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Cancer Causes & Control

, Volume 27, Issue 11, pp 1303–1314 | Cite as

Pre- and postdiagnostic diet in relation to mortality among breast cancer survivors in the CPS-II Nutrition Cohort

  • Marjorie L. McCulloughEmail author
  • Susan M. Gapstur
  • Roma Shah
  • Peter T. Campbell
  • Ying Wang
  • Colleen Doyle
  • Mia M. Gaudet
Original paper

Abstract

Purpose

Due to the limited evidence on the role of diet and cause-specific mortality among breast cancer survivors, current nutrition guidelines for this population are consistent with those for cancer prevention. We evaluated whether diets consistent with the American Cancer Society recommendations for cancer prevention were associated with risk of death in breast cancer survivors.

Methods

Participants reported information on diet and other factors at baseline in 1992–1993 and twice during follow-up. A nine-point score reflecting concordance with diet recommendations was calculated. Multivariable-adjusted relative risks (RR) and 95 % confidence intervals (CI) for diet score in relation to overall and cause-specific mortality were computed using Cox proportional hazards regression methods.

Results

Among 4,452 women diagnosed with locally and regionally staged breast cancer after baseline and until 2011, 1,204 died during follow-up through 2012 (398 from breast cancer). Prediagnostic diet score was not associated with mortality from any cause. Postdiagnostic diet score was associated with neither breast cancer-specific mortality (RR 1.44, 95 % CI 0.90–2.30 for scores 6–9 vs 0–2) nor cardiovascular disease mortality (RR 0.81, 95 % CI 0.47–1.39), but compared to a score of 0–2, a score of 6–9 was associated with a borderline lower risk of other causes of death (RR 0.78, 95 % CI 0.56–1.07, p trend = 0.03; per two-point increase in score RR 0.88, 95 % CI 0.79–0.99). Of diet score components, only limiting red and processed meat consumption was associated with statistically significantly lower risk of total, CVD, and other non-breast cancer mortality.

Conclusions

Diets consistent with guidelines for cancer prevention were not associated with breast cancer-specific mortality. However, their association with other causes of mortality underscores the importance of consuming a healthy diet in this population.

Keywords

Breast cancer Diet guidelines Diet patterns Red meat Processed meat Mortality 

Notes

Acknowledgments

We thank the CPS-II participants and Study Management Group for their invaluable contributions to this research. We also acknowledge the contribution to this study from central cancer registries supported through the Centers for Disease Control and Prevention’s National Program of Cancer Registries, as well as cancer registries supported by the National Cancer Institute’s Surveillance Epidemiology and End Results program.

Funding

The American Cancer Society funds the creation, maintenance, and updating of the Cancer Prevention Study-II cohort.

Author contributions

MLM, SMG, MMG, RS, and PTC made substantial contributions to conception and design, or acquisition of data, or analysis and interpretation of data; MLM, SMG, MMG, RS, PTC, and CD were involved in drafting the manuscript or revising it critically for important intellectual content; all authors gave final approval of the version to be published.

Compliance with ethical standards

Conflict of interest

The 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 of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The CPS-II Nutrition Cohort is approved by the Institutional Review Board at Emory University.

Supplementary material

10552_2016_802_MOESM1_ESM.docx (22 kb)
Associations of ACS guidelines diet score and mortality according to consistency of pre- and postdiagnostic ACS guidelines scores among the 2,152 breast cancer patients with information on postdiagnostic diet. “Consistently high” scores=6–9 at both time periods; “Improved” scores=0–2 for prediagnostic diet and 3–9 (any improvement) after diagnosis. “Worsened” scores were 6–9 at prediagnostic assessment, and 0–5 after diagnosis (any decrease). Consistently low (0–2) scores are the reference group for all categories. Other combinations are not shown. (DOCX 22 kb)
10552_2016_802_MOESM2_ESM.docx (14 kb)
Supplementary material 2 (DOCX 15 kb)

References

  1. 1.
    American Cancer Society (2015) Cancer facts and figures 2015. American Cancer Society, Atlanta GAGoogle Scholar
  2. 2.
    World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) (2014) Continuous update project report: diet, nutrition, physical activity, and breast cancer survivors. http://www.wcrf.org/sites/default/files/breast-cancer-survivors-2014-report.pdf
  3. 3.
    American Cancer Society (2013) Breast cancer facts & figures 2013–2014. American Cancer Society Inc, AtlantaGoogle Scholar
  4. 4.
    American Cancer Society (2014) Cancer treatment and survivorship facts & figures 2014–2015. American Cancer Society, AtlantaGoogle Scholar
  5. 5.
    Kushi LH, Doyle C, McCullough M et al (2012) American Cancer Society Guidelines on nutrition and physical activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity. CA Cancer J Clin 62:30–67CrossRefPubMedGoogle Scholar
  6. 6.
    Rock CL, Doyle C, Demark-Wahnefried W et al (2012) Nutrition and physical activity guidelines for cancer survivors. CA Cancer J Clin 62:242–274CrossRefGoogle Scholar
  7. 7.
    Doyle C, Kushi L, Byers T et al (2006) Nutrition and physical activity during and after cancer treatment: an American Cancer Society guide for informed choices. CA Cancer J Clin 56:323–353CrossRefPubMedGoogle Scholar
  8. 8.
    World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) (2010) Continuous update project report: food, nutrition, physical activity, and the prevention of breast cancer. http://www.wcrf.org/sites/default/files/breast-cancer-2010-report.pdf
  9. 9.
    Jung S, Spiegelman D, Baglietto L et al (2013) Fruit and vegetable intake and risk of breast cancer by hormone receptor status. J Natl Cancer Inst 105:219–236CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Fung TT, Hu FB, McCullough ML, Newby PK, Willett WC, Holmes MD (2006) Diet quality is associated with the risk of estrogen receptor-negative breast cancer in postmenopausal women. J Nutr 136:466–472PubMedGoogle Scholar
  11. 11.
    Eliassen AH, Liao X, Rosner B, Tamimi RM, Tworoger SS, Hankinson SE (2015) Plasma carotenoids and risk of breast cancer over 20 y of follow-up. Am J Clin Nutr 101:1197–1205CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Kim EH, Willett WC, Fung T, Rosner B, Holmes MD (2011) Diet quality indices and postmenopausal breast cancer survival. Nutr Cancer 63:381–388CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Izano MA, Fung TT, Chiuve SS, Hu FB, Holmes MD (2013) Are diet quality scores after breast cancer diagnosis associated with improved breast cancer survival? Nutr Cancer 65:820–826CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Inoue-Choi M, Robien K, Lazovich D (2013) Adherence to the WCRF/AICR guidelines for cancer prevention is associated with lower mortality among older female cancer survivors. Cancer Epidemiol Biomark Prev 22:792–802CrossRefGoogle Scholar
  15. 15.
    George SM, Irwin ML, Smith AW et al (2011) Postdiagnosis diet quality, the combination of diet quality and recreational physical activity, and prognosis after early-stage breast cancer. Cancer Causes Control 22:589–598CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    George SM, Ballard-Barbash R, Shikany JM et al (2014) Better postdiagnosis diet quality is associated with reduced risk of death among postmenopausal women with invasive breast cancer in the women’s health initiative. Cancer Epidemiol Biomark Prev 23:575–583CrossRefGoogle Scholar
  17. 17.
    Hu FB (2002) Dietary pattern analysis: a new direction in nutritional epidemiology. Curr Opin Lipidol 13:3–9CrossRefPubMedGoogle Scholar
  18. 18.
    Liese AD, Krebs-Smith SM, Subar AF et al (2015) The Dietary Patterns Methods Project: synthesis of findings across cohorts and relevance to dietary guidance. J Nutr 145:393–402CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Darby SC, Ewertz M, McGale P et al (2013) Risk of ischemic heart disease in women after radiotherapy for breast cancer. New Engl J Med 368:987–998CrossRefPubMedGoogle Scholar
  20. 20.
    Calle EE, Rodriguez C, Jacobs EJ et al (2002) The American Cancer Society Cancer Prevention Study II Nutrition Cohort–rationale, study design, and baseline characteristics. Cancer 94:2490–2501CrossRefPubMedGoogle Scholar
  21. 21.
    Calle EE, Terrell DD (1993) Utility of the National Death Index for ascertainment of mortality among Cancer Prevention Study II participants. Am J Epidemiol 137:235–241PubMedGoogle Scholar
  22. 22.
    Block G, Hartman AM, Naughton D (1990) A reduced dietary questionnaire: development and validation. Epidemiology 1:58–64CrossRefPubMedGoogle Scholar
  23. 23.
    Flagg EW, Coates RJ, Calle EE, Potischman N, Thun MJ (2000) Validation of the American Cancer Society cancer prevention study ii nutrition survey cohort food frequency questionnaire. Epidemiology 11:462–468CrossRefPubMedGoogle Scholar
  24. 24.
    Feskanich D, Rimm EB, Giovannucci EL et al (1993) Reproducibility and validity of food intake measurements from a semiquantitative food frequency questionnaire. J Am Diet Assoc 93:790–796CrossRefPubMedGoogle Scholar
  25. 25.
    Salvini S, Hunter DJ, Sampson L et al (1989) Food-based validation of a dietary questionnaire: the effects of week-to-week variation in food consumption. Int J Epidemiol 18:858–867CrossRefPubMedGoogle Scholar
  26. 26.
    McCullough ML, Patel AV, Kushi LH et al (2011) Following cancer prevention guidelines reduces risk of cancer, cardiovascular disease, and all-cause mortality. Cancer Epidemiol Biomark Prev 20:1089–1097CrossRefGoogle Scholar
  27. 27.
    Chlebowski RT, Blackburn GL, Thomson CA et al (2006) Dietary fat reduction and breast cancer outcome: interim efficacy results from the Women’s Intervention Nutrition Study. J Natl Cancer Inst 98:1767–1776CrossRefPubMedGoogle Scholar
  28. 28.
    Pierce JP, Natarajan L, Caan BJ et al (2007) Influence of a diet very high in vegetables, fruit, and fiber and low in fat on prognosis following treatment for breast cancer: the Women’s Healthy Eating and Living (WHEL) randomized trial. JAMA 298:289–298CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Gapstur SM, Khan S (2007) Fat, fruits, vegetables, and breast cancer survivorship. JAMA 298:335–336CrossRefPubMedGoogle Scholar
  30. 30.
    World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) (2011) Continuous update project report: food, nutrition, physical activity and the prevention of colorectal cancer. http://www.wcrf.org/sites/default/files/colorectal-cancer-2011-report
  31. 31.
    Bernstein AM, Sun Q, Hu FB, Stampfer MJ, Manson JE, Willett WC (2010) Major dietary protein sources and risk of coronary heart disease in women. Circulation 122:876–883CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Pan A, Sun Q, Bernstein AM, Manson JE, Willett WC, Hu FB (2013) Changes in red meat consumption and subsequent risk of type 2 diabetes mellitus: three cohorts of US men and women. JAMA Int Med 173:1328–1335CrossRefGoogle Scholar
  33. 33.
    Sinha R, Cross AJ, Graubard BI, Leitzmann MF, Schatzkin A (2009) Meat intake and mortality: a prospective study of over half a million people. Arch Intern Med 169:562–571CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Pan A, Sun Q, Bernstein AM et al (2012) Red meat consumption and mortality: results from 2 prospective cohort studies. Arch Intern Med 172:555–563CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    McCullough ML, Gapstur SM, Shah R, Jacobs EJ, Campbell PT (2013) Association between red and processed meat intake and mortality among colorectal cancer survivors. J Clin Oncol 31:2773–2782CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Vrieling A, Buck K, Seibold P et al (2013) Dietary patterns and survival in German postmenopausal breast cancer survivors. Br J Cancer 108:188–192CrossRefPubMedGoogle Scholar
  37. 37.
    Trichopoulou A, Costacou T, Bamia C, Trichopoulos D (2003) Adherence to a mediterranean diet and survival in a Greek population. N Engl J Med 348:2599–2608CrossRefPubMedGoogle Scholar
  38. 38.
    Appel L, Moore T, Obarzanek E et al (1997) A clinical trial of the effects of dietary patterns on blood pressure. N Engl J Med 336:1117–1124CrossRefPubMedGoogle Scholar
  39. 39.
    Fung TT, Chiuve SE, McCullough ML, Rexrode KM, Logroscino G, Hu FB (2008) Adherence to a DASH-style diet and risk of coronary heart disease and stroke in women. Arch Intern Med 168:713–720CrossRefPubMedGoogle Scholar
  40. 40.
    Chiuve SE, Fung TT, Rimm EB et al (2012) Alternative dietary indices both strongly predict risk of chronic disease. J Nutr 142:1009–1018CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Romaguera D, Vergnaud AC, Peeters PH et al (2012) Is concordance with World Cancer Research Fund/American Institute for Cancer Research guidelines for cancer prevention related to subsequent risk of cancer? Results from the EPIC study. Am J Clin Nutr 96:150–163CrossRefPubMedGoogle Scholar
  42. 42.
    Runowicz CD, Leach CR, Henry NL, et al. (2015) American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline. CA Cancer J ClinGoogle Scholar
  43. 43.
    Blanchard CM, Courneya KS, Stein K (2008) Cancer survivors’ adherence to lifestyle behavior recommendations and associations with health-related quality of life: results from the American Cancer Society’s SCS-II. J Clin Oncol 26:2198–2204CrossRefPubMedGoogle Scholar
  44. 44.
    Zhao G, Li C, Okoro CA et al (2013) Trends in modifiable lifestyle-related risk factors following diagnosis in breast cancer survivors. J Cancer Surviv Res Pract 7:563–569CrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Epidemiology Research ProgramAmerican Cancer SocietyAtlantaUSA
  2. 2.Prevention and Early Detection, Cancer Control ProgramAmerican Cancer SocietyAtlantaUSA

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