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Low-Fat Dietary Pattern and Risk of Benign Proliferative Breast Disease: A Randomized, Controlled Dietary Modification Trial

Authors' Affiliations: ¹ Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York; ² Division of Research, Kaiser Permanente Northern California, Oakland, California; ³ Harbor-University of California at Los Angeles Medical Center, Torrance, California; ⁴ Department of Geriatric Medicine, University of Hawaii, Honolulu, Hawaii; ⁵ Department of Preventive Medicine, School of Medicine, State University of New York at Stony Brook, Stony Brook, New York; ⁶ Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; ⁷ Division of Preventive Medicine, School of Medicine, University of Alabama, Birmingham, Alabama; and ⁸ Department of Pathology, Vanderbilt University Medical School, Nashville, Tennessee

Requests for reprints: Thomas E. Rohan, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461. Phone: 718-430-3355; Fax: 718-430-8653; E-mail: rohan{at}aecom.yu.edu.

Modifiable factors, including diet, might alter breast cancer risk. We used the Women's Health Initiative Dietary Modification trial to test the effect of the intervention on risk of benign proliferative breast disease, a condition associated with increased risk of, and considered to be on the pathway to, invasive breast cancer. The Women's Health Initiative Dietary Modification trial was a randomized, controlled, primary prevention trial conducted in 40 U.S. clinical centers from 1993 to 2005. A total of 48,835 postmenopausal women, ages 50 to 79 years, without prior breast cancer, were enrolled. Participants were randomly assigned to the dietary modification intervention group or to the comparison group. The intervention was designed to reduce total dietary fat intake to 20% of total energy intake, and to increase fruit and vegetable intake to 5 servings/d and intake of grain products to 6 servings/d, but resulted in smaller, albeit significant, changes in practice. Participants had biennial mammograms and regular clinical breast exams. We identified women who reported breast biopsies free of cancer, obtained the histologic sections, and subjected them to standardized central review. During follow-up (average, 7.7 years), 570 incident cases of benign proliferative breast disease were ascertained in the intervention group and 793 in the comparison group. The hazard ratio for the association between dietary modification and benign proliferative breast disease was 1.09 (95% confidence interval, 0.98-1.23). Risk varied by levels of baseline total vitamin D intake but it varied little by levels of other baseline variables. These results suggest that a modest reduction in fat intake and increase in fruit, vegetable, and grain intake do not alter the risk of benign proliferative breast disease.

Key Words: diet • benign proliferative breast disease