Cancer Causes & Control

, Volume 15, Issue 8, pp 805–818 | Cite as

Phyto-oestrogen Intake and Breast Cancer Risk in South Asian Women in England: Findings from a Population-based Case-Control Study

  • Isabel dos Santos Silva
  • Punam Mangtani
  • Valerie McCormack
  • Dee Bhakta
  • Anthony J McMichael
  • Leena Sevak


Objective: This study investigates whether intake of phyto-oestrogens is associated with breast cancer risk in South Asian women from the Indian subcontinent, whose diet is rich in pulses and vegetables but poor in soyfoods.

Methods: A total of 240 South Asian breast cancer cases living in England and 477 age-matched population-based controls were recruited into the study. Dietary intake was measured using a validated food frequency questionnaire. Conditional logistic regression models were used to estimate the effect of phyto-oestrogen intake on breast cancer risk.

Results: After adjustment for known breast cancer risk factors and total energy intake, there was moderate evidence of a dose-effect response in the odds of breast cancer with isoflavone intake (p-value for trend 0.08), with women in the top quartile having approximately half the odds of breast cancer of those in the bottom one (odds ratio (OR) 0.58, 95% confidence interval (CI) 0.33, 1.00) but with no reductions in the odds for women in the second and third quartiles. The ORs for second, third and highest quartiles of total lignan intake compared to the lowest were 0.78 (95% CI 0.48, 1.26), 0.74 (0.46, 1.19) and 0.66 (0.41, 1.07), respectively, again with moderate evidence of a linear dose-effect response (p-value for trend 0.09). Further adjustment for non-startch polysaccharides (NSP) intake slightly weakened the phyto-oestrogens-breast cancer associations.

Conclusions: These findings are consistent with the possibility that high phyto-oestrogen intake may protect against breast cancer, but further research is required to confirm this hypothesis.

breast cancer diet phyto-oestrogens migrants South Asians 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Endogenous Hormones and Breast Cancer Collaborative Group (2002)Endogenous sex hormones and breast cancer risk in postmenopausal women:re-analysis of nine prospective studies. J Natl Cancer Inst 94:606-616.Google Scholar
  2. 2.
    Collaborative Group on Hormonal Factors in Breast Cancer (1997)Breast cancer and hormone replacement therapy.Combined reanalysis of data from 51 epidemiological studies involving 52,705 women with breast cancer.Lancet 350:1047-1059.Google Scholar
  3. 3.
    Adlercreutz H, Mazur W (1997)Phytoeostrogens and western diseases.Ann.Med.29:95-120.PubMedGoogle Scholar
  4. 4.
    Barnes S (1998).Phytoestrogens and breast cancer.In:Adlercruetz H,ed.Phytoestrogens.Baillie`re's Clinical Endocrinology and Metabolism,Vol.12.London: Baillie`re Tindall,559-579.Google Scholar
  5. 5.
    Mazur W (1998)Phytoestrogen content in foods.In:Adlercruetz H,ed.Phytoestrogens.Baillie`re's Clinical Endocrinology and Metabolism,Vol.12.London: Baillie`re Tindall,729-742.Google Scholar
  6. 6.
    Price KR,Fenwick GR (1985)Naturally occurring oestrogens in foods-a review.Food Addit Contam 2:73-106.PubMedGoogle Scholar
  7. 7.
    Horn-Ross PL, John EM, Lee M,et al.(2001)Phytoestrogen comsumption and breast cancer risk in a multiethnic population.The Bay Area Breast Cancer Study.Am J Epidemiol 154:434-441.Google Scholar
  8. 8.
    Horn-Ross PL, Hoggatt KJ, West DW,et al.(2002)Recent diet and breast cancer risk:the California Teachers Study (USA).Cancer Causes Control 13:407-415.CrossRefPubMedGoogle Scholar
  9. 9.
    Ackroyd WR, Doughty J, Walker A (1982)Legumes in Human Nutrition.Rome:Food and Agriculture Organisation of the United Nations.Google Scholar
  10. 10.
    dos Santos Silva I, Mangtani P, McCormack V, Bhakta D, Sevak L, McMichael A (2002)Lifelong vegetarianism and risk of breast cancer:a population-based case-control study among South Asian migrant women living in England.Int J Cancer 99:238-244.CrossRefPubMedGoogle Scholar
  11. 11.
    Thompson LU, Robb P, Cheung F (1991)Mammalian lignan production from various foods.Nutr Cancer 16:43-52.PubMedGoogle Scholar
  12. 12.
    Kassam-Khamis T, Nanchahal K, Mangtani P, dos Santos Silva I, McMichael A, Anderson A (1999)Development of an interview-administered food-frequency questionnaire for use among women of South Asian ethnic origin in Britain.J Hum Nutr Diet 12:7-19.CrossRefGoogle Scholar
  13. 13.
    Sevak L, Mangtani P, McCormack V, Bhakta D, Kassam-Khamis T, dos Santos Silva I (in press)Validation of a food frequency questionnaire to assess macro-and micro-nutrient intake among South Asians in the United Kingdom.Eur J Nutr.Google Scholar
  14. 14.
    Nelson M, Atkinson M, Darbyshire S (1994)Food photography I: the perception of food portion size from photographs.Br J Nutr 72:649-663.PubMedGoogle Scholar
  15. 15.
    Nelson M, Atkinson M, Darbyshire S (1996)Food photography II:use of food photographs for estimating portion size and the nutrient content of meals.Br J Nutr 76:31-49.PubMedGoogle Scholar
  16. 16.
    Bhakta D (2003)Comparison of dietary patterns of South Asian migrants and native British women,with a particular focus on the intake and biological levels of phyto-oestrogens.PhD thesis. London: University of London.Google Scholar
  17. 17.
    Horn-Ross PL, Barnes S, Lee M,et al.(2000)Assessing phyto-estrogen exposure in epidemiologic studies:development of a database (United States).Cancer Causes Control11:289-298.CrossRefGoogle Scholar
  18. 18.
    Mazur W, Fotsis T, Wahala K, Ojala S, Salakka A, Adlercreutz H (1996)Isotopic dilution gas chromatography-mass spectrometric method for the determination of iso avonoids,coumestrol and lignans in food samples.Anal Biochem.233:169-180.CrossRefPubMedGoogle Scholar
  19. 19.
    COMP-EAT 5 (1998)COMP-EAT versions 5.London: Nutrition Systems.Google Scholar
  20. 20.
    Breslow NE,Day NE (1980)Statistical Methods in Cancer Research.Vol.1.The Analysis of Case-Control Studies.Lyon: International Agency for Research on Cancer.Google Scholar
  21. 21.
    Willett W,ed.(1998)Nutritional Epidemiology Monographs in Epidemiology and Biostatistics Vol.30 2nd ednOxford: Oxford University Press.Google Scholar
  22. 22.
    Rosner B, Willett WC, Spiegelman D (1989)Correction of logistic regression relative risk estimates and con dence intervals for systematic within-person measurement errors.Stat Med 8:1051-1069.PubMedGoogle Scholar
  23. 23.
    Bingham SA, Liggins J, Bluck L, Coward L (1998)Iso avone Concentrations in Foods:The Biological Effects of Phyto-oestrogens.London: Ministry of Agriculture,Fisheries and Foods.Google Scholar
  24. 24.
    Mazur W, Duke J, Wahala K, Rasku S, Adlercreutz H (1998) Iso.avonoids and lignans in legumes:nutritional and health aspects in humans.Nutr Biochem 9:1-8.Google Scholar
  25. 25.
    Pillow PC, Duphorne CM, Chang S,et al.(1999)Development of a database for assessing dietary phytoestrogen intake.Nutr Cancer 33:3-19.PubMedGoogle Scholar
  26. 26.
    Horn-Ross PL, Lee M, John EM, Koo J.(2000)Sources of phytoestrogen exposure among non-Asian women in California, USA.Cancer Causes Control 11:299-302.CrossRefPubMedGoogle Scholar
  27. 27.
    de Keijn MJJ, van der Schouw YT, Wilson PWF,et al.(2001) Intake of dietary phytoestrogens is low in postmenopausal women in the United States:the Framingham study.J Nutr131:1826-1832.PubMedGoogle Scholar
  28. 28.
    Strom SS, Yamamura Y, Duphorne CM,et al.(1999)Phytoes-trogens intake and prostate cancer:a case-control study using a new database.Nutr Cancer31:20-25.Google Scholar
  29. 29.
    Dai Q, Shu X-O, Jin F,et al.(2001)Population-based case-control study of soyfood intake and breast cancer risk in Shanghai.Br J Cancer85:372-378.CrossRefPubMedGoogle Scholar
  30. 30.
    Yamamoto S, Sobue T, Kobayashi M, Sasaki S, Tsugane S (2003) Soy,iso.avones and breast cancer risk in Japan.J Natl Cancer Inst 95:906-913.PubMedGoogle Scholar
  31. 31.
    Keinan-Boker L, Van der Scouw YT, De Kleijn MJJ, Jacques PF, Grobbee DE, Peeters PHM (2002)Intake of dietary phytoestro-gens by Dutch women.J Nutr 132:1319-1328.PubMedGoogle Scholar
  32. 32.
    Cassidy A, Bingham S, Setchell K (1995)Biological affects of iso.avones in young women:importance of the chemical compo-sition of soyabean productsBr J Nutr 74:587-601.PubMedGoogle Scholar
  33. 33.
    Jakes RW, Duffy SW, Ng FC,et al.(2002)Mammographic parenchymal patterns and self-reported soy intake in Singapore Chinese women.Cancer Epidemiol.Biomark Prev 11:608-613.Google Scholar
  34. 34.
    Hirayama T (1990)Life-style and mortality:a large-scale census-based cohort study in Japan.In:Wahrendorf J,ed.Contributions to Epidemiology and Biostatistics Vol.6.Karger: Basil.Google Scholar
  35. 35.
    Greenstein J, Kushi L, Zheng W,et al.(1996).Risk of breast cancer associated with intake of specific foods and food groups. Am J Epidemiol 143:S36 (141).Google Scholar
  36. 36.
    Key TJ, Sharp GB, Appleby PN,et al.(1999)Soya foods and breast cancer risk:a prospective study in Hiroshima and Nagasaki, Japan.Br J Cancer 81:1248-1256.CrossRefPubMedGoogle Scholar
  37. 37.
    Nomura A, Henderson BE, Lee J (1978)Breast cancer and diet among the Japanese in Hawaii.Am J Clin Nutr 31:2020-2025.PubMedGoogle Scholar
  38. 38.
    Hirohata T, Shigematsu T, Nomura AMY, Nomura Y, Horie A, Hirohata I (1985)Occurrence of breast cancer in relation to diet and reproductive history:a case-control study in Fukuoka,Japan. Natl Cancer Inst Monogr 69:187-190.PubMedGoogle Scholar
  39. 39.
    Lee HP, Gourley L, Duffy SW, Este`ve J, Lee J, Day NE (1991) Dietary effects on breast-cancer risk in Singapore.Lancet 337: 1197-1200.CrossRefPubMedGoogle Scholar
  40. 40.
    Lee HP, Gourley L, Duffy SW, Este`ve J, Lee J, Day NE (1992) Risk factors for breast cancer by age and menopausal status:a case-control study in Singapore.Cancer Causes Control 3:313-322.PubMedGoogle Scholar
  41. 41.
    Hirose K, Tajima K, Hamajima N,et al.(1995)A large-scale, hospital-based case-control study of risk factors of breast cancer according to menopausal status.Jpn J Cancer Res 86:146-154.PubMedGoogle Scholar
  42. 42.
    Yuan JM, Wang QS, Ross RK, Henderson BE, Yu MC (1995) Diet and breast cancer in Shanghai and Tianjin,China.Br J Cancer 71:1353-1358.PubMedGoogle Scholar
  43. 43.
    Wu AH, Ziegler RG, Horn-Ross PL,et al.(1996)Tofu and risk of breast cancer in Asian-American.Cancer Epidemiol Biomark Prev 5:901-906.Google Scholar
  44. 44.
    Witte JS, Ursin G, Siemiatycki J, Thompson WD, Paganini-Hill A, Haile RW (1997)Diet and premenopausal bilateral breast cancer: a case-control study.Breast Cancer Res Treat 42:243-251.CrossRefPubMedGoogle Scholar
  45. 45.
    Shu X-O, Jin F, Dai Q,et al.(2001)Soyfood intake during adolescence and subsequent risk of breast cancer among Chinese women.Cancer Epidemiol Biomark Prev 10:483-488.Google Scholar
  46. 46.
    Wu AH, Wan P, Hankin J, Tseng C-C, Yu MC, Pike MC (2002) Adolescent and adult soy intake and risk of breast cancer in Asian-Americans.Carcinogenesis 23:1491-1496.CrossRefPubMedGoogle Scholar
  47. 47.
    Peterson J, Lagiou P, Samoli E,et al.(2003)Flavonoid intake and breast cancer risk:a case-control study in Greece.Br J Cancer 89:1255-1259.CrossRefPubMedGoogle Scholar
  48. 48.
    den Tonkelaar I, Keinan-Boker L, Van't Veer P,et al.(2001) Urinary phytoestrogens and postmenopausal breast cancer risk. Cancer Epidemiol Biomark Prev 10:223-228.Google Scholar
  49. 49.
    Hultén K, Winkvist A, Lenner P, Johansson R, Adlercreutz H, Hallmans G (2002)An incident case-referent study on plasma enterolactone and breast cancer risk.Eur J Nutr 41:168-176.CrossRefPubMedGoogle Scholar
  50. 50.
    Ingram D, Sanders K, Kolybaba M, Lopez D (1998)Case-control study of phyto-oestrogens and breast cancer.Lancet 350: 990-994.CrossRefGoogle Scholar
  51. 51.
    Zheng W, Dai Q, Custer LJ,et al (1999)Urinary excretion of iso avonoids and the risk of breast cancer.Cancer Epidemiol Biomark Prev8:35-40.Google Scholar
  52. 52.
    Murkies A, Dalais FS, Briganti EM,et al.(2000)Phytoestrogen and breast cancer in postmenopausal women:a case control study. Menopause 7:289-296.PubMedGoogle Scholar
  53. 53.
    Pietinen P, Stumpf K, Männistö S, Kataja V, Uusitupa M, Adlercreutz H (2001)Serum enterolactone and risk of breast cancer:a case-control study in Eastern Finland.Cancer Epidemiol Biomark Prev 10:339-344.Google Scholar
  54. 54.
    Dai Q, Frankle AA, Jin F,et al.(2002)Urinary excretion of phytoestrogen and risk of breast cancer among Chinese women in Shangai.Cancer Epidemiol Biomark Prev 11:815-821.Google Scholar
  55. 55.
    Hilakivi-Clarke L, Onojafe I, Raygada M,et al.(1999)Prepuber-tal exposure to zearalenone or genistein reduces mammary tumorigenesis.Br J Cancer80:1682-1688.CrossRefPubMedGoogle Scholar

Copyright information

© Kluwer Academic Publishers 2004

Authors and Affiliations

  • Isabel dos Santos Silva
    • 1
  • Punam Mangtani
    • 1
  • Valerie McCormack
    • 1
  • Dee Bhakta
    • 1
    • 2
  • Anthony J McMichael
    • 1
    • 3
  • Leena Sevak
    • 1
    • 4
  1. 1.Department of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonUK
  2. 2.Department of Health & Human SciencesLondon Metropolitan UniversityLondon
  3. 3.National Centre for Epidemiology and Population HealthThe Australian National UniversityCanberraAustralia
  4. 4.Brent Teaching Primary Care TrustWembley Centre for Health & CareWembley

Personalised recommendations