Dietary Fat Intake Reduction for Patients with Resected Breast Cancer

  • Rowan T. Chlebowski
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 364)


In early 1994, a clinical trial has been initiated to definitively address, for the first time, whether a dietary fat intake reduction program can influence the clinical course of patients with breast cancer. This study, the Women’s Intervention Nutrition Study (WINS) is based on a hypothesis which is directly supported by laboratory, animal and epidemiological observations.1-3 In addition, the feasibility of prospectively testing this hypothesis has been established by a series of pilot clinical studies. 2,4-8 These results represent a culmination of over a decade of research activity and are outlined in more detail below.


Breast Cancer Breast Cancer Patient Systemic Adjuvant Therapy Breast Cancer Growth Early Breast Cancer Trialist 
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  1. 1.
    Chlebowski, R.T., D. Rose, I.M. Buzzard, G.L. Blackburn, W. Insull Jr., M. Grosvenor, R. Elashoff, and E.L. Wynder, Adjuvant dietary fat intake reduction in postmenopausal breast cancer management, Breast Cancer Res. Treat. 20:73 (1991).CrossRefGoogle Scholar
  2. 2.
    Chlebowski, R.T., G.L. Blackburn, I.M. Buzzard, D.P. Rose, S. Martino, J.D. Khandekar, R.M. York, R.W. Jeffrey, R.M. Elashoff, and E.L. Wynder, For the Women’s Intervention Nutrition Study. Adherence to a dietary fat intake reduction program in postmenopausal women receiving therapy for early breast cancer, J. Clin. Oncol. 11:2072 (1993).PubMedGoogle Scholar
  3. 3.
    Cohen, L.A., D.P. Rose, and E.L. Wynder, A rationale for dietary intervention in the treatment of postmenopausal breast cancer patients: an update, Nutr. Cancer. 19:1 (1993).PubMedCrossRefGoogle Scholar
  4. 4.
    Chlebowski, R.T., D.W. Nixon, G.L. Blackburn, P. Jochimsen, E.F. Scanlon, W. Insull Jr., I.M. Buzzard, R. Elashoff, R. Butrum, and E. L. Wynder, A breast cancer Nutrition Adjuvant Study (NAS): protocol design and initial patient adherence, Breast Cancer Res. Treat. 10:21 (1987).PubMedCrossRefGoogle Scholar
  5. 5.
    Boyar, A.P., D.P. Rose, J. R. Loughridge, A. Engle, A. Palgi, K. Laakso, D. Kinne, and E.L. Wynder, Response to a diet low in total fat in women with postmenopausal breast cancer: a pilot study, Nutr. Cancer. 11:93 (1988).PubMedCrossRefGoogle Scholar
  6. 6.
    Boyd, N.F., M. Cousins, and V. Kriukov, A randomized controlled trial of dietary fat reduction: the retention of subjects and characteristics of drop outs, J. Clin. Epidemiol. 45:31 (1992).PubMedCrossRefGoogle Scholar
  7. 7.
    Holm, L.-E., E. Nordevang, E. Ikkala, L. Hallstrom, and E. Callmer, Dietary intervention as adjuvant therapy in breast cancer patients: a feasibility study, Breast Cancer Res. Treat. 16:103 (1990).PubMedCrossRefGoogle Scholar
  8. 8.
    Kristal, A.R., E. White, A.L. Shattuck, S. Curry, G.L. Anderson, A. Fowler, and N. Urban, Long-term maintenance of a low-fat diet: durability of fat-related dietary habits in the Women’s Health Trial, J. Am. Diet. Assoc. 92:553 (1992).PubMedGoogle Scholar
  9. 9.
    Wynder, E.L., T. Kajitani, J. Kuno, J.C. Lucas Jr., A. de Palo, and J. Farrow, A comparison of survival rates between American and Japanese patients with breast cancer, Surg. Gynecoi Obstet. 117:196 (1963).Google Scholar
  10. 10.
    Sakamoto, G., H. Sugano, and W.H. Hartman, Stage-by-stage survival from breast cancer in the U.S. and Japan, Jpn. J. Cancer. 25:161 (1979).Google Scholar
  11. 11.
    Markka, M. and G. Sakamoto, Natural history of breast cancer among Japanese and Caucasian females, Gan To Kagaku Ryoho 17:1239 (1990).Google Scholar
  12. 12.
    Allen, D.S., R.D. Bulbrook, M.A. Chaudary, J.L. Hayward, M. Yoshida, S. Miura, and J.T. Murai, Recurrence and survival rates in British and Japanese women with breast cancer, Breast Cancer Res. Treat. 18:sl31 (1991).Google Scholar
  13. 13.
    Morrison, A.S., C.R. Lowe, B. MacMahon, B. Ravnihar, and S. Yuasa, Some international differences in treatment and survival in breast cancer, Int. J. Cancer 18:269 (1976).PubMedCrossRefGoogle Scholar
  14. 14.
    Lands, W.E.M., T. Hamazaki, K. Yamazaki, H.Okuyama, K. Sakai, Y. Goto, and V.S. Hubbard, Changing dietary patterns, Am. J. Clin. Nutr. 51:991 (1990).PubMedGoogle Scholar
  15. 15.
    Nomura A.M.Y., L. Le Marchand, L.N. Kolonel, and J.H. Hankin, The effect of dietary fat on breast cancer survival among Caucasian and Japanese women in Hawaii}, Breast Cancer Res. Treat.} 18}:135s (1CrossRefGoogle Scholar
  16. 16.
    Henderson, I.C., Rapporteur’s report — Treatment and response, Breast Cancer Res. Treat. 18:157s (1991).CrossRefGoogle Scholar
  17. 17.
    Early Breast Cancer Trialists’ Collaborative Group, Systemic treatment of early breast cancer by hormonal cytotoxic or immune therapy, Lancet 339:1 (1992).Google Scholar
  18. 18.
    Willett, W.C., DJ. Hunter, M. Stampfer, G. Colditz, J.E. Manson, D. Spiegelman, B. Rosner, C.H. Hennekens, and F.E. Speizer, Dietary fat and fiber in relation to risk of breast cancer. An 8-year follow-up, JAMA 268:2037 (1992).PubMedCrossRefGoogle Scholar
  19. 19.
    Howe, G.R., T. Hirohata, T.G. Hislop, J.M. Iscovich, J.-M. Yuan, K. Katsouyanni, F. Lubin, E. Marubini, B. Modan, T. Rohan, P.T. Toniolo, and Y. Shunzhang, Dietary factors and risk of breast cancer: combined analysis of 12 case-control studies, J. Natl. Cancer Inst., 82:561 (1990).PubMedCrossRefGoogle Scholar
  20. 20.
    Erickson, K.L. and N.E. Hubbard, Dietary fat and tumor metastasis, Nutr. Rev. 48:6 (1990).PubMedCrossRefGoogle Scholar
  21. 21.
    Rose, D.P., J.M. Connolly, and CL. Meschter, Effect of dietary fat on human breast cancer growth and lung metastasis in nude mice, J. Natl. Cancer Inst. 83:1491 (1991).PubMedCrossRefGoogle Scholar
  22. 22.
    Rose, D.P. and J.M. Connolly, Influence of dietary fat intake on local recurrence and progression of metastases arising from MDA-MB-435 human breast cancer cells in nude mice after excision of the primary tumor, Nutr. Cancer 18:113 (1992).PubMedCrossRefGoogle Scholar
  23. 23.
    Longcope, C, Relationships of estrogen to breast cancer, of diet to breast cancer, and of diet to estradiol metabolism, J. Natl. Cancer Inst. 82:896 (1990).PubMedCrossRefGoogle Scholar
  24. 24.
    Prentice, R., D. Thompson, C. Clifford, S. Gorbach, B. Goldin, and D. Byar, Dietary fat reduction and plasma estradiol concentration in healthy postmenopausal women, J. Natl. Cancer Inst. 82:129(1990).PubMedCrossRefGoogle Scholar
  25. 25.
    Rose, D.P., A. Boyar, C. Cohen, and L.E. Strong, Effect of a low-fat diet on hormone levels in women with cystic breast disease. I. Serum steroids and gonadotropins, J. Natl. Cancer Inst. 78:623 (1987).PubMedGoogle Scholar
  26. 26.
    Rose, D.P., R.T. Chlebowski, J.M. Connolly, L.A. Jones, and E.L. Wynder, The effects of tamoxifen adjuvant therapy and a low-fat diet on serum binding proteins and estradiol bioavailability in postmenopausal breast cancer patients, Cancer Res. 52:5386 (1992).PubMedGoogle Scholar
  27. 27.
    Rose, D.P., J.M. Connolly, R.T. Chlebowski, I.M. Buzzard, and E.L. Wynder, The effects of a low-fat dietary intervention and tamoxifen adjuvant therapy on the serum estrogen and sex hormone-binding globulin concentrations of postmenopausal breast cancer patients, Breast Cancer Res. Treat. 27:253 (1993).PubMedCrossRefGoogle Scholar
  28. 28.
    Shimizu, H., R.K. Ross, L. Bernstein, M.C. Pike, and B.E. Henderson, Serum oestrogen levels in postmenopausal women: comparison of American whites and Japanese in Japan, Br. J. Cancer. 62:451 (1990).PubMedCrossRefGoogle Scholar
  29. 29.
    Wang, D.Y., T.J.A. Key, M.C. Pike, J. Boreham, and J. Chen, Serum hormone levels in British and rural Chinese females, Breast Cancer Res. Treat. 18:41 (1991).CrossRefGoogle Scholar
  30. 30.
    Senie, R.T., P.P. Rosen, P. Rhodes, M.L. Lesser, and D.W. Kinne, Obesity at diagnosis of breast carcinoma influences duration of disease-free survival, Ann. Intern. Med. 116:26 (1992).PubMedGoogle Scholar
  31. 31.
    Bastarruchea, J., G.N. Hortobagyi, T.L. Smith, S.C. Kai, and A. U. Buydan, Obesity as an adverse prognostic factor for patients receiving adjuvant chemotherapy for breast cancer, Ann. Intern. Med. 119:18 (1993).Google Scholar
  32. 32.
    Camoriano, J.K., C.L. Loprinzi, J.N. Ingle, T.M. Therneau, J.E. Krook, and M.H. Veeder, Weight change in women treated with adjuvant therapy or observed following mastectomy for node-positive breast cancer, J. Clin. Oncol. 8:1327 (1990).PubMedGoogle Scholar
  33. 33.
    Chlebowski, R.T, J.M. Weiner, R. Reynolds, J. Luce, L. Bulcavage, and J.R. Bateman, Long term survival following relapse after 5-FU but not CMF adjuvant breast cancer therapy, Breast Cancer Res. Treat. 7:23 (1986).PubMedCrossRefGoogle Scholar
  34. 34.
    Dixon, J., D.A. Moritz, and F.L. Baker, Breast cancer and weight gain: an unexpected finding, Oncol. Nurs. Forum 5:5 (1978).PubMedGoogle Scholar
  35. 35.
    Hoskin, P.J., S. Ashley, and J.R. Yarnold, Changes in body weight after treatment for breast cancer and the effect of tamoxifen, Br. J. Cancer 62(Suppl XI):26 (1990).Google Scholar
  36. 36.
    Denmark-Wahnefried, W, E.P. Winer, and B.K. Rimer, Why women gain weight with adjuvant chemotherapy for breast cancer, J. Clin. Oncol. 11:1418 (1993).Google Scholar
  37. 37.
    Heasman, K.Z., J.H. Sutherland, J.A. Campbell, T. Elhakim, and N.F. Boyd, Weight gain during adjuvant chemotherapy for breast cancer, Breast Cancer Res. Treat. 5:195 (1986).CrossRefGoogle Scholar
  38. 38.
    Gregorio, D., L. Emrich, S. Graham, J. Marshall, and T. Nemoto, Dietary fat consumption and survival among women with breast cancer, J.Natl. Cancer Inst. 75:37 (1985).PubMedGoogle Scholar
  39. 39.
    Holm, L.-E., E. Callmer, M.-L. Hjalmar, E. Lidbrink, B. Nilsson, and L. Skoog, Dietary habits and prognostic factors in breast cancer, J. Natl. Cancer Inst. 81:1218 (1989).PubMedCrossRefGoogle Scholar
  40. 40.
    Holm, L.-E., E. Nordevang, M.-L. Hjalmar, E. Lidbrink, E. Callmer, and B. Nilsson, Treatment failure and dietary habits in women with breast cancer, J. Natl. Cancer Inst. 85:32 (1993).PubMedCrossRefGoogle Scholar
  41. 41.
    Tretli, S., T. Haldorsen, and L. Ottestad, The effect of pre-morbid height and weight on the survival of breast cancer patients, Br. J. Cancer 62:299 (1990).PubMedCrossRefGoogle Scholar
  42. 42.
    Henderson, M.M., Role of intervention trials in research on nutrition and cancer, Cancer Res. 52:2030s (1992).PubMedGoogle Scholar
  43. 43.
    Ewertz, M., S. Gillanders, L. Meyer, and K. Zedeler, Survival of breast cancer patients in relation to factors which affect the risk of developing breast cancer, Int. J. Cancer 49:526 (1991).PubMedCrossRefGoogle Scholar
  44. 44.
    Rohan, T., J. Hiller, and A. McMichael, Dietary factors and survival from breast cancer, Nutr. Cancer 20:167 (1993).PubMedCrossRefGoogle Scholar
  45. 45.
    Newman, S.C., A.B. Miller, and G.R Howe, A study of the effect of weight and dietary fat on breast cancer survival time, Am. J. Epidemiol. 123:767 (1986).PubMedGoogle Scholar
  46. 46.
    Kyogoku, S., T. Hirohata, Y. Nomura, T. Shigematsu, S. Takeshita, and T. Hirohata, Diet and prognosis of breast cancer, Nutr. Cancer 17:271 (1992).PubMedCrossRefGoogle Scholar
  47. 47.
    Nayfield, S.G., J.E. Karp, L.G. Ford, F.A. Dori, and B.S. Kramer, Potential role of tamoxi-fen in prevention of breast cancer, J. Natl. Cancer Inst. 83:1450 (1991).PubMedCrossRefGoogle Scholar
  48. 48.
    Love, R.R., P.A. Newcomb, D.A. Wiebe, T.S. Surawicz, V.C. Jordan, P.P. Carbone, and D.L. DeMets, Effects of tamoxifen therapy on lipid and lipoprotein levels in postmeno-pausal patients with node-negative breast cancer, J. Natl. Cancer Inst. 82:1327 (1990).PubMedCrossRefGoogle Scholar
  49. 49.
    Buzzard, I.M., E.H. Asp, R.T. Chlebowski, A.P. Boyar, R.W. Jeffrey, D.W. Nixon, G.L. Blackburn, P.R. Jochimsen, E.F. Scanlon, W. Insull Jr., R.M. Elashoff, R. Butrum, and E.L. Wynder, Diet intervention methods to reduce fat intake: nutrient and food group composition of self-selected low-fat diets, J. Am. Diet. Assoc. 90:42 (1990).PubMedGoogle Scholar
  50. 50.
    Chlebowski, R.T, D.P. Rose, I.M. Buzzard, G.L. Blackburn, M. York, W. Insull Jr., J. Khandekar, S. Martino, R.M. Elashoff, and E.L. Wynder, Dietary fat reduction in adjuvant breast cancer therapy: current rationale and feasibility issues,Adjuvant Ther. Cancer 6:357 (1990).Google Scholar
  51. 51.
    Nordevang, E., E. Dckala, E. Callmer, L. Hallstrom, and L.-E. Holm, Dietary intervention in breast cancer patients: effects on dietary habits and nutrient intake, Eur. J. Clin. Nutr. 44:681 (1990).PubMedGoogle Scholar
  52. 52.
    Nordevang, E., E. Callmer, A. Marmur, and L.-E. Holm, Dietary intervention in breast cancer patients: effects on food choice, Eur. J. Clin. Nutr. 46:387 (1992).PubMedGoogle Scholar
  53. 53.
    Gorbach, S.L., A. Morrill-LaBrode, M.N. Woods, J.T. Dwyer, W.D. Selles, M. Henderson, W. Insull Jr., S. Goldman, D. Thompson, C. Clifford, and L. Sheppard, Changes in food patterns during a low-fat dietary intervention in women, J. Am. Diet. Assoc. 90:802 (1990).PubMedGoogle Scholar
  54. 54.
    Henderson, M.M., L.H. Kushi, DJ. Thompson, S.L. Gorbach, C.K. Clifford, W. Insull Jr., M. Moskowitz, and R.S. Thompson, Feasibility of a randomized trial of a low-fat diet for the prevention of breast cancer: dietary compliance in the Women’s Health Trial Vanguard Study, Prev. Med. 19:115 (1990).PubMedCrossRefGoogle Scholar
  55. 55.
    Hillner, B.E. and T.J. Smith, Efficacy and cost-effectiveness of adjuvant chemotherapy in women with node-negative breast cancer: a decision-analysis model, N. Engl. J. Med. 324:160(1991).PubMedCrossRefGoogle Scholar
  56. 56.
    Food and Nutrition Board: Recommended Dietary Allowances (10th rev ed.). Washington, D.C., National Academy of Sciences, 1989.Google Scholar
  57. 57.
    Chlebowski, R.T., G. Blackburn, J.P. Richie, and E. Wynder, Unanticipated effect of dietary fat intake reduction on HDL cholesterol in postmenopausal women receiving tamoxifen, Proc. Am. Soc. Clin. Oncol. 12:214 (1994).Google Scholar
  58. 58.
    Howat, P.M., R. Mohan, C. Champagne, C. Monlezun, P. Wozniak, and G.A. Bray, Validity and reliability of reported dietary intake data,J. Am. Diet. Assoc. 94:169 (1994).PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1994

Authors and Affiliations

  • Rowan T. Chlebowski
    • 1
  1. 1.Division of Medical OncologyHarbor-UCLA Medical CenterTorranceUSA

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