Dietary pattern influences breast cancer prognosis in women without hot flashes: the women's healthy eating and living trial

Ellen B. Gold, John P. Pierce, Loki Natarajan, Marcia L. Stefanick, Gail A. Laughlin, Bette J. Caan, Shirley W. Flatt, Jennifer A. Emond, Nazmus Saquib, Lisa Madlensky, Sheila Kealey, Linda Wasserman, Cynthia A. Thomson, Cheryl L. Rock, Barbara A. Parker, Njeri Karanja, Vicky Jones, Richard A. Hajek, Minya Pu, Joanne E. Mortimer

Research output: Contribution to journalArticlepeer-review

57 Scopus citations


Purpose To determine whether a low-fat diet high in vegetables, fruit, and fiber differentially affects prognosis in breast cancer survivors with hot flashes (HF) or without HF after treatment. Patients and Methods A secondary analysis was conducted on 2,967 breast cancer survivors, age 18 to 70 years, who were randomly assigned between 1995 and 2000 in a multicenter, controlled trial of a dietary intervention to prevent additional breast cancer events and observed through June 1, 2006. We compared the dietary intervention group with a group who received five-a-day dietary guidelines. Results Independent of HF status, a substantial between-group difference among those who did and did not receive dietary guidelines was achieved and maintained at 4 years in intake of vegetable/fruit servings per day (54% higher; 10 v6.5 servings/d, respectively), fiber (31% higher; 25.5 v 19.4 g/d, respectively), and percent energy from fat (14% lower; 26.9% v 31.3%, respectively). Adjusting for tumor characteristics and antiestrogen treatment, HF-negative women assigned to the intervention had 31% fewer events than HF-negative women assigned to the comparison group (hazard ratio [HR] = 0.69; 95% CI, 0.51 to 0.93; P =.02). The intervention did not affect prognosis in the women with baseline HFs. Furthermore, compared with HF-negative women assigned to the comparison group, HF-positive women had significantly fewer events in both the intervention (HR = 0.77; 95% CI, 0.59 to 1.00; P =. 05) and comparison groups (HR = 0.65; 95% CI, 0.49 to 0.85; P =. 002). Conclusion A diet with higher vegetable, fruit, and fiber and lower fat intakes than the five-a-day diet may reduce risk of additional events in HF-negative breast cancer survivors. This suggestive finding needs confirmation in a trial in which it is the primary hypothesis.

Original languageEnglish (US)
Pages (from-to)352-359
Number of pages8
JournalJournal of Clinical Oncology
Issue number3
StatePublished - Jan 20 2009

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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