Environment and Breast Cancer: Science Review

Evidence From Humans
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The effect of dietary exposures on recurrence and mortality in early stage breast cancer
Hebert, J. R., Hurley, T. G., Ma, Y. Breast Cancer Research & Treatment. 1998. 51:1, 17-28.
Topic area
Body size
Study design
Prospective cohort
Study Participants
Number of Cases
109 (breast cancer recurrences), 73 (breast cancer deaths)
Menopausal Status
The menopausal status of women included in this study is listed here.
Pre menopausal
Post menopausal
Number in Cohort
Cohort: 472 (222 premenopausal) (250 postmenopausal)
Cohort participation rate
Approximately 95%
Participant selection: Inclusion and exclusion criteria
Criteria used to select participants in the study.
In: women diagnosed with early breast cancer between 1982 and 1984 who visited Memorial Sloan-Kettering Cancer Center (New York, NY) (MSKCC); age 20-80 years at enrollment; resident of New York, New Jersey, Pennsylvania or Connecticut; women with newly diagnosed, histopathologically confirmed, TNM stage I,II or IIIa breast cancer with single breast involvement Ex: patients diagnosed as Stage IIIb (extended to chest wall), Stage IV, in situ, or Paget's disease of the nipple
Comment about participation selection
Strengths: prospective study; breast cancer diagnoses confirmed through histopathology reports; breast cancer stage noted; high participation rate; conducted in-person interviews; anthropometric data were obtained by trained staff; ER and PR status recorded; administered a food frequency questionnaire (FFQ); obtained vital status on all but one woman from the cohort; analyzed breast cancer recurrence and death by BMI; Limitations: not a population based study; women in the study tended to be more educated and have lower fat intakes and BMI than the U.S. average for women in the same age group; few cases of recurrence and death; analyzed breast cancer recurrence and mortality in premenopausal women in a cohort with only 222 premenopausal women; possibility that women under-reported their dietary fat intake; could not analyze breast cancer recurrence and mortality in women who lost weight after diagnosis due to small numbers
How exposure was measured
Questionnaire, in person Anthropometric measurement, researcher-administered
Statistical Analysis
Breast cancer outcome investigated
Breast cancer recurrence or progression
Mortality from breast cancer
Ethnic groups with separate analysis
If this study provided a separate analysis by ethnic or racial group, the groups are listed here.
Confounders considered
Other breast cancer risk factors, such as family history, age at first birth, and hormone replacement therapy use, that were taken into account in the study.
Adequately controlled, Confounders: stage of breast cancer, age, meat intake, butter/margarine/lard intake, beer, menopausal status and estrogen receptor
Genetic characterization included
If the study analyzed relationships between environmental factors and inherited genetic variations, this field will be marked “Yes.” “No”, if not.
Description of major analysis
Effect modifiers: menopausal status Follow-up: 8-10 years
Strength of associations reported
Breast cancer recurrence increased 9% for each kg/m^2 (BMI) in premenopausal women, RR=1.09(1.02-1.17) p=0.01
Breast cancer death increased 12% for each kg/m^2 (BMI) in premenopausal women, RR=1.12(1.03-1.22) p=0.007
Results Comments
BMI in postmenopausal women was not significantly related to breast cancer recurrence.
Author address
Department of Medicine, University of Massachusetts Medical School, Worcester 01655, USA. james.hebert@ummed.edu