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Dietary lignan intakes in relation to survival among women with breast cancer: the Western New York Exposures and Breast Cancer (WEB) Study

Abstract

Dietary lignan intakes have been associated with reduced breast cancer risks; however, no previous studies have investigated whether lignan intake might be associated with breast cancer survival. We examined the association of dietary lignan intakes with survival in 1122 women with primary, incident, histologically confirmed breast cancer identified between 1996 and 2001, and with vital status determined through December 31, 2006. Diet in the 12–24 months before diagnosis was assessed with an extensive food frequency questionnaire, and potential confounders assessed from an extensive epidemiologic interview and abstracted clinical data. Lignan intake was calculated using published food composition data. Hazard ratios (HR), and 95% confidence intervals (CIs) for dietary lignan intakes with all cause, and breast cancer mortality were estimated using Cox proportional hazards adjusting for age, education, race, total energy intake, tumor stage, and body mass index. Of the 1122 women with complete dietary data, 160 had died by the end of follow-up. Among postmenopausal women only, those in the highest versus lowest quartile of lignan intakes had a statistically significant reduction in the risk of all cause mortality (HR 0.49, 95% CI 0.26–0.91) and a significantly reduced risk of breast cancer mortality (HR 0.29, 95% CI 0.11–0.76). Higher intakes of dried beans (HR 0.61, 95% CI 0.36–1.03), but not fruits, vegetables, or grains, were also weakly associated with overall mortality. In summary, our results suggest that higher lignan intakes may be associated with improved survival among postmenopausal women with breast cancer.

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Abbreviations

BMI:

Body mass index

CI:

Confidence interval

ER:

Estrogen receptor

FFQ:

Food frequency questionnaire

HR:

Hazard ratio

References

  1. 1.

    Kushi LH, Kwan ML, Lee MM, Ambrosone CB (2007) Lifestyle factors and survival in women with breast cancer. J Nutr 137:236S–242S

    CAS  PubMed  Google Scholar 

  2. 2.

    Snyder DC, Sloane R, Lobach D, Lipkus IM, Peterson B, Kraus W et al (2008) Differences in baseline characteristics and outcomes at 1- and 2-year follow-up of cancer survivors accrued via self-referral versus cancer registry in the FRESH START Diet and exercise trial. Cancer Epidemiol Biomarkers Prev 17:1288–1294

    Article  PubMed  Google Scholar 

  3. 3.

    Kellen E, Vansant G, Christiaens MR, Neven P, Van LE (2009) Lifestyle changes and breast cancer prognosis: a review. Breast Cancer Res Treat 114:13–22

    Article  PubMed  Google Scholar 

  4. 4.

    Kwan ML, Weltzien E, Kushi LH, Castillo A, Slattery ML, Caan BJ (2009) Dietary patterns and breast cancer recurrence and survival among women with early-stage breast cancer. J Clin Oncol 27:919–926

    Article  PubMed  Google Scholar 

  5. 5.

    Dal ML, Zucchetto A, Talamini R, Serraino D, Stocco CF, Vercelli M et al (2008) Effect of obesity and other lifestyle factors on mortality in women with breast cancer. Int J Cancer 123:2188–2194

    Article  Google Scholar 

  6. 6.

    Ha TC, Lyons-Wall PM, Moore DE, Tattam BN, Boyages J, Ung OA et al (2006) Phytoestrogens and indicators of breast cancer prognosis. Nutr Cancer 56:3–10

    Article  CAS  PubMed  Google Scholar 

  7. 7.

    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 55:132–140

    Article  CAS  PubMed  Google Scholar 

  8. 8.

    Blackburn GL, Wang KA (2007) Dietary fat reduction and breast cancer outcome: results from the Women’s Intervention Nutrition Study (WINS). Am J Clin Nutr 86:s878–s881

    PubMed  Google Scholar 

  9. 9.

    Pierce JP, Natarajan L, Caan BJ, Parker BA, Greenberg ER, Flatt SW 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 298:289–298

    Article  CAS  PubMed  Google Scholar 

  10. 10.

    Cornwell T, Cohick W, Raskin I (2004) Dietary phytoestrogens and health. Phytochemistry 65:995–1016

    Article  CAS  PubMed  Google Scholar 

  11. 11.

    Humfrey CD (1998) Phytoestrogens and human health effects: weighing up the current evidence. Nat Toxins 6:51–59

    Article  CAS  PubMed  Google Scholar 

  12. 12.

    Knight DC, Eden JA (1996) A review of the clinical effects of phytoestrogens. Obstet Gynecol 87:897–904

    CAS  PubMed  Google Scholar 

  13. 13.

    Kurzer MS, Xu X (1997) Dietary phytoestrogens. Annu Rev Nutr 17:353–381

    Article  CAS  PubMed  Google Scholar 

  14. 14.

    Frische EJ, Hutchins AM, Martini MC, Thomas W, Slavin JL (2003) Effect of flaxseed and wheat bran on serum hormones and lignan excretion in premenopausal women. J Am Coll Nutr 22:550–554

    PubMed  Google Scholar 

  15. 15.

    Hutchins AM, Martini MC, Olson BA, Thomas W, Slavin JL (2001) Flaxseed consumption influences endogenous hormone concentrations in postmenopausal women. Nutr Cancer 39:58–65

    Article  CAS  PubMed  Google Scholar 

  16. 16.

    Hutchins AM, Martini MC, Olson BA, Thomas W, Slavin JL (2000) Flaxseed influences urinary lignan excretion in a dose-dependent manner in postmenopausal women. Cancer Epidemiol Biomarkers Prev 9:1113–1118

    CAS  PubMed  Google Scholar 

  17. 17.

    Brooks JD, Thompson LU (2005) Mammalian lignans and genistein decrease the activities of aromatase and 17beta-hydroxysteroid dehydrogenase in MCF-7 cells. J Steroid Biochem Mol Biol 94:461–467

    Article  CAS  PubMed  Google Scholar 

  18. 18.

    Dabrosin C, Chen J, Wang L, Thompson LU (2002) Flaxseed inhibits metastasis and decreases extracellular vascular endothelial growth factor in human breast cancer xenografts. Cancer Lett 185:31–37

    Article  CAS  PubMed  Google Scholar 

  19. 19.

    Rickard SE, Yuan YV, Thompson LU (2000) Plasma insulin-like growth factor I levels in rats are reduced by dietary supplementation of flaxseed or its lignan secoisolariciresinol diglycoside. Cancer Lett 161:47–55

    Article  CAS  PubMed  Google Scholar 

  20. 20.

    Power KA, Saarinen NM, Chen JM, Thompson LU (2006) Mammalian lignans enterolactone and enterodiol, alone and in combination with the isoflavone genistein, do not promote the growth of MCF-7 xenografts in ovariectomized athymic nude mice. Int J Cancer 118:1316–1320

    Article  CAS  PubMed  Google Scholar 

  21. 21.

    Saarinen NM, Power K, Chen J, Thompson LU (2006) Flaxseed attenuates the tumor growth stimulating effect of soy protein in ovariectomized athymic mice with MCF-7 human breast cancer xenografts. Int J Cancer 119:925–931

    Article  CAS  PubMed  Google Scholar 

  22. 22.

    Serraino M, Thompson LU (1992) The effect of flaxseed supplementation on the initiation and promotional stages of mammary tumorigenesis. Nutr Cancer 17:153–159

    Article  CAS  PubMed  Google Scholar 

  23. 23.

    Wang L, Chen J, Thompson LU (2005) The inhibitory effect of flaxseed on the growth and metastasis of estrogen receptor negative human breast cancer xenograftsis attributed to both its lignan and oil components. Int J Cancer 116:793–798

    Article  CAS  PubMed  Google Scholar 

  24. 24.

    Fink BN, Steck SE, Wolff MS, Britton JA, Kabat GC, Gaudet MM et al (2007) Dietary flavonoid intake and breast cancer survival among women on Long Island. Cancer Epidemiol Biomarkers Prev 16:2285–2292

    Article  CAS  PubMed  Google Scholar 

  25. 25.

    Boyapati SM, Shu XO, Ruan ZX, Dai Q, Cai Q, Gao YT et al (2005) Soyfood intake and breast cancer survival: a followup of the Shanghai Breast Cancer Study. Breast Cancer Res Treat 92:11–17

    Article  PubMed  Google Scholar 

  26. 26.

    Milder IE, Feskens EJ, Arts IC, Bueno-de-Mesquita HB, Hollman PC, Kromhout D (2006) Intakes of 4 dietary lignans and cause-specific and all-cause mortality in the Zutphen Elderly Study. Am J Clin Nutr 84:400–405

    CAS  PubMed  Google Scholar 

  27. 27.

    Tao MH, Shields PG, Nie J, Marian C, Ambrosone CB, McCann SE et al (2009) DNA promoter methylation in breast tumors: no association with genetic polymorphisms in MTHFR and MTR. Cancer Epidemiol Biomarkers Prev 18:998–1002

    Article  CAS  PubMed  Google Scholar 

  28. 28.

    Brasky TM, Bonner MR, Dorn J, Marhsall JR, Vena JE, Brasure JR et al (2009) Tonsillectomy and breast cancer risk in the Western New York Diet Study. Cancer Causes Control 20:369–374

    Article  PubMed  Google Scholar 

  29. 29.

    Quick SK, Shields PG, Nie J, Platek ME, McCann SE, Hutson AD et al (2008) Effect modification by catalase genotype suggests a role for oxidative stress in the association of hormone replacement therapy with postmenopausal breast cancer risk. Cancer Epidemiol Biomarkers Prev 17:1082–1087

    Article  CAS  PubMed  Google Scholar 

  30. 30.

    Tao MH, Shields PG, Nie J, Millen A, Ambrosone CB, Edge SB et al (2009) DNA hypermethylation and clinicopathological features in breast cancer: the Western New York Exposures and Breast Cancer (WEB) Study. Breast Cancer Res Treat 114:559–568

    Article  CAS  PubMed  Google Scholar 

  31. 31.

    McCann SE, McCann WE, Hong CC, Marshall JR, Edge SB, Trevisan M (2007) Dietary patterns related to glycemic index and load and risk of premenopausal and postmenopausal breast cancer in the Western New York Exposure and Breast Cancer Study. Am J Clin Nutr 86:465–471

    CAS  PubMed  Google Scholar 

  32. 32.

    Nie J, Beyea J, Bonner MR, Han D, Vena JE, Rogerson P et al (2007) Exposure to traffic emissions throughout life and risk of breast cancer: the Western New York Exposures and Breast Cancer (WEB) study. Cancer Causes Control 18:947–955

    Article  PubMed  Google Scholar 

  33. 33.

    Han D, Nie J, Bonner MR, McCann SE, Muti P, Trevisan M et al (2006) Lifetime adult weight gain, central adiposity, and the risk of pre- and postmenopausal breast cancer in the Western New York exposures and breast cancer study. Int J Cancer 119:2931–2937

    Article  CAS  PubMed  Google Scholar 

  34. 34.

    Barba M, McCann SE, Nie J, Vito D, Stranges S, Fuhrman B et al (2006) Perinatal exposures and breast cancer risk in the Western New York Exposures and Breast Cancer (WEB) Study. Cancer Causes Control 17:395–401

    Article  PubMed  Google Scholar 

  35. 35.

    McCann SE, Kulkarni S, Trevisan M, Vito D, Nie J, Edge SB et al (2006) Dietary lignan intakes and risk of breast cancer by tumor estrogen receptor status. Breast Cancer Res Treat 99:309–311

    Article  CAS  PubMed  Google Scholar 

  36. 36.

    Bonner MR, Nie J, Han D, Vena JE, Rogerson P, Muti P et al (2005) Secondhand smoke exposure in early life and the risk of breast cancer among never smokers (United States). Cancer Causes Control 16:683–689

    Article  PubMed  Google Scholar 

  37. 37.

    Han D, Rogerson PA, Bonner MR, Nie J, Vena JE, Muti P et al (2005) Assessing spatio-temporal variability of risk surfaces using residential history data in a case control study of breast cancer. Int J Health Geogr 4:9

    Article  PubMed  Google Scholar 

  38. 38.

    Bonner MR, Han D, Nie J, Rogerson P, Vena JE, Muti P et al (2005) Breast cancer risk and exposure in early life to polycyclic aromatic hydrocarbons using total suspended particulates as a proxy measure. Cancer Epidemiol Biomarkers Prev 14:53–60

    CAS  PubMed  Google Scholar 

  39. 39.

    Han D, Rogerson PA, Nie J, Bonner MR, Vena JE, Vito D et al (2004) Geographic clustering of residence in early life and subsequent risk of breast cancer (United States). Cancer Causes Control 15:921–929

    Article  PubMed  Google Scholar 

  40. 40.

    McCann SE, Ip C, Ip MM, McGuire MK, Muti P, Edge SB et al (2004) Dietary intake of conjugated linoleic acids and risk of premenopausal and postmenopausal breast cancer, Western New York Exposures and Breast Cancer Study (WEB Study). Cancer Epidemiol Biomarkers Prev 13:1480–1484

    CAS  PubMed  Google Scholar 

  41. 41.

    McCann SE, Muti P, Vito D, Edge SB, Trevisan M, Freudenheim JL (2004) Dietary lignan intakes and risk of pre- and postmenopausal breast cancer. Int J Cancer 111:440–443

    Article  CAS  PubMed  Google Scholar 

  42. 42.

    Block G, Hartman AM, Dresser CM, Carroll MD, Gannon J, Gardner L (1986) A data-based approach to diet questionnaire design and testing. Am J Epidemiol 124:453–469

    CAS  PubMed  Google Scholar 

  43. 43.

    Block G, Coyle LM, Hartman AM, Scoppa SM (1993) HHHQ-DIETSYS analysis software, version 3.0. National Cancer Institute, Bethesda, MD

  44. 44.

    Thompson LU, Boucher BA, Liu Z, Cotterchio M, Kreiger N (2006) Phytoestrogen content of foods consumed in Canada, including isoflavones, lignans and coumestan. Nutr Cancer 54:184–201

    Article  CAS  PubMed  Google Scholar 

  45. 45.

    Chen J, Stavro PM, Thompson LU (2002) Dietary flaxseed inhibits human breast cancer growth and metastasis and downregulates expression of insulin-like growth factor and epidermal growth factor receptor. Nutr Cancer 43:187–192

    Article  CAS  PubMed  Google Scholar 

  46. 46.

    Thompson LU, Rickard SE, Orcheson LJ, Seidl MM (1996) Flaxseed and its lignan and oil components reduce mammary tumor growth at a late stage of carcinogenesis. Carcinogenesis 17:1373–1376

    Article  CAS  PubMed  Google Scholar 

  47. 47.

    Thompson LU, Chen JM, Li T, Strasser-Weippl K, Goss PE (2005) Dietary flaxseed alters tumor biological markers in postmenopausal breast cancer. Clin Cancer Res 11:3828–3835

    Article  CAS  PubMed  Google Scholar 

  48. 48.

    Demark-Wahnefried W, Price DT, Polascik TJ, Robertson CN, Anderson EE, Paulson DF et al (2001) Pilot study of dietary fat restriction and flaxseed supplementation in men with prostate cancer before surgery: exploring the effects on hormonal levels, prostate-specific antigen, and histopathologic features. Urology 58:47–52

    Article  CAS  PubMed  Google Scholar 

  49. 49.

    Newairy AS, Abdou HM (2009) Protective role of flax lignans against lead acetate induced oxidative damage and hyperlipidemia in rats. Food Chem Toxicol 47:813–818

    Article  CAS  PubMed  Google Scholar 

  50. 50.

    Servili M, Esposto S, Fabiani R, Urbani S, Taticchi A, Mariucci F et al (2009) Phenolic compounds in olive oil: antioxidant, health and organoleptic activities according to their chemical structure. Inflammopharmacol 17:76–84

    Article  CAS  PubMed  Google Scholar 

  51. 51.

    Yamauchi S, Masuda T, Sugahara T, Kawaguchi Y, Ohuchi M, Someya T et al (2008) Antioxidant activity of butane type lignans, secoisolariciresinol, dihydroguaiaretic acid, and 7,7′-oxodihydroguaiaretic acid. Biosci Biotechnol Biochem 72:2981–2986

    Article  CAS  PubMed  Google Scholar 

  52. 52.

    Lee JC, Krochak R, Blouin A, Kanterakis S, Chatterjee S, Arguiri E et al (2009) Dietary flaxseed prevents radiation-induced oxidative lung damage, inflammation and fibrosis in a mouse model of thoracic radiation injury. Cancer Biol Ther 8:47–53

    Article  CAS  PubMed  Google Scholar 

  53. 53.

    Axelrod D, Smith J, Kornreich D, Grinstead E, Singh B, Cangiarella J et al (2008) Breast cancer in young women. J Am Coll Surg 206:1193–1203

    Article  PubMed  Google Scholar 

  54. 54.

    Gnerlich JL, Deshpande AD, Jeffe DB, Sweet A, White N, Margenthaler JA (2009) Elevated breast cancer mortality in women younger than age 40 years compared with older women is attributed to poorer survival in early-stage disease. J Am Coll Surg 208:341–347

    Article  PubMed  Google Scholar 

  55. 55.

    Thomas GA, Leonard RC (2009) How age affects the biology of breast cancer. Clin Oncol (R Coll Radiol) 21:81–85

    CAS  Google Scholar 

  56. 56.

    American Cancer Society (2008) Breast cancer facts & figures 2007–2008. American Cancer Society, Atlanta

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Acknowledgments

Supported in part by grants DAMD17-96-1-6202US from the Army Medical Research and Materiel Command, and R01CA92040 from the NIH.

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Correspondence to Susan E. McCann.

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McCann, S.E., Thompson, L.U., Nie, J. et al. Dietary lignan intakes in relation to survival among women with breast cancer: the Western New York Exposures and Breast Cancer (WEB) Study. Breast Cancer Res Treat 122, 229–235 (2010). https://doi.org/10.1007/s10549-009-0681-x

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Keywords

  • Breast cancer
  • Diet
  • Lignans
  • Phytoestrogens
  • Survival