Pre- and post-diagnostic intake of whole grain and dairy products and breast cancer prognosis: the Danish Diet, Cancer and Health cohort

  • Julie Louise Munk AndersenEmail author
  • Louise Hansen
  • Birthe Lykke Riegels Thomsen
  • Lisa Rudolph Christiansen
  • Lars Ove Dragsted
  • Anja Olsen



Fiber rich foods and dairy products have been suggested to be associated with breast cancer prognosis, though existing research is limited and either report on pre- or post-diagnostic dietary intake in relation to breast cancer prognosis. We investigated the associations between intake of whole grain (WG) and dairy products assessed both pre- and post-diagnostically in relation to breast cancer prognosis.


A total of 1965 women from the Diet, Cancer and Health cohort who were diagnosed with breast cancer between baseline (1993–1997) and December 2013 were included and followed for a median of 7 years after diagnosis. During follow-up, 309 women experienced breast cancer recurrence and 460 women died, of whom 301 died from breast cancer. Dietary assessment by food frequency questionnaires was obtained up to three times, pre- and post-diagnostic, over a period of 18 years. Cox proportional hazard models were used to estimate hazard ratios.


No associations were observed between pre- or post-diagnostic intake of total WG or total dairy products and breast cancer prognosis. A high pre-diagnostic intake of oatmeal/muesli was associated with lower all-cause mortality (HR 0.76, 95% CI 0.59–0.99), whereas high post-diagnostic intake of rye bread was associated with higher breast cancer-specific mortality (HR 1.29, 95% CI 1.02–1.63). A generally high intake of cheese was associated with a higher recurrence rate.


Pre-diagnostic intake of oatmeal/muesli was associated with lower all-cause mortality, and post-diagnostic intake of rye bread was associated with higher breast cancer specific mortality.


Epidemiology Whole grains Dairy products Cohort study Breast cancer prognosis 



We thank Katja Boll and Nick Martinussen for data management and assistance and we thank Kirsten Frederiksen for statistical support.


This study was funded by the Danish Cancer Society Research Center, Strandboulevarden 49, 2100 Copenhagen, Denmark

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards by the regional ethical committees on human studies in Copenhagen and Aarhus (File (KF)11-037/01), by the Danish Data Protection Agency and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Research involving animal rights

This article does not contain any studies with animals performed by any of the authors.


  1. 1.
    Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 68(6):394–424. CrossRefGoogle Scholar
  2. 2.
    World Cancer Research Fund International/American Institute for Cancer Research (2014) Continuous update project report: diet, nutrition, physical activity and breast cancer survivors 2014. Available at:
  3. 3.
    Flachs EM, Eriksen L, Koch MB, Ryd JT, Dibba E, Skov-Ettrup L, Juel K. Statens Institut for Folkesundhed,Syddansk Universitet (2015) Sygdomsbyrden i Danmark – sygdomme. Sundhedsstyrelsen, KøbenhavnGoogle Scholar
  4. 4.
  5. 5.
    Key TJ, Verkasalo PK, Banks E (2001) Epidemiology of breast cancer. Lancet Oncol 2(3):133–140. CrossRefPubMedGoogle Scholar
  6. 6.
    Russo J, Russo IH (2006) The role of estrogen in the initiation of breast cancer. J Steroid Biochem Mol Biol 102(1–5):89–96. CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Key TJ (2011) Endogenous oestrogens and breast cancer risk in premenopausal and postmenopausal women. Steroids 76(8):812–815. CrossRefPubMedGoogle Scholar
  8. 8.
    World Cancer Research Fund/American Institute for Cancer Research (2018) Diet, nutrition, physical activity and cancer: a global perspective. Continous Update Project Expert Report 2018. Available at
  9. 9.
    Slavin JL (2000) Mechanisms for the impact of whole grain foods on cancer risk. J Am Coll Nutr 19(3 Suppl):300S–307SCrossRefGoogle Scholar
  10. 10.
    Arts CJ, Govers CA, van den Berg H, Wolters MG, van Leeuwen P, Thijssen JH (1991) In vitro binding of estrogens by dietary fiber and the in vivo apparent digestibility tested in pigs. J Steroid Biochem Mol Biol 38(5):621–628CrossRefGoogle Scholar
  11. 11.
    Rose DP, Goldman M, Connolly JM, Strong LE (1991) High-fiber diet reduces serum estrogen concentrations in premenopausal women. Am J Clin Nutr 54(3):520–525. CrossRefPubMedGoogle Scholar
  12. 12.
    Aune D, Chan DS, Greenwood DC, Vieira AR, Rosenblatt DA, Vieira R, Norat T (2012) Dietary fiber and breast cancer risk: a systematic review and meta-analysis of prospective studies. Ann Oncol 23(6):1394–1402. CrossRefPubMedGoogle Scholar
  13. 13.
    Zang J, Shen M, Du S, Chen T, Zou S (2015) The association between dairy intake and breast cancer in western and asian populations: a systematic review and meta-analysis. J Breast Cancer 18(4):313–322. CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Holmes MD, Pollak MN, Willett WC, Hankinson SE (2002) Dietary correlates of plasma insulin-like growth factor I and insulin-like growth factor binding protein 3 concentrations. Cancer Epidemiol Biomark Prev 11(9):852–861Google Scholar
  15. 15.
    Brinkman MT, Baglietto L, Krishnan K, English DR, Severi G, Morris HA, Hopper JL, Giles GG (2010) Consumption of animal products, their nutrient components and postmenopausal circulating steroid hormone concentrations. Eur J Clin Nutr 64(2):176–183. CrossRefPubMedGoogle Scholar
  16. 16.
    Xie SP, James SY, Colston KW (1997) Vitamin D derivatives inhibit the mitogenic effects of IGF-I on MCF-7 human breast cancer cells. J Endocrinol 154(3):495–504CrossRefGoogle Scholar
  17. 17.
    Cui Y, Rohan TE (2006) Vitamin D, calcium, and breast cancer risk: a review. Cancer Epidemiol Biomark Prev 15(8):1427–1437. CrossRefGoogle Scholar
  18. 18.
    Shin MH, Holmes MD, Hankinson SE, Wu K, Colditz GA, Willett WC (2002) Intake of dairy products, calcium, and vitamin D and risk of breast cancer. J Natl Cancer Inst 94(17):1301–1311CrossRefGoogle Scholar
  19. 19.
    Grimberg A (2003) Mechanisms by which IGF-I may promote cancer. Cancer Biol Ther 2(6):630–635CrossRefGoogle Scholar
  20. 20.
    Kroenke CH, Kwan ML, Sweeney C, Castillo A, Caan BJ (2013) High- and low-fat dairy intake, recurrence, and mortality after breast cancer diagnosis. J Natl Cancer Inst 105(9):616–623. CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Holmes MD, Stampfer MJ, Colditz GA, Rosner B, Hunter DJ, Willett WC (1999) Dietary factors and the survival of women with breast carcinoma. Cancer 86(5):826–835CrossRefGoogle Scholar
  22. 22.
    World Cancer Research Fund/American Institute for Cancer Research (2018) Continous update project report: diet, nutrition, physical activity and breast cancer 2018. ​Available at
  23. 23.
    Pedersen AN, Christensen T, Matthiessen J, Knudsen VK, Rosenlund-Sørensen M, Biltoft-Jensen A, Hinsch HJ, Ygil KH, Kørup K, Saxholt E, Trolle E, Sødergaard AB, Fagt S (2015) Danskernes Kostvaner 2011–2013. 1. Udgave edn. DTU Fødevareinstituttet, CopenhagenGoogle Scholar
  24. 24.
    Saxe GA, Rock CL, Wicha MS, Schottenfeld D (1999) Diet and risk for breast cancer recurrence and survival. Breast Cancer Res Treat 53(3):241–253CrossRefGoogle Scholar
  25. 25.
    Buck K, Zaineddin AK, Vrieling A, Heinz J, Linseisen J, Flesch-Janys D, Chang-Claude J (2011) Estimated enterolignans, lignan-rich foods, and fibre in relation to survival after postmenopausal breast cancer. Br J Cancer 105(8):1151–1157. CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Beasley JM, Newcomb PA, Trentham-Dietz A, Hampton JM, Bersch AJ, Passarelli MN, Holick CN, Titus-Ernstoff L, Egan KM, Holmes MD, Willett WC (2011) Post-diagnosis dietary factors and survival after invasive breast cancer. Breast Cancer Res Treat 128(1):229–236. CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    McEligot AJ, Largent J, Ziogas A, Peel D, Anton-Culver H (2006) Dietary fat, fiber, vegetable, and micronutrients are associated with overall survival in postmenopausal women diagnosed with breast cancer. Nutr Cancer 55(2):132–140. CrossRefPubMedGoogle Scholar
  28. 28.
    Belle FN, Kampman E, McTiernan A, Bernstein L, Baumgartner K, Baumgartner R, Ambs A, Ballard-Barbash R, Neuhouser ML (2011) Dietary fiber, carbohydrates, glycemic index, and glycemic load in relation to breast cancer prognosis in the HEAL cohort. Cancer Epidemiol Biomark Prev 20(5):890–899. CrossRefGoogle Scholar
  29. 29.
    Pedersen CB (2011) The Danish civil registration system. Scand J Public Health 39(7 Suppl):22–25. CrossRefPubMedGoogle Scholar
  30. 30.
    Gjertstorff M (2011) The Danish cancer registry. Scand J Public Health 39:42–45CrossRefGoogle Scholar
  31. 31.
    ​Andersen KW, Mouridsen HT (1988) Danish Breast Cancer Cooperative Group (DBCG): a description of the register of the nation-wide programme for primary breast cancer. Acta Oncol 27(6):627–647. CrossRefPubMedGoogle Scholar
  32. 32.
    Helweg-Larsen K (2011) The Danish register of causes of death. Scand J Public Health 39(7_Suppl):26–29CrossRefGoogle Scholar
  33. 33.
    Mejborn H, Ygil KH, Fagt S, Trolle E, Kørup K, Christiensen T (2014) Wholegrain intake of Danes 2011-2012Google Scholar
  34. 34.
    Tjonneland A, Olsen A, Boll K, Stripp C, Christensen J, Engholm G, Overvad K (2007) Study design, exposure variables, and socioeconomic determinants of participation in diet, cancer and health: a population-based prospective cohort study of 57,053 men and women in Denmark. Scand J Public Health 35(4):432–441. CrossRefPubMedGoogle Scholar
  35. 35.
    Lundqvist A, Andersson E, Ahlberg I, Nilbert M, Gerdtham U (2016) Socioeconomic inequalities in breast cancer incidence and mortality in Europe—a systematic review and meta-analysis. Eur J Pub Health 26(5):804–813. CrossRefGoogle Scholar
  36. 36.
    Haraldsdottir A, Torfadottir JE, Valdimarsdottir UA, Adami HO, Aspelund T, Tryggvadottir L, Thordardottir M, Birgisdottir BE, Harris TB, Launer LJ, Gudnason V, Steingrimsdottir L (2018) Dietary habits in adolescence and midlife and risk of breast cancer in older women. PLoS ONE 13(5):e0198017. CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Wu H, Kyro C, Tjonneland A, Boll K, Olsen A, Overvad K, Landberg R (2019) Long-term whole grain wheat and rye intake reflected by adipose tissue alkylresorcinols and breast cancer: a case-cohort study. Nutrients. CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Schisterman EF, Cole SR, Platt RW (2009) Overadjustment bias and unnecessary adjustment in epidemiologic studies. Epidemiology 20(4):488–495. CrossRefPubMedPubMedCentralGoogle Scholar

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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Danish Cancer Society Research CenterCopenhagenDenmark
  2. 2.Section for Preventive and Clinical Nutrition, Department of Nutrition, Exercise and SportsFrederiksberg CDenmark

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