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Breast Cancer Research and Treatment

, Volume 154, Issue 2, pp 389–401 | Cite as

Pre-diagnostic polyphenol intake and breast cancer survival: the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort

  • Cecilie Kyrø
  • Raul Zamora-Ros
  • Augustin Scalbert
  • Anne Tjønneland
  • Laure Dossus
  • Christoffer Johansen
  • Pernille Envold Bidstrup
  • Elisabete Weiderpass
  • Jane Christensen
  • Heather Ward
  • Dagfinn Aune
  • Elio Riboli
  • Mathilde His
  • Françoise Clavel-Chapelon
  • Laura Baglietto
  • Verena Katzke
  • Tilman Kühn
  • Heiner Boeing
  • Anna Floegel
  • Kim Overvad
  • Cristina Lasheras
  • Noémie Travier
  • Maria-José Sánchez
  • Pilar Amiano
  • Maria-Dolores Chirlaque
  • Eva Ardanaz
  • Kay-Tee Khaw
  • Nick Wareham
  • Aurora Perez-Cornago
  • Antonia Trichopoulou
  • Pagona Lagiou
  • Effie Vasilopoulou
  • Giovanna Masala
  • Sara Grioni
  • Franco Berrino
  • Rosario Tumino
  • Carlotta Sacerdote
  • Amalia Mattiello
  • H. B(as). Bueno-de-Mesquita
  • Petra H. Peeters
  • Carla van Gils
  • Signe Borgquist
  • Salma Butt
  • Anne Zeleniuch-Jacquotte
  • Malin Sund
  • Anette Hjartåker
  • Guri Skeie
  • Anja Olsen
  • Isabelle Romieu
Epidemiology

Abstract

The aim was to investigate the association between pre-diagnostic intakes of polyphenol classes (flavonoids, lignans, phenolic acids, stilbenes, and other polyphenols) in relation to breast cancer survival (all-cause and breast cancer-specific mortality). We used data from the European Prospective Investigation into Cancer and Nutrition cohort. Pre-diagnostic usual diet was assessed using dietary questionnaires, and polyphenol intakes were estimated using the Phenol-Explorer database. We followed 11,782 breast cancer cases from time of diagnosis until death, end of follow-up or last day of contact. During a median of 6 years, 1482 women died (753 of breast cancer). We related polyphenol intake to all-cause and breast cancer-specific mortality using Cox proportional hazard models with time since diagnosis as underlying time and strata for age and country. Among postmenopausal women, an intake of lignans in the highest versus lowest quartile was related to a 28 % lower risk of dying from breast (adjusted model: HR, quartile 4 vs. quartile 1, 0.72, 95 % CI 0.53; 0.98). In contrast, in premenopausal women, a positive association between lignan intake and all-cause mortality was found (adjusted model: HR, quartile 4 vs. quartile 1, 1.63, 95 % CI 1.03; 2.57). We found no association for other polyphenol classes. Intake of lignans before breast cancer diagnosis may be related to improved survival among postmenopausal women, but may on the contrary worsen the survival for premenopausal women. This suggests that the role of phytoestrogens in breast cancer survival is complex and may be dependent of menopausal status.

Keywords

Breast cancer Survivorship Polyphenols Phytoestrogens Lignans 

Abbreviations

EPIC

The European Prospective Investigation into Cancer and Nutrition

ICD-10

The 10th revision of the International Classification of Disease, Injuries and Causes of Death

ER

Estrogen receptor

HR

Hazard ratio

CI

Confidence interval

UK

United Kingdom

Notes

Acknowledgments

The authors thank Bertrand Hemon, Katja Boll, and Nick Martinussen for help with data management.

Funding

This work was funded by Innovation Fund Denmark (ELIN: 0603-00580B). The coordination of EPIC is financially supported by the European Commission (DG-SANCO) and the International Agency for Research on Cancer. The national cohorts are supported by Danish Cancer Society (Denmark); Ligue Contre le Cancer, Institut Gustave Roussy, Mutuelle Générale de l’Education Nationale, Institut National de la Santé et de la Recherche Médicale (France); German Cancer Aid, German Cancer Research Center, Federal Ministry of Education and Research (Germany); the Hellenic Health Foundation (Greece); Associazione Italiana per la Ricerca sul Cancro-AIRC-Italy, and National Research Council (Italy); Dutch Ministry of Public Health, Welfare and Sports, Netherlands Cancer Registry, LK Research Funds, Dutch Prevention Funds, Dutch Zorg Onderzoek Nederland, World Cancer Research Fund, Statistics Netherlands (The Netherlands); ERC-2009-AdG 232997, the Norwegian Research Council, Extrastiftelsen Helse og Rehabiliering med Extra-midler (Norway); Health Research Fund, Regional Governments of Andalucía, Asturias, Basque Country, Murcia (no. 6236) and Navarra, RETIC (RD06/0020/0091 and RD12/0036/0018) (Spain); Swedish Cancer Society, Swedish Scientific Council and Regional Government of Skåne and Västerbotten (Sweden); and Cancer Research UK, Medical Research Council (UK).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Supplementary material

10549_2015_3595_MOESM1_ESM.docx (53 kb)
Supplementary material 1 (DOCX 52 kb)

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Cecilie Kyrø
    • 1
    • 2
  • Raul Zamora-Ros
    • 2
  • Augustin Scalbert
    • 2
  • Anne Tjønneland
    • 1
  • Laure Dossus
    • 3
    • 4
  • Christoffer Johansen
    • 1
    • 5
  • Pernille Envold Bidstrup
    • 1
  • Elisabete Weiderpass
    • 6
    • 7
    • 8
    • 9
  • Jane Christensen
    • 1
  • Heather Ward
    • 10
  • Dagfinn Aune
    • 10
  • Elio Riboli
    • 10
  • Mathilde His
    • 3
    • 4
    • 11
  • Françoise Clavel-Chapelon
    • 3
    • 4
    • 11
  • Laura Baglietto
    • 3
    • 4
    • 11
    • 12
    • 13
  • Verena Katzke
    • 14
  • Tilman Kühn
    • 14
  • Heiner Boeing
    • 15
  • Anna Floegel
    • 15
  • Kim Overvad
    • 16
  • Cristina Lasheras
    • 17
  • Noémie Travier
    • 18
  • Maria-José Sánchez
    • 19
    • 20
  • Pilar Amiano
    • 20
    • 21
  • Maria-Dolores Chirlaque
    • 20
    • 22
    • 23
  • Eva Ardanaz
    • 20
    • 24
    • 25
  • Kay-Tee Khaw
    • 26
  • Nick Wareham
    • 27
  • Aurora Perez-Cornago
    • 28
  • Antonia Trichopoulou
    • 29
    • 30
  • Pagona Lagiou
    • 29
    • 30
  • Effie Vasilopoulou
    • 29
    • 30
  • Giovanna Masala
    • 31
  • Sara Grioni
    • 32
  • Franco Berrino
    • 32
  • Rosario Tumino
    • 33
  • Carlotta Sacerdote
    • 34
  • Amalia Mattiello
    • 35
  • H. B(as). Bueno-de-Mesquita
    • 10
    • 36
    • 37
    • 38
  • Petra H. Peeters
    • 10
    • 39
  • Carla van Gils
    • 39
  • Signe Borgquist
    • 40
  • Salma Butt
    • 41
  • Anne Zeleniuch-Jacquotte
    • 42
  • Malin Sund
    • 43
  • Anette Hjartåker
    • 44
  • Guri Skeie
    • 6
  • Anja Olsen
    • 1
  • Isabelle Romieu
    • 2
  1. 1.Danish Cancer Society Research CenterCopenhagenDenmark
  2. 2.International Agency for Research on Cancer (WHO–IARC)LyonFrance
  3. 3.Inserm, CESP Centre for Research in Epidemiology and Population HealthVillejuifFrance
  4. 4.Université Paris-SudVillejuifFrance
  5. 5.5073, Oncology Clinic, Finsen Centre, RigshospitaletUniversity of CopenhagenCopenhagenDenmark
  6. 6.Department of Community Medicine, Faculty of Health SciencesUniversity of Tromsø, The Arctic University of NorwayTromsøNorway
  7. 7.Department of Research, Cancer Registry of NorwayInstitute of Population Based Cancer ResearchOsloNorway
  8. 8.Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
  9. 9.Genetic Epidemiology Group, Folkhälsan Research CenterSamfundet FolkhälsanHelsinkiFinland
  10. 10.Department of Epidemiology and Biostatistics, School of Public HealthImperial College LondonLondonUK
  11. 11.Gustave RoussyVillejuifFrance
  12. 12.Cancer Epidemiology CentreCancer Council of VictoriaMelbourneAustralia
  13. 13.Centre for Epidemiology and Biostatistics, School of Population and Global HealthUniversity of MelbourneMelbourneAustralia
  14. 14.Division of Cancer EpidemiologyGerman Cancer Research Center, DKFZHeidelbergGermany
  15. 15.Department of EpidemiologyGerman Institute of Human Nutrition Potsdam-RehbrueckeNuthetalGermany
  16. 16.Section for Epidemiology, Department of Public HealthAarhus UniversityAarhusDenmark
  17. 17.Department of Functional Biology, Faculty of MedicineUniversity of OviedoAsturiasSpain
  18. 18.Unit of Nutrition and CancerCatalan Institute of Oncology (ICO-IDIBELL)BarcelonaSpain
  19. 19.Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs.GRANADAHospitales Universitarios de Granada/Universidad de GranadaGranadaSpain
  20. 20.CIBER de Epidemiología y Salud Pública (CIBERESP)MadridSpain
  21. 21.Public Health Division of GipuzkoaBioDonostia Research InstituteSan SebastiánSpain
  22. 22.Department of EpidemiologyRegional Health Council, IMIB-ArrixacaMurciaSpain
  23. 23.Department of Health and Social SciencesUniversidad de MurciaMurciaSpain
  24. 24.Navarra Public Health InstitutePamplonaSpain
  25. 25.Navarra Institute for Health Research (IdiSNA)PamplonaSpain
  26. 26.Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
  27. 27.MRC Epidemiology UnitUniversity of CambridgeCambridgeUK
  28. 28.Cancer Epidemiology Unit, Nuffield Department of Population HealthUniversity of OxfordOxfordUK
  29. 29.Hellenic Health FoundationAthensGreece
  30. 30.WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical StatisticsUniversity of Athens Medical SchoolAthensGreece
  31. 31.Molecular and Nutritional Epidemiology UnitCancer Research and Prevention Institute – ISPOFlorenceItaly
  32. 32.Epidemiology and Prevention UnitFondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
  33. 33.Cancer Registry and Histopathology Unit“Civile–M.P. Arezzo” HospitalRagusaItaly
  34. 34.Cancer Epidemiology Unit, San Giovanni Battista HospitalCPO Piemonte and University of TurinTurinItaly
  35. 35.Dipartimento di Medicina Clinica e ChirurgiaFederico II UniversityNaplesItaly
  36. 36.Department for Determinants of Chronic Diseases (DCD)National Institute for Public Health and the Environment (RIVM)BilthovenThe Netherlands
  37. 37.Department of Gastroenterology and HepatologyUniversity Medical CentreUtrechtThe Netherlands
  38. 38.Department of Social & Preventive Medicine, Faculty of MedicineUniversity of MalayaKuala LumpurMalaysia
  39. 39.Department of Epidemiology, Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
  40. 40.Division of Oncology and Pathology, Department of Clinical SciencesLund UniversityLundSweden
  41. 41.Department of Surgery, Clinical Sciences, Skåne University HospitalLund UniversityMalmöSweden
  42. 42.Department of Population HealthNYU School of MedicineNew YorkUSA
  43. 43.Department of Surgical and Perioperative SciencesUmeå UniversityUmeåSweden
  44. 44.Department of Nutrition, Institute of Basic Medical SciencesUniversity of OsloOsloNorway

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