title: High- and low-fat dairy intake, recurrence, and mortality after breast cancer diagnosis.
abstract: BACKGROUND
  Dietary fat in dairy is a source of estrogenic hormones and may be related to worse breast cancer survival. We evaluated associations between high- and low-fat dairy intake, recurrence, and mortality after breast cancer diagnosis.
  
  
  METHODS
  We included 1893 women from the Life After Cancer Epidemiology study diagnosed with early-stage invasive breast cancer from 1997 to 2000, who completed the Fred Hutchinson Cancer Research Center Food Frequency Questionnaire after diagnosis. A total of 349 women had a recurrence and 372 died during a median follow-up of 11.8 years, with 189 deaths from breast cancer. We used delayed entry Cox proportional hazards regression to evaluate associations between categories of the cumulative average of dairy fat at baseline and at follow-up 5 to 6 years later and subsequent outcomes. Tests of statistical significance were two-sided.
  
  
  RESULTS
  In multivariable-adjusted analyses, overall dairy intake was unrelated to breast cancer-specific outcomes, although it was positively related to overall mortality. Low-fat dairy intake was unrelated to recurrence or survival. However, high-fat dairy intake was positively associated with outcomes. Compared with the reference (0 to <0.5 servings/day), those consuming larger amounts of high-fat dairy had higher breast cancer mortality (0.5 to <1.0 servings/day: hazard ratio [HR] = 1.20, 95% confidence interval [CI] = 0.82 to 1.77; and ≥1.0 servings/day: HR = 1.49, 95% CI = 1.00 to 2.24, P trend = .05), higher all-cause mortality (P trend < .001), and higher non-breast cancer mortality (P trend = .007); the relationship with breast cancer recurrence was positive but not statistically significant. The higher risk appeared consistent across different types of high-fat dairy products.
  
  
  CONCLUSIONS
  Intake of high-fat dairy, but not low-fat dairy, was related to a higher risk of mortality after breast cancer diagnosis.
authors.affiliation: Kaiser Permanente, Division of Research, 2101 Webster, Oakland, CA 94612, USA. candyce.h.kroenke@kp.org
authors.forename: Candyce H
authors.initials: CH
authors.lastname: Kroenke
authors.forename: Marilyn L
authors.initials: ML
authors.lastname: Kwan
authors.forename: Carol
authors.initials: C
authors.lastname: Sweeney
authors.forename: Adrienne
authors.initials: A
authors.lastname: Castillo
authors.forename: Bette J
authors.initials: BJ
authors.lastname: Caan
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality*; D002140:California / Q000453:epidemiology; D018270:Carcinoma, Ductal, Breast / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality*; D003611:Dairy Products / Q000009:adverse effects*; D004032:Diet / Q000009:adverse effects*; D004041:Dietary Fats / Q000008:administration & dosage / Q000009:adverse effects*; D004967:Estrogens / Q000097:blood*; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality*; D016017:Odds Ratio; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D004041:Dietary Fats; D004967:Estrogens