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Fruits, Vegetables, and Micronutrients in Relation to Breast Cancer Modified by Menopause and Hormone Receptor Status

Departments of ¹ Epidemiology and ² Nutrition, School of Public Health, University of North Carolina, Chapel Hill, North Carolina; ³ Department of Community and Preventive Medicine, Mount Sinai School of Medicine, New York, New York; ⁴ Department of Preventive Medicine, School of Medicine, State University of New York at Stony Brook, Stony Brook, New York; ⁵ Global Epidemiology, Worldwide Safety and Risk Management, Pfizer, Inc., New York, New York; and ⁶ Department of Epidemiology, Mailman School of Public Health and ⁷ Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York

Requests for reprints: Mia M. Gaudet, Department of Epidemiology, School of Public Health, University of North Carolina, CB 7435, Chapel Hill, NC 27599-7435. Phone: 919-966-9835; Fax: 919-966-2089. E-mail: gaudet{at}email.unc.edu

Whether fruit, vegetable, and antioxidant micronutrient consumption is associated with a reduction in breast cancer incidence remains unresolved. To address this issue, we analyzed data from a large population-based case-control study, with consideration given to whether the associations varied with menopausal status or with clinical characteristics of the cases' disease. Study participants completed a modified Block food frequency questionnaire, which included assessment of the frequency and portion sizes of 13 fruits and fruit juices and 16 vegetables and the use of multiple and single vitamin supplements. Statistical analyses were done on 1,463 cases and 1,500 controls. Among postmenopausal women, reduced odds ratios [OR; 95% confidence intervals (95% CI)] were noted for the highest fifth, as compared with the lowest fifth, of intake of any vegetables [0.63 (0.46–0.86); P for trend < 0.01] and leafy vegetables [0.66 (0.50–0.86); P for trend = 0.03] after controlling for age and energy intake. Adjusted ORs (95% CIs) were also decreased for postmenopausal breast cancer in relation to high intake of carotenoids, -carotene, ß-carotene, lutein, and particularly lycopene [0.66 (0.48–0.90); P for trend = 0.03]. Inverse associations for fruits and vegetables were stronger for postmenopausal women with estrogen receptor (ER)+ tumors (OR, 0.65; 95% CI, 0.51–0.82) than ER– tumors (OR, 0.92; 95% CI, 0.64–1.32), but results were less consistent for micronutrients. No similarly reduced associations were observed among premenopausal women. ORs did not appreciably differ by in situ or invasive breast cancer or by whether cases had begun chemotherapy. Our results support an inverse association for fruit and vegetable intake among postmenopausal but not premenopausal breast cancer, which may be more pronounced among women with ER+ tumors.

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