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Cancer Epidemiology, Biomarkers & Prevention
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Research Articles

Dairy Products and Ovarian Cancer: A Pooled Analysis of 12 Cohort Studies

Jeanine M. Genkinger, David J. Hunter, Donna Spiegelman, Kristin E. Anderson, Alan Arslan, W. Lawrence Beeson, Julie E. Buring, Gary E. Fraser, Jo L. Freudenheim, R. Alexandra Goldbohm, Susan E. Hankinson, David R. Jacobs Jr., Anita Koushik, James V. Lacey Jr., Susanna C. Larsson, Michael Leitzmann, Marji L. McCullough, Anthony B. Miller, Carmen Rodriguez, Thomas E. Rohan, Leo J. Schouten, Roy Shore, Ellen Smit, Alicja Wolk, Shumin M. Zhang and Stephanie A. Smith-Warner
Jeanine M. Genkinger
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David J. Hunter
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Donna Spiegelman
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Kristin E. Anderson
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Alan Arslan
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W. Lawrence Beeson
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Julie E. Buring
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Gary E. Fraser
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Jo L. Freudenheim
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R. Alexandra Goldbohm
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Susan E. Hankinson
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David R. Jacobs Jr.
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Anita Koushik
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James V. Lacey Jr.
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Susanna C. Larsson
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Michael Leitzmann
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Marji L. McCullough
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Anthony B. Miller
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Carmen Rodriguez
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Thomas E. Rohan
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Leo J. Schouten
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Roy Shore
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Ellen Smit
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Alicja Wolk
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Shumin M. Zhang
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Stephanie A. Smith-Warner
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DOI: 10.1158/1055-9965.EPI-05-0484 Published February 2006
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    Figure 1.

    Multivariate adjusted RRs and 95% CI for ovarian cancer according to lactose intake (>30 compared with <10 g/d) by study. Multivariate RRs were adjusted for age at menarche (<13, 13, >13 years), menopausal status at baseline (premenopausal, postmenopausal, dubious), oral contraceptive use (ever, never), hormone replacement therapy use among postmenopausal women (never, past, current), parity (0, 1, 2, >2), BMI (<23, 23 to <25, 25 to <30, ≥30 kg/m2), smoking status (never, past, current), physical activity (low, medium, high), and energy intake (continuously), modeled identically across studies. Black squares and horizontal lines, study-specific RRs and 95% CIs for ≥30 g/d lactose intake compared with <10 g/d. The area of the black squares is proportional to the inverse of the sum of the between-study variance and the study-specific variance, which is related to the sample size, the total number of cases, and the range of variation in intake. Diamond, pooled multivariate RR and the 95% CI. Vertical dashed line, pooled multivariate RR.

Tables

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  • Table 1.

    Daily mean intakes of dairy nutrients and foods by cohort study in the ovarian cancer analyses in the Pooling Project of Prospective Studies of Diet and Cancer

    CohortFollow-up yearsBaseline cohort size*No. casesMean (SD) intake
    Dietary calcium (mg/d)Total calcium† (mg/d)Lactose (g/d)Dietary vitamin D (IU/d)Total vitamin D† (IU/d)Total milk (g/d)‡Hard cheese (g/d)‡Cottage cheese (g/d)‡Yogurt (g/d)‡Ice cream (g/d)‡
    AHS1976-198818,40253833 (124)880 (139)18 (14)——419 (349)8 (8)35 (36)——
    BCDDP1987-199932,885142862 (369)1,186 (2,979)19 (14)206 (122)341 (279)260 (269)13 (20)11 (22)—19 (36)
    CNBSS§1980-200049,613223673 (253)—8 (7)——200 (199)22 (23)14 (27)29 (61)10 (17)
    CPS II1992-200161,202278884 (379)1,136 (584)19 (13)197 (119)342 (258)277 (265)11 (14)—44 (71)7 (19)
    IWHS1986-200128,486208748 (285)1,029 (483)15 (11)223 (111)382 (292)275 (265)11 (13)19 (31)12 (39)11 (19)
    NLCS§1986-199562,412208869 (259)—14 (7)——187 (153)23 (18)10 (26)53 (57)—
    NYSC1980-198722,55077828 (209)873 (220)15 (9)203 (68)371 (227)137 (87)————
    NYU1985-199812,40165810 (307)888 (327)14 (11)——202 (243)17 (22)15 (26)38 (61)19 (32)
    NHSa1980-198680,195120722 (298)731 (310)14 (11)167 (107)279 (262)215 (241)14 (15)21 (34)21 (54)13 (20)
    NHSb1986-200259,538315718 (254)1,056 (492)13 (10)182 (100)319 (243)221 (230)13 (13)17 (25)28 (55)13 (18)
    NHS II1991-200291,50252787 (271)910 (381)16 (11)223 (109)351 (231)268 (255)12 (12)9 (16)31 (55)8 (12)
    SMC1987-200361,103287913 (255)—16 (10)162 (51)—156 (130)27 (19)—104 (108)7 (10)
    WHS1993-200432,466104729 (258)940 (442)14 (10)217 (104)324 (216)215 (222)9 (11)10 (17)36 (64)7 (13)
    • NOTE: Studies that have a “—” did not estimate that nutrient or did not ask on their questionnaire about the consumption of that food item.

      Abbreviations: AHS, Adventist Health Study; BCDDP, Breast Cancer Detection Demonstration Project Follow-up Study; CNBSS, Canadian National Breast Screening Study; CPS II, Cancer Prevention Study II Nutrition Cohort; IWHS, Iowa Women's Health Study; NLCS, the Netherlands Cohort Study; NYSC, New York State Cohort; NYU, New York University Women's Health Study; NHSa, Nurses' Health Study (part a); NHSb, Nurses' Health Study (part b); NHS II, Nurses' Health Study II; SMC, Swedish Mammography Cohort; WHS, Women's Health Study.

    • ↵* Baseline cohort size was determined after specific exclusions (i.e., had a prior cancer diagnosis other than nonmelanoma skin cancer at baseline, had a bilateral oophorectomy before baseline, or had loge-transformed energy intakes beyond 3 SDs from the study-specific loge-transformed mean energy intake of the population).

    • ↵† Total calcium and vitamin D intake includes dietary and supplemental sources.

    • ↵‡ Milk: 1 8 oz serving is equivalent to 245 g; hard cheese: 1 oz serving is equivalent to 28 g; cottage cheese: 1 0.5 cups serving is equivalent to 105 g; yogurt: 1 cup serving is equivalent to 227 g; ice cream: 1 0.5 cups serving is equivalent to 66g.

    • ↵§ The Canadian National Breast Screening Study and the Netherlands Cohort Study are analyzed as case-cohort studies so the baseline cohort size does not reflect the above exclusions.

  • Table 2.

    Median Pearson correlations for dairy products and nutrients across all studies included in the ovarian cancer analyses in the Pooling Project of Prospective Studies of Diet and Cancer

    LactoseTotal milkWhole milkLow-fat milkHard cheeseCottage cheeseYogurtIce creamDietary calciumTotal calciumDietary vitamin DTotal vitamin D
    Lactose1.000.830.210.67−0.080.080.180.020.900.630.830.40
    Total milk1.000.360.840.030.080.070.030.770.540.710.34
    Whole milk1.00−0.190.030.00−0.020.060.140.030.130.04
    Low-fat milk1.000.010.090.070.010.690.470.680.33
    Hard cheese1.000.090.040.090.170.08−0.10−0.04
    Cottage cheese1.000.150.030.140.100.040.04
    Yogurt1.000.000.280.230.170.13
    Ice cream1.00−0.01−0.01−0.02−0.02
    Dietary calcium1.000.700.790.39
    Total calcium1.000.500.47
    Dietary vitamin D1.000.47
    Total vitamin D1.00
    • NOTE: Median correlation value was calculated over all studies that measured that dairy food or nutrient. Studies that did not measure that particular food or nutrient were excluded from that specific analysis. For whole milk, New York State Cohort was excluded; for low-fat milk, New York State Cohort was excluded; for hard cheese, New York State Cohort was excluded; for cottage cheese, Cancer Prevention Study II Nutrition Cohort, New York State Cohort, and Swedish Mammography Cohort were excluded; for yogurt, Adventist Health Study, Breast Cancer Detection Demonstration Project Follow-up Study, and New York State Cohort were excluded; for ice cream, Adventist Health Study, the Netherlands Cohort Study, and New York State Cohort were excluded; for total calcium (dietary + supplemental), Canadian National Breast Screening Study, the Netherlands Cohort Study, and Swedish Mammography Cohort were excluded; for dietary vitamin D, Adventist Health Study, Canadian National Breast Screening Study, the Netherlands Cohort Study, and New York University Women's Health Study were excluded; and for total vitamin D, Adventist Health Study, Canadian National Breast Screening Study, the Netherlands Cohort Study, New York University Women's Health Study, and Swedish Mammography Cohort were excluded. All studies measured lactose, total milk, and dietary calcium.

  • Table 3.

    Pooled age and multivariate adjusted RRs and 95% CIs for ovarian cancer according to intake of dairy foods and nutrients

    Categories of intakePheterogeneity*Ptrend†
    Foods
        Milk‡ (g/d)    Range01-69.970-124.9125-249.9250-499.9≥500
        Cases214305320673321273
    Age RR1.00 (Reference)0.98 (0.81-1.17)1.07 (0.85-1.34)1.09 (0.87-1.36)0.90 (0.73-1.10)1.10 (0.89-1.36)0.480.20
    MV RR1.00 (Reference)0.98 (0.81-1.17)1.07 (0.84-1.35)1.09 (0.87-1.36)0.90 (0.73-1.11)1.11 (0.87-1.41)0.300.43
        Whole§,∥ (g/d)    Range01-124.9125-249.9≥250
        Cases1,120428226145
    Age RR1.00 (Reference)0.92 (0.82-1.04)1.01 (0.87-1.18)0.93 (0.75-1.16)0.280.83
    MV RR1.00 (Reference)0.94 (0.83-1.05)1.04 (0.88-1.21)0.95 (0.73-1.24)0.100.99
        Low-fat§ (g/d)    Range01-124.9125-249.9≥250
        Cases818343449373
    Age RR1.00 (Reference)1.00 (0.87-1.15)1.08 (0.93-1.25)1.07 (0.94-1.23)0.440.38
    MV RR1.00 (Reference)0.99 (0.86-1.14)1.08 (0.93-1.25)1.07 (0.93-1.23)0.510.38
        Hard cheese¶,** (g/d)    Range01-24.925-49.9≥50
        Cases1911,444253139
    Age RR1.00 (Reference)1.05 (0.87-1.27)1.05 (0.74-1.49)1.24 (0.92-1.68)0.660.51
    MV RR1.00 (Reference)1.09 (0.90-1.33)1.09 (0.77-1.53)1.30 (0.96-1.78)0.740.38
        Cottage cheese††,‡‡ (g/d)    Range01-25.926-52.9≥53
        Cases54266817975
    Age RR1.00 (Reference)0.96 (0.85-1.09)0.91 (0.75-1.12)0.88 (0.63-1.23)0.140.31
    MV RR1.00 (Reference)0.97 (0.85-1.10)0.92 (0.75-1.13)0.88 (0.63-1.23)0.140.33
        Yogurt¶,§§ (g/d)    Range01-27.928-56.957-113.9≥114
        Cases800407177197228
    Age RR1.00 (Reference)0.98 (0.87-1.12)0.89 (0.75-1.05)0.90 (0.76-1.07)1.04 (0.87-1.24)0.800.86
    MV RR1.00 (Reference)0.97 (0.85-1.10)0.87 (0.73-1.04)0.89 (0.75-1.06)1.04 (0.86-1.24)0.750.89
        Ice cream∥∥ (g/d)    Range01-16.917-32.933-65.9≥66
        Cases5618622306733
    Age RR1.00 (Reference)0.98 (0.88-1.10)1.07 (0.87-1.32)1.13 (0.83-1.52)0.85 (0.59-1.23)0.670.82
    MV RR1.00 (Reference)1.02 (0.90-1.14)1.12 (0.90-1.38)1.18 (0.85-1.63)0.91 (0.63-1.32)0.660.55
    Nutrients
        Dietary calcium¶¶ (mg/d)    Range<500500-699.9700-899.9900-1,099.91,100-1,299.9≥1,300
        Cases287554562354182140
    Age RR1.00 (Reference)1.02 (0.88-1.18)1.06 (0.87-1.28)1.00 (0.78-1.29)0.98 (0.79-1.21)1.17 (0.93-1.47)0.430.33
    MV RR1.00 (Reference)1.02 (0.88-1.18)1.05 (0.89-1.24)1.00 (0.79-1.27)0.98 (0.79-1.21)1.17 (0.93-1.47)0.530.38
        Total calcium¶¶,*** (mg/d)    Range<500500-699.9700-899.9900-1,099.91,100-1,299.9≥1,300
        Cases119251274213169335
    Age RR1.00 (Reference)1.01 (0.85-1.33)1.10 (0.87-1.40)1.08 (0.85-1.36)1.22 (0.95-1.56)1.18 (0.90-1.53)0.270.11
    MV RR1.00 (Reference)1.05 (0.84-1.30)1.06 (0.85-1.34)1.04 (0.82-1.32)1.16 (0.90-1.48)1.08 (0.84-1.38)0.370.49
        Lactose (g/d)    Range<1010-19.920-29.9≥ 30
        Cases785793344210
    Age RR1.00 (Reference)1.09 (0.97-1.22)1.06 (0.91-1.24)1.21 (1.03-1.42)0.550.17
    MV RR1.00 (Reference)1.09 (0.97-1.22)1.07 (0.91-1.25)1.19 (1.01-1.40)0.580.19
        Dietary vitamin D†††,‡‡‡ (IU/d)    Range<100100-199.9200-299.9300-399.9400-499.9≥ 500
        Cases2266994271367124
    Age RR1.00 (Reference)1.05 (0.90-1.22)1.11 (0.94-1.31)1.07 (0.84-1.36)1.60 (1.20-2.13)1.46 (0.80-2.65)0.150.02
    MV RR1.00 (Reference)1.05 (0.90-1.23)1.10 (0.93-1.30)1.05 (0.83-1.33)1.56 (1.17-2.08)1.37 (0.78-2.40)0.210.04
        Total vitamin D†††,‡‡‡ (IU/d)    Range<100100-199.9200-299.9300-399.9400-499.9≥500
        Cases125346252113121339
    Age RR1.00 (Reference)1.20 (0.97-1.48)1.28 (1.02-1.59)1.11 (0.80-1.54)1.33 (1.02-1.72)1.16 (0.94-1.44)0.490.29
    MV RR1.00 (Reference)1.20 (0.97-1.48)1.26 (1.00-1.57)1.09 (0.79-1.51)1.27 (0.98-1.64)1.12 (0.90-1.38)0.550.60
    • NOTE: Multivariate RRs were adjusted for age at menarche (<13, 13, >13 years), menopausal status at baseline (premenopausal, postmenopausal, dubious), oral contraceptive use (ever, never), hormone replacement therapy use among postmenopausal women (never, past, current), parity (0, 1, 2, >2), BMI (<23, 23-<25, 25-<30, ≥30 kg/m2), smoking status (never, past, current), physical activity (low, medium, high), and energy intake (continuously), modeled identically across studies.

      Abbreviation: MV RR, multivariate RR.

    • ↵* P value, test for between-studies heterogeneity is based on the highest category of intake for that food or nutrient.

    • ↵† P value, test for trend.

    • ↵‡ New York State Cohort was not included in the categories 250 to 499.9 and ≥500 g/d of milk because this study had no cases in that category.

    • ↵§ New York State Cohort was not included in the low-fat or whole-milk analyses because they did not measure consumption of these items separately.

    • ↵∥ Nurses' Health Study II was not included in the category ≥250 g/d of whole milk because this study had no cases in that category.

    • ↵¶ New York State Cohort is not included in the hard cheese or yogurt analyses because they did not measure consumption of these food items.

    • ↵** Adventist Health Study, Nurses' Health Study (part a) and Nurses' Health Study II were not included in the category ≥50 g/d of hard cheese because this study had no cases in that category.

    • ↵†† Nurses' Health Study II was not included in the category ≥53 g/d of cottage cheese because this study had no cases in that category.

    • ↵‡‡ Cancer Prevention Study II Nutrition Cohort, New York State Cohort, and Swedish Mammography Cohort were not included in this analysis because they did not measure consumption of this item.

    • ↵§§ Adventist Health Study and Breast Cancer Detection Demonstration Project Follow-up Study are not included in the yogurt analysis because they did not measure consumption of this food item.

    • ↵∥∥ Adventist Health Study, the Netherlands Cohort Study, and New York State Cohort are excluded from the ice cream analyses because they did not measure consumption of this food item. Nurses' Health Study II and Women's Health Study were not included in the category ≥66 g/d of ice cream because this study had no cases in that category.

    • ↵¶¶ Adventist Health Study was not included in the analysis of dietary or total calcium because this study had no cases in the reference group.

    • ↵*** Canadian National Breast Screening Study, the Netherlands Cohort Study, Swedish Mammography Cohort are excluded from the total calcium and vitamin D analyses because they did not have supplement use data available for these nutrients.

    • ↵††† New York State Cohort, Nurses' Health Study (part a) were not included in the category ≥500 g/d of dietary vitamin D because this study had no cases in that category.

    • ↵‡‡‡ Adventist Health Study, Canadian National Breast Screening Study, the Netherlands Cohort Study, New York University Women's Health Study are excluded from the dietary and total (dietary and supplemental) vitamin D analyses because they did not assess vitamin D intake; Swedish Mammography Cohort is excluded from the total (dietary and supplemental) vitamin D analyses because they did not have supplement use data available.

  • Table 4.

    Pooled multivariate adjusted RRs and 95% CIs for histologic subtypes of ovarian cancer according to dairy food and nutrient intake, continuous model

    Increment* (/d)All ovarian cancer
    Endometrioid cancer†
    Mucinous cancer‡
    Serous cancer§
    P∥
    Case, nRR (95% CI)¶P**Case nRR (95% CI)¶P**Case nRR (95% CI)¶P**Case nRR (95% CI)¶P**
    Foods
        Milk250 g2,1061.02 (0.97-1.08)0.342551.10 (0.95-1.27)0.501200.97 (0.77-1.22)0.401,0151.06 (0.94-1.19)0.010.60
            Whole milk††250 g1,9190.98 (0.88-1.10)0.092400.91 (0.65-1.27)0.291131.19 (0.88-1.61)0.889300.91 (0.76-1.08)0.190.37
            Low-fat milk††250 g1,9831.04 (0.98-1.09)0.642491.16 (1.00-1.34)0.811160.93 (0.73-1.20)0.429681.08 (0.99-1.18)0.260.21
        Cheese
            Hard cheese‡‡25 g2,0271.02 (0.93-1.11)0.172591.11 (0.92-1.35)0.771221.00 (0.75-1.33)0.569821.07 (0.97-1.18)0.690.75
            Cottage cheese§§105 g1,4640.82 (0.63-1.08)0.221820.95 (0.50-1.81)0.64871.59 (0.92-2.57)0.537080.90 (0.62-1.32)0.210.05
        Yogurt∥∥227 g1,8090.91 (0.77-1.07)0.802390.98 (0.64-1.49)0.831190.83 (0.42-1.64)0.719310.93 (0.74-1.18)0.930.95
        Ice cream¶¶66 g1,7531.00 (0.84-1.20)0.492371.13 (0.68-1.87)0.76960.47 (0.12-1.83)0.208691.17 (0.94-1.44)0.850.36
    Nutrients
        Dietary calcium350mg2,1321.03 (0.97-1.09)0.322611.08 (0.93-1.25)0.391220.88 (0.70-1.11)0.701,0251.08 (0.97-1.21)0.030.50
        Total calcium***350mg1,4141.01 (0.99-1.02)0.411481.08 (0.94-1.24)0.03591.08 (0.89-1.30)0.486821.00 (0.93-1.07)0.290.53
        Lactose10 g2,1321.04 (0.99-1.08)0.262611.07 (0.95-1.20)0.631220.97 (0.81-1.16)0.661,0251.06 (0.97-1.16)0.020.63
        Dietary vitamin D†††100 IU1,5831.06 (1.00-1.12)0.281981.17 (0.97-1.42)0.04810.95 (0.73-1.24)0.227821.04 (0.98-1.12)0.830.84
        Total vitamin D‡‡‡100 IU1,2961.02 (0.99-1.04)0.311481.08 (1.02-1.15)0.21590.99 (0.85-1.10)0.256471.02 (0.94-1.09)0.850.17
    • ↵* Increment for foods is based on the standard serving size and for nutrients is based on the mean of the SD of the mean intake for each nutrient.

    • ↵† Endometrioid analyses additionally exclude Adventist Health Study, New York State Cohort, and New York University Women's Health Study due to small case numbers.

    • ↵‡ Mucinous analyses additionally exclude Adventist Health Study, Breast Cancer Detection Demonstration Project Follow-up Study, New York State Cohort, New York University Women's Health Study, Nurses' Health Study II, and Women's Health Study due to small case numbers.

    • ↵§ Serous analyses additionally exclude Adventist Health Study due to small case numbers.

    • ↵∥ P value for the test for the common effect by histologic types of ovarian cancer (endometrioid, mucinous, and serous).

    • ↵¶ Multivariate RRs were adjusted for age at menarche (<13, 13, >13 years), menopausal status at baseline (premenopausal, postmenopausal, dubious), oral contraceptive use (ever, never), hormone replacement therapy use among postmenopausal women (never, past, current), parity (0, 1, 2, >2), BMI (<23, 23-<25, 25-<30, ≥30 kg/m2), smoking status (never, past, current), physical activity (low, medium, high), and energy intake (continuously), modeled identically across studies.

    • ↵** P value, test for between-studies heterogeneity.

    • ↵†† New York State Cohort is not included in the low-fat or whole-milk analyses because they did not measure consumption of these items separately.

    • ↵‡‡ New York State Cohort is not included in the hard cheese analyses because they did not measure consumption of this food item.

    • ↵§§ Cancer Prevention Study II Nutrition Cohort, New York State Cohort, and Swedish Mammography Cohort are excluded from the cottage cheese analyses because they did not measure consumption of this food item.

    • ↵∥∥ Adventist Health Study, Breast Cancer Detection Demonstration Project Follow-up Study, and New York State Cohort are excluded from the yogurt analyses because they did not measure consumption of this food item.

    • ↵¶¶ Adventist Health Study, the Netherlands Cohort Study, and New York State Cohort are excluded from the ice cream analyses because they did not measure consumption of this food item.

    • ↵*** Canadian National Breast Screening Study, the Netherlands Cohort Study, and Swedish Mammography Cohort are excluded from the total calcium analyses because they did not have supplement use data available.

    • ↵††† Adventist Health Study, Canadian National Breast Screening Study, the Netherlands Cohort Study, New York University Women's Health Study are excluded from the dietary and total vitamin D analyses because they did not assess vitamin D intake.

    • ↵‡‡‡ Swedish Mammography Cohort is excluded from the total vitamin D analyses because they did not have supplement use data available.

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Cancer Epidemiology Biomarkers & Prevention: 15 (2)
February 2006
Volume 15, Issue 2
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Dairy Products and Ovarian Cancer: A Pooled Analysis of 12 Cohort Studies
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Dairy Products and Ovarian Cancer: A Pooled Analysis of 12 Cohort Studies
Jeanine M. Genkinger, David J. Hunter, Donna Spiegelman, Kristin E. Anderson, Alan Arslan, W. Lawrence Beeson, Julie E. Buring, Gary E. Fraser, Jo L. Freudenheim, R. Alexandra Goldbohm, Susan E. Hankinson, David R. Jacobs Jr., Anita Koushik, James V. Lacey Jr., Susanna C. Larsson, Michael Leitzmann, Marji L. McCullough, Anthony B. Miller, Carmen Rodriguez, Thomas E. Rohan, Leo J. Schouten, Roy Shore, Ellen Smit, Alicja Wolk, Shumin M. Zhang and Stephanie A. Smith-Warner
Cancer Epidemiol Biomarkers Prev February 1 2006 (15) (2) 364-372; DOI: 10.1158/1055-9965.EPI-05-0484

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Dairy Products and Ovarian Cancer: A Pooled Analysis of 12 Cohort Studies
Jeanine M. Genkinger, David J. Hunter, Donna Spiegelman, Kristin E. Anderson, Alan Arslan, W. Lawrence Beeson, Julie E. Buring, Gary E. Fraser, Jo L. Freudenheim, R. Alexandra Goldbohm, Susan E. Hankinson, David R. Jacobs Jr., Anita Koushik, James V. Lacey Jr., Susanna C. Larsson, Michael Leitzmann, Marji L. McCullough, Anthony B. Miller, Carmen Rodriguez, Thomas E. Rohan, Leo J. Schouten, Roy Shore, Ellen Smit, Alicja Wolk, Shumin M. Zhang and Stephanie A. Smith-Warner
Cancer Epidemiol Biomarkers Prev February 1 2006 (15) (2) 364-372; DOI: 10.1158/1055-9965.EPI-05-0484
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