Breast Cancer Research and Treatment

, Volume 125, Issue 2, pp 519–527 | Cite as

Vegetable intake is associated with reduced breast cancer recurrence in tamoxifen users: a secondary analysis from the Women’s Healthy Eating and Living Study

  • Cynthia A. ThomsonEmail author
  • Cheryl L. Rock
  • Patricia A. Thompson
  • Bette J. Caan
  • Ellen Cussler
  • Shirley W. Flatt
  • John P. Pierce


The protective effect of vegetables on the risk of breast cancer recurrence is uncertain. We sought to evaluate the association between breast cancer recurrence and vegetable intake including analyses stratified on tamoxifen use. Experimental evidence of anti-carcinogenic activity of phytochemicals in cruciferous vegetables in combination with tamoxifen led to specific evaluation of this class of vegetables as well. To assess the association between vegetable intake and breast cancer recurrence, vegetable intake from repeat 24-h dietary recalls were examined as a secondary analysis of 3,080 breast cancer survivors enrolled in the Women’s Healthy Eating and Living (WHEL) Study. At the time of enrollment women were, on average, 23.5 months post-diagnosis. The hazard of recurrence, controlling for relevant and significant clinical and demographic variables, with vegetable intake was assessed overall and separately for women taking tamoxifen. WHEL participants reported mean baseline intakes (\({\bar{\text {x}}}\), SE) of 3.1 ± 0.05 and 0.5 ± 0.02 servings/day of total and cruciferous vegetables, respectively. Baseline vegetable intake in the highest as compared to lowest tertiles was associated with an overall lower adjusted hazard ratios (HR) for recurrence of 0.69, 95% CI 0.55–0.87. Among women taking tamoxifen, the HRs were 0.56, 95% CI 0.41–0.77 for total vegetables and 0.65, 95% CI 0.47–0.89 for cruciferous vegetable intake. The hazard in women using tamoxifen who reported cruciferous vegetable intake above the median and who were within the highest tertile of total vegetable intake was HR 0.48; 95% CI 0.32–0.70. This secondary analysis in over 3,000 breast cancer survivors suggests that baseline vegetable intake may be associated with a reduction in the risk of breast cancer recurrent or new events particularly for those using tamoxifen. Such associations should be explored further as the possibility that vegetable intake is simply a surrogate for other health-promoting behaviors cannot be ruled out.


Diet Breast cancer Vegetables Tamoxifen 



Women’s Healthy Eating and Living


Body mass index


Hazards ratio


Confidence interval


Select estrogen receptor modulator


United States


United States Department of Agriculture


Nutrient database software



The author acknowledges The Women’s Healthy Eating and Living Study Group who were involved in recruitment, intervention, and data collection for this publication as well as the WHEL staff and study participants; V. Hartz and S. Faerber who further assisted in data collection/management, and importantly Dr. Loki Natarajan, senior biostatistician for the WHEL Study, who provided significant guidance on the analysis. This work was supported by National Institutes of Health (NIH)/National Cancer Institute (NCI) [Grant numbers CA69375 to JPP, CA93658 to CAT]; the Walton Family Foundation; and some data were collected from General Clinical Research Centers funded by National Institutes of Health [M01-RR00070, M01-RR00079, M01-RR00827].


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Copyright information

© Springer Science+Business Media, LLC. 2010

Authors and Affiliations

  • Cynthia A. Thomson
    • 1
    Email author
  • Cheryl L. Rock
    • 2
  • Patricia A. Thompson
    • 3
  • Bette J. Caan
    • 4
  • Ellen Cussler
    • 5
  • Shirley W. Flatt
    • 2
  • John P. Pierce
    • 2
  1. 1.Department of Nutritional ScienceUniversity of Arizona Cancer Center, University of ArizonaTucsonUSA
  2. 2.Moores UCSD Cancer CenterUniversity of CaliforniaSan Diego, La JollaUSA
  3. 3.University of Arizona Cancer Center, University of ArizonaTucsonUSA
  4. 4.Kaiser Permanente Northern CaliforniaOaklandUSA
  5. 5.Department of PhysiologyUniversity of ArizonaTucsonUSA

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