chirlaque & Aurelio Barricarte

  31. Public Health Department of Gipuzkoa, Basque Government, San Sebastián, Spain

    Pilar Amiano

  32. Department of Epidemiology, Murcia Regional Health Council, Murcia, Spain

    Maria-Dolores Chirlaque

  33. Public Health Institute of Navarra, Pamplona, Spain

    Aurelio Barricarte

  34. Nutrition Epidemiology Research Group, Department of Clinical Sciences, Lund University, Malmö, Sweden

    Peter Wallström

  35. Diabetes and Cardiovascular Disease, Genetic Epidemiology, Department of Clinical Sciences, Lund University, Malmö, Sweden

    Emily Sonestedt

  36. Departments of Surgical and Perioperative Sciences, Surgery and Public Health and Clinical Medicine, Nutrition Research, Umeå University, Umeå, Sweden

    Malin Sund

  37. Department of Food Science, BioCenter, Swedish University of Agriculture Science, Uppsala, Sweden

    Rikard Landberg

  38. Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK

    Kay-Thee Khaw

  39. MRC Epidemiology Unit, Cambridge, UK

    Nicholas J. Wareham

  40. Cancer Epidemiology Unit, University of Oxford, Oxford, UK

    Ruth C. Travis

  41. Human Genetics Foundation (HUGEF), Turin, Italy

    Fulvio Ricceri

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  1. Raul Zamora-Ros
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  2. Pietro Ferrari
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  40. Ruth C. Travis
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  41. Augustin Scalbert
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  42. Heather A. Ward
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  43. Elio Riboli
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  44. Isabelle Romieu
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Correspondence to Raul Zamora-Ros.

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Zamora-Ros, R., Ferrari, P., González, C.A. et al. Dietary flavonoid and lignan intake and breast cancer risk according to menopause and hormone receptor status in the European Prospective Investigation into Cancer and Nutrition (EPIC) Study. Breast Cancer Res Treat 139, 163–176 (2013). https://doi.org/10.1007/s10549-013-2483-4

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  • DOI: https://doi.org/10.1007/s10549-013-2483-4

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