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Folate intake and breast cancer mortality in a cohort of Swedish women

  • Epidemiology
  • Published:
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Abstract

Folate may influence breast cancer development and progression through its role in one-carbon metabolism. However, epidemiologic data on the relation between folate and breast cancer survival are limited. We investigated whether dietary folate intake was associated with survival in 3,116 women diagnosed with breast cancer in the population-based Swedish Mammography Cohort. Participants completed a 67-item food frequency questionnaire in 1987. Cox proportional hazard models were used to calculate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for death from breast cancer and death from any cause. During 25,716 person-years of follow-up from 1987 to 2008, there were 852 deaths with 381 breast cancer deaths. Dietary folate intake was inversely associated with breast cancer and overall mortality. Women in the highest quartile of folate intake had a multivariable HR (95% CI) of death from breast cancer of 0.78 (0.58–1.03) compared to those in the lowest quartile (P trend = 0.03). The corresponding HR (95% CI) for death from any cause was 0.79 (0.66–0.96; P trend = 0.004). The protective association between dietary folate intake and breast cancer death was strongest among those with ER-negative tumors (HR = 0.42; 95% = CI 0.22–0.79; P trend = 0.01) comparing the highest to lowest quartile. Our findings suggest that folate intake before breast cancer diagnosis may improve breast cancer and overall survival. While these findings need to be confirmed in future studies, they do offer assurance that dietary folate intake at the levels observed in our population does not unfavorably affect survival after breast cancer.

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Abbreviations

SMC:

Swedish mammography cohort

BMI:

Body mass index

SD:

Standard deviation

ER:

Estrogen receptor

PR:

Progesterone receptor

FFQ:

Food frequency questionnaire

ICD:

International classification of diseases

HR:

Hazard ratio

CI:

Confidence interval

References

  1. Patterson RE, Cadmus LA, Emond JA, Pierce JP (2010) Physical activity, diet, adiposity and female breast cancer prognosis: a review of the epidemiologic literature. Maturitas 66(1):5–15

    Article  PubMed  Google Scholar 

  2. Mason JB, Choi S-W (2000) Folate and carcinogenesis: developing a unifying hypothesis. Adv Enzyme Regul 40(1):127–141

    Article  PubMed  CAS  Google Scholar 

  3. 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):826–835

    Article  PubMed  CAS  Google Scholar 

  4. McEligot A, 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

    Article  PubMed  CAS  Google Scholar 

  5. Xu X, Gammon MD, Wetmur JG, Bradshaw PT, Teitelbaum SL, Neugut AI, Santella RM, Chen J (2008) B-vitamin intake, one-carbon metabolism, and survival in a population-based study of women with breast cancer. Cancer Epidemiol Biomarkers Prev 17(8):2109–2116

    Article  PubMed  CAS  Google Scholar 

  6. Saquib J, Rock CL, Natarajan L, Saquib N, Newman VA, Patterson RE, Thomson CA, Al-Delaimy WK, Pierce JP (2011) Dietary intake, supplement use, and survival among women diagnosed with early-stage breast cancer. Nutr Cancer 63(3):327–333

    Article  PubMed  CAS  Google Scholar 

  7. Sellers TA, Alberts SR, Vierkant RA, Grabrick DM, Cerhan JR, Vachon CM, Olson JE, Kushi LH, Potter JD (2002) High-folate diets and breast cancer survival in a prospective cohort study. Nutr Cancer 44(2):139–144

    Article  PubMed  Google Scholar 

  8. Wolk A, Larsson SC, Johansson J-E, Ekman P (2006) Long-term fatty fish consumption and renal cell carcinoma incidence in women. JAMA 296(11):1371–1376

    Article  PubMed  CAS  Google Scholar 

  9. Mattsson B, Wallgren A (1984) Completeness of the Swedish Cancer Register. Non-notified cancer cases recorded on death certificates in 1978. Acta Radiol Oncol 23:305–313

    Article  PubMed  CAS  Google Scholar 

  10. Larsson SC, Bergkvist L, Wolk A (2009) Long-term meat intake and risk of breast cancer by oestrogen and progesterone receptor status in a cohort of Swedish women. Eur J Cancer 45(17):3042–3046

    Article  PubMed  CAS  Google Scholar 

  11. Bergström L, Kylberg E, Hagman U, Erikson H, Bruce Å (1991) The food composition database KOST: the National Food Administration’s Information System for nutritive values of food. Vår Fö da 43:439–447

    Google Scholar 

  12. Willett W, Stampfer MJ (1986) Total energy intake: implications for epidemiologic analyses. Am J Epidemiol 124(1):17–27

    PubMed  CAS  Google Scholar 

  13. Ludvigsson J, Otterblad-Olausson P, Pettersson B, Ekbom A (2009) The Swedish personal identity number: possibilities and pitfalls in healthcare and medical research. Eur J Epidemiol 24(11):659–667

    Article  PubMed  Google Scholar 

  14. Larsson SC, Bergkvist L, Wolk A (2008) Folate intake and risk of breast cancer by estrogen and progesterone receptor status in a Swedish cohort. Cancer Epidemiol Biomarkers Prev 17(12):3444–3449

    Article  PubMed  CAS  Google Scholar 

  15. Larsson SC, Åkesson A, Bergkvist L, Wolk A (2010) Multivitamin use and breast cancer incidence in a prospective cohort of Swedish women. Am J Clin Nutr 91(5):1268–1272

    Article  PubMed  CAS  Google Scholar 

  16. Lamprecht SA, Lipkin M (2003) Chemoprevention of colon cancer by calcium, vitamin D and folate: molecular mechanisms. Nat Rev Cancer 3(8):601–614

    Article  PubMed  CAS  Google Scholar 

  17. Kim Y-I (2003) Role of folate in colon cancer development and progression. J Nutr 133(11):3731S–3739S

    PubMed  CAS  Google Scholar 

  18. Kim Y-I (2006) Folate: a magic bullet or a double edged sword for colorectal cancer prevention? Gut 55(10):1387–1389

    Article  PubMed  CAS  Google Scholar 

  19. Kotsopoulos J, Medline A, Renlund R, Sohn K-J, Martin R, Hwang SW, Lu S, Archer MC, Kim Y-I (2005) Effects of dietary folate on the development and progression of mammary tumors in rats. Carcinogenesis 26(9):1603–1612

    Article  PubMed  CAS  Google Scholar 

  20. Cho E, Holmes M, Hankinson SE, Willett WC (2007) Nutrients involved in one-carbon metabolism and risk of breast cancer among premenopausal women. Cancer Epidemiol Biomarkers Prev 16(12):2787–2790

    Article  PubMed  CAS  Google Scholar 

  21. Lin J, Lee I-M, Cook NR, Selhub J, Manson JE, Buring JE, Zhang SM (2008) Plasma folate, vitamin B-6, vitamin B-12, and risk of breast cancer in women. Am J Clin Nutr 87(3):734–743

    PubMed  CAS  Google Scholar 

  22. Sellers TA, Vierkant RA, Cerhan JR, Gapstur SM, Vachon CM, Olson JE, Pankratz VS, Kushi LH, Folsom AR (2002) Interaction of dietary folate intake, alcohol, and risk of hormone receptor-defined breast cancer in a prospective study of postmenopausal women. Cancer Epidemiol Biomarkers Prev 11(10):1104–1107

    PubMed  CAS  Google Scholar 

  23. Zhang SM, Hankinson SE, Hunter DJ, Giovannucci EL, Colditz GA, Willett WC (2005) Folate intake and risk of breast cancer characterized by hormone receptor status. Cancer Epidemiol Biomarkers Prev 14(8):2004–2008

    Article  PubMed  CAS  Google Scholar 

  24. Ferguson AT, Lapidus RG, Baylin SB, Davidson NE (1995) Demethylation of the estrogen receptor gene in estrogen receptor-negative breast cancer cells can reactivate estrogen receptor gene expression. Cancer Res 55(11):2279–2283

    PubMed  CAS  Google Scholar 

  25. Lapidus RG, Nass SJ, Butash KA, Parl FF, Weitzman SA, Graff JG, Herman JG, Davidson NE (1998) Mapping of ER gene CpG island methylation by methylation-specific polymerase chain reaction. Cancer Res 58(12):2515–2519

    PubMed  CAS  Google Scholar 

  26. Maunsell E, Drolet M, Brisson J, Robert J, Deschênes L (2002) Dietary change after breast cancer: extent, predictors, and relation with psychological distress. J Clin Oncol 20(4):1017–1025

    Article  PubMed  Google Scholar 

  27. Salminen EK, Lagstrom HK (2000) Does breast cancer change patients’ dietary habits? Eur J Clin Nutr 54(11):844

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

This study was supported by the Swedish Cancer Foundation, the Swedish Research Council/Committee for Infrastructure, and the Swedish Foundation for International Cooperation in Research and Higher Education. H.R.H. was supported by NIH training grant T32 ES007069 and MCHB grant 5T76MC00001 (formerly MCJ201).

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Division of Nutritional Epidemiology, The National Institute for Environmental Medicine, Karolinska Institutet, P.O. Box 210, SE, 171 77, Stockholm, Sweden

    Holly R. Harris & Alicja Wolk

  2. Obstetrics and Gynecology Epidemiology Center, Brigham and Women’s Hospital, 221 Longwood Avenue, Boston, MA, USA, 02115

    Holly R. Harris

  3. Department of Surgery and Centre for Clinical Research, Central Hospital, 721 89, Västerås, Sweden

    Leif Bergkvist

Authors
  1. Holly R. Harris
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Correspondence to Holly R. Harris.

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Harris, H.R., Bergkvist, L. & Wolk, A. Folate intake and breast cancer mortality in a cohort of Swedish women. Breast Cancer Res Treat 132, 243–250 (2012). https://doi.org/10.1007/s10549-011-1838-y

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  • DOI: https://doi.org/10.1007/s10549-011-1838-y

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