Original Paper

Cancer Causes & Control

, Volume 20, Issue 6, pp 803-809

First online:

Prospective study of the association between grapefruit intake and risk of breast cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC)

  • Elizabeth A. SpencerAffiliated withCancer Epidemiology Unit, University of Oxford Email author 
  • , Timothy J. KeyAffiliated withCancer Epidemiology Unit, University of Oxford
  • , Paul N. ApplebyAffiliated withCancer Epidemiology Unit, University of Oxford
  • , Carla H. van GilsAffiliated withJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht
  • , Anja OlsenAffiliated withInstitute of Cancer Epidemiology, Danish Cancer Society
  • , Anne TjønnelandAffiliated withInstitute of Cancer Epidemiology, Danish Cancer Society
  • , Françoise Clavel-ChapelonAffiliated withINSERM (Institut National de la Santé et de la Recherche Médicale), ERI 20, EA 4045, and Institut Gustave Roussy
  • , Marie-Christine Boutron-RuaultAffiliated withINSERM (Institut National de la Santé et de la Recherche Médicale), ERI 20, EA 4045, and Institut Gustave Roussy
  • , Marina TouillaudAffiliated withINSERM (Institut National de la Santé et de la Recherche Médicale), ERI 20, EA 4045, and Institut Gustave Roussy
    • , Maria-José SánchezAffiliated withAndalusian School of Public HealthCIBER Epidemiología y Salud Pública (CIBERESP)
    • , Sheila BinghamAffiliated withDepartment of Public Health and Primary Care, MRC Dunn Human Nutrition Unit, University of CambridgeDepartment of Public Health and Primary Care, MRC Centre for Nutritional Epidemiology in Cancer Prevention and Survival, University of Cambridge
    • , Kay Tee KhawAffiliated withDepartment of Public Health and Primary Care, University of Cambridge
    • , Nadia SlimaniAffiliated withInternational Agency for Research on Cancer, The World Health Organisation
    • , Rudolf KaaksAffiliated withDivision of Cancer Epidemiology, German Cancer Research Centre
    • , Elio RiboliAffiliated withDepartment of Epidemiology and Public Health, Imperial College

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Abstract

Grapefruit inhibits cytochrome P450 3A4 and may affect estrogen metabolism. In the European Prospective Investigation into Cancer and Nutrition (EPIC), we examined the relationships of grapefruit intake with risk of breast cancer and with serum sex hormone levels. 114,504 women with information on dietary intake of grapefruit and on reproductive and lifestyle risk factors were followed for a median 9.5 years and 3,747 incident breast cancers were identified. Fifty-nine percent of women reported eating grapefruit, 4% ate ≥ 60 g/day. Cox proportional hazard models were used to estimate the hazard ratio (HR) for breast cancer according to grapefruit intake, adjusting for study centre, reproductive factors, body mass index, energy intake, and alcohol intake. Grapefruit intake was not related to the risk of breast cancer: compared with women who ate no grapefruit, women with the highest intake of ≥60 g/day had a HR of 0.93 (95% CI 0.77–1.13), p for linear trend = 0.5. There was no relationship between grapefruit intake and breast cancer risk among premenopausal women, all postmenopausal women, or postmenopausal women categorized by hormone replacement therapy use (all p>0.05). There was no association between grapefruit intake and estradiol or estrone among postmenopausal women. In this study, we found no evidence of an association between grapefruit intake and risk of breast cancer.

Keywords

Breast cancer CYP3A4 metabolism Grapefruit intake Prospective studies