TY - JOUR
T1 - Cancer incidence and mortality during the intervention and postintervention periods of the women's health initiative dietary modification trial
AU - Thomson, Cynthia A.
AU - Van Horn, Linda
AU - Caan, Bette J.
AU - Aragaki, Aaron K.
AU - Chlebowski, Rowan T.
AU - Manson, Jo Ann E.
AU - Rohan, Thomas E.
AU - Tinker, Lesley F.
AU - Kuller, Lewis H.
AU - Hou, Lifang
AU - Lane, Dorothy S.
AU - Johnson, Karen C.
AU - Vitolins, Mara Z.
AU - Prentice, Ross L.
N1 - Publisher Copyright:
© 2014 American Association for Cancer Research.
PY - 2014/12/1
Y1 - 2014/12/1
N2 - Background: The Women's Health Initiative (WHI) low-fat (20% kcal) dietary modification (DM) trial (1993-2005) demonstrated a nonsignificant reduction in breast cancer, a nominally significant reduction in ovarian cancer, and no effect on other cancers (mean 8.3 years intervention). Consent to nonintervention follow-up was 83% (n = 37,858). This analysis was designed to assess postintervention cancer risk in women randomized to the low-fat diet (40%) versus usual diet comparison (60%).Methods: Randomized, controlled low-fat diet intervention for prevention of breast and colorectal cancers conducted in 48,835 postmenopausal U.S. women, ages 50 to 79 years at 40 U.S. sites. Outcomes included total invasive cancer, breast cancer, and colorectal cancer, and cancer-specific and overall mortality.Results: There were no intervention effects on invasive breast or colorectal cancer, other cancers, or cancer-specific or overall mortality during the postintervention period or the combined intervention and follow-up periods. For invasive breast cancer, the hazard ratios (HR) and 95% confidence interval (CI) were 0.92 (0.84-1.01) during intervention, 1.08 (0.94-1.24) during the postintervention period, and 0.97 (0.89-1.05) during cumulative follow-up. A reduced risk for estrogen receptor positive/progesterone receptor-negative tumors was demonstrated during follow-up. In women with higher baseline fat intake (quartile), point estimates of breast cancer risk were HR, 0.76 (95% CI, 0.62-0.92) during intervention versus HR, 1.11 (95% CI, 0.84-1.4) during postintervention follow-up (Pdiff = 0.03).Conclusions: Dietary fat intake increased postintervention in intervention women; no long-term reduction in cancer risk or mortality was shown in the WHI DM trial.Impact: Dietary advisement to reduce fat for cancer prevention after menopause generally was not supported by the WHI DM trial.
AB - Background: The Women's Health Initiative (WHI) low-fat (20% kcal) dietary modification (DM) trial (1993-2005) demonstrated a nonsignificant reduction in breast cancer, a nominally significant reduction in ovarian cancer, and no effect on other cancers (mean 8.3 years intervention). Consent to nonintervention follow-up was 83% (n = 37,858). This analysis was designed to assess postintervention cancer risk in women randomized to the low-fat diet (40%) versus usual diet comparison (60%).Methods: Randomized, controlled low-fat diet intervention for prevention of breast and colorectal cancers conducted in 48,835 postmenopausal U.S. women, ages 50 to 79 years at 40 U.S. sites. Outcomes included total invasive cancer, breast cancer, and colorectal cancer, and cancer-specific and overall mortality.Results: There were no intervention effects on invasive breast or colorectal cancer, other cancers, or cancer-specific or overall mortality during the postintervention period or the combined intervention and follow-up periods. For invasive breast cancer, the hazard ratios (HR) and 95% confidence interval (CI) were 0.92 (0.84-1.01) during intervention, 1.08 (0.94-1.24) during the postintervention period, and 0.97 (0.89-1.05) during cumulative follow-up. A reduced risk for estrogen receptor positive/progesterone receptor-negative tumors was demonstrated during follow-up. In women with higher baseline fat intake (quartile), point estimates of breast cancer risk were HR, 0.76 (95% CI, 0.62-0.92) during intervention versus HR, 1.11 (95% CI, 0.84-1.4) during postintervention follow-up (Pdiff = 0.03).Conclusions: Dietary fat intake increased postintervention in intervention women; no long-term reduction in cancer risk or mortality was shown in the WHI DM trial.Impact: Dietary advisement to reduce fat for cancer prevention after menopause generally was not supported by the WHI DM trial.
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U2 - 10.1158/1055-9965.EPI-14-0922
DO - 10.1158/1055-9965.EPI-14-0922
M3 - Article
C2 - 25258014
AN - SCOPUS:84919362632
SN - 1055-9965
VL - 23
SP - 2924
EP - 2935
JO - Cancer Epidemiology Biomarkers and Prevention
JF - Cancer Epidemiology Biomarkers and Prevention
IS - 12
ER -