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Total energy intake and breast cancer risk in sisters: the Breast Cancer Family Registry

  • Epidemiology
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Abstract

Energy restriction inhibits mammary tumor development in animal models. Epidemiologic studies in humans generally do not support an association between dietary energy intake and breast cancer risk, although some studies suggest a more complex interplay between measures of energy intake, physical activity, and body size. We examined the association between total energy intake jointly with physical activity and body mass index (BMI) and the risk of breast cancer among 1,775 women diagnosed with breast cancer between 1995 and 2006 and 2,529 of their unaffected sisters, enrolled in the Breast Cancer Family Registry. We collected dietary data using the Hawaii–Los Angeles Multiethnic Cohort food frequency questionnaire. Using conditional logistic regression to estimate the odds ratios (OR) and 95 % confidence intervals (CI) associated with total energy intake, we observed an overall 60–70 % increased risk of breast cancer among women in the highest quartile of total energy intake compared to those in the lowest quartile (Q4 vs. Q1: OR = 1.6, 95 % CI: 1.3–2.0; P trend < 0.0001); these associations were limited to pre-menopausal women or women with hormone receptor-positive cancers. Although the associations were slightly stronger among women with a higher BMI or lower level of average lifetime physical activity, we observed a positive association between total energy intake and breast cancer risk across different strata of physical activity and BMI. Our results suggest that within sisters, high energy intake may increase the risk of breast cancer independent of physical activity and body size. If replicated in prospective studies, then these findings suggest that reductions in total energy intake may help in modifying breast cancer risk.

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Acknowledgments

This study was funded through a Susan G. Komen Breast Cancer Foundation Career Development Award (KG081157) (F·F. Zhang). This study was also supported by the National Cancer Institute, National Institutes of Health under RFA-CA-06-503 and through cooperative agreements with members of the Breast Cancer Family Registry (BCFR) and Principal Investigators, including Cancer Care Ontario (U01 CA69467), Cancer Prevention Institute of California (U01 CA69417), Columbia University (U01 CA69398), Fox Chase Cancer Center (U01 CA69631), Huntsman Cancer Institute (U01 CA69446), University of Melbourne (U01 CA69638), and Georgetown University Medical Center Informatics Support Center (HHSN261200900010C). Au note: (The content of this manuscript does not necessarily reflect the views or policies of the National Cancer Institute or any of the collaborating centers in the BCFR, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government or the BCFR.) COI: (The authors declared no conflict of interests.)

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Authors and Affiliations

  1. Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA, 02111, USA

    Fang Fang Zhang

  2. School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, 76107, USA

    Fang Fang Zhang & Manleen Kaur

  3. Cancer Prevention Institute of California, Fremont, CA, 94538, USA

    Esther M. John & Dee West

  4. Division of Epidemiology, Department of Health Research & Policy, and Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, 94305, USA

    Esther M. John & Dee West

  5. Prosserman Center for Health Research, Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, ON, M5T 3L9, Canada

    Julia A. Knight

  6. Fox Chase Cancer Center, Philadelphia, PA, 19111, USA

    Mary Daly & Beth Stearman

  7. Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, 84112, USA

    Saundra Buys

  8. Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, ON, M5G 1X5, Canada

    Irene L. Andrulis

  9. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA

    Beth Stearman

  10. Mailman School of Public Health, Columbia University, New York, NY, 10032, USA

    Mary Beth Terry

  11. Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, 10032, USA

    Mary Beth Terry

  12. Dalla Lana School of Public Health, University of Toronto, Toronto, ON, M5T 3M7, Canada

    Julia A. Knight

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  1. Fang Fang Zhang
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Zhang, F.F., John, E.M., Knight, J.A. et al. Total energy intake and breast cancer risk in sisters: the Breast Cancer Family Registry. Breast Cancer Res Treat 137, 541–551 (2013). https://doi.org/10.1007/s10549-012-2342-8

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