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1 Unità Operativa di Epidemiologia, Istituto Nazionale Tumori, Milan, Italy; 2 Department of Social and Preventive Medicine, University at Buffalo, State University of New York at Buffalo, Buffalo, NY; and 3 Unità Operativa Registro Tumori, Istituto Nazionale Tumori, Milan, Italy
Requests for reprints: Sabina Sieri, National Cancer Institute-Milan, Unit of Epidemiology, Via G. Venezian 1, Milan, MI 20133, Italy. Phone: 0039-02-23903506; Fax: 011-0039-02-23903510. E-mail: sieri{at}istitutotumori.mi.it
The aim of this study was to evaluate the association between dietary patterns and risk of developing breast cancer in an Italian cohort. Women volunteers were recruited from 1987 to 1992 from residents in Varese province, northern Italy, an area covered by a cancer registry. Participants completed a semiquantitative food frequency questionnaire, and anthropometric and other data were collected systematically. Using nutritional data from 8984 women with an average follow up of 9.5 years and 207 incident cases of breast cancer, we conducted an exploratory factor analysis to identify major dietary patterns. Four dietary patterns, which explained 30% of the variance, emerged: salad vegetables (mainly consisting of raw vegetables and olive oil); western (mainly consisting of potatoes, red meat, eggs and butter); canteen (pasta and tomato sauce); and prudent (cooked vegetables, pulses, and fish, with negative loading on wines and spirits). After adjustment for potential confounders, only the salad vegetables pattern was associated with significantly lower (34–35%) breast cancer incidence (RR = 0.66, CI95% = 0.47±0.95 comparing highest with lowest tertile) with a significant linear trend (P = 0.016). Women with body mass index <25 had an even greater risk reduction in the highest tertile of the salad vegetables pattern (>50% less risk than the lowest tertile, RR = 0.39, CI95% = 0.22–0.69) with a significant trend (P = 0.001); whereas women with body mass index 
25 had no protective effect for the consumption of salad vegetables. These findings suggest that a diet rich in raw vegetables and olive oil protects against breast cancer.
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