title: Pre-diagnostic polyphenol intake and breast cancer survival: the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort.
abstract: The aim was to investigate the association between pre-diagnostic intakes of polyphenol classes (flavonoids, lignans, phenolic acids, stilbenes, and other polyphenols) in relation to breast cancer survival (all-cause and breast cancer-specific mortality). We used data from the European Prospective Investigation into Cancer and Nutrition cohort. Pre-diagnostic usual diet was assessed using dietary questionnaires, and polyphenol intakes were estimated using the Phenol-Explorer database. We followed 11,782 breast cancer cases from time of diagnosis until death, end of follow-up or last day of contact. During a median of 6 years, 1482 women died (753 of breast cancer). We related polyphenol intake to all-cause and breast cancer-specific mortality using Cox proportional hazard models with time since diagnosis as underlying time and strata for age and country. Among postmenopausal women, an intake of lignans in the highest versus lowest quartile was related to a 28 % lower risk of dying from breast (adjusted model: HR, quartile 4 vs. quartile 1, 0.72, 95 % CI 0.53; 0.98). In contrast, in premenopausal women, a positive association between lignan intake and all-cause mortality was found (adjusted model: HR, quartile 4 vs. quartile 1, 1.63, 95 % CI 1.03; 2.57). We found no association for other polyphenol classes. Intake of lignans before breast cancer diagnosis may be related to improved survival among postmenopausal women, but may on the contrary worsen the survival for premenopausal women. This suggests that the role of phytoestrogens in breast cancer survival is complex and may be dependent of menopausal status.
authors.affiliation: Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark. ceciliek@cancer.dk.|International Agency for Research on Cancer (WHO-IARC), Lyon, France. ceciliek@cancer.dk.
authors.forename: Cecilie
authors.initials: C
authors.lastname: Kyrø
authors.affiliation: International Agency for Research on Cancer (WHO-IARC), Lyon, France.
authors.forename: Raul
authors.initials: R
authors.lastname: Zamora-Ros
authors.affiliation: International Agency for Research on Cancer (WHO-IARC), Lyon, France.
authors.forename: Augustin
authors.initials: A
authors.lastname: Scalbert
authors.affiliation: Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark.
authors.forename: Anne
authors.initials: A
authors.lastname: Tjønneland
authors.affiliation: Inserm, CESP Centre for Research in Epidemiology and Population Health, Villejuif, France.|Université Paris-Sud, Villejuif, France.
authors.forename: Laure
authors.initials: L
authors.lastname: Dossus
authors.affiliation: Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark.|5073, Oncology Clinic, Finsen Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Christoffer
authors.initials: C
authors.lastname: Johansen
authors.affiliation: Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark.
authors.forename: Pernille Envold
authors.initials: PE
authors.lastname: Bidstrup
authors.affiliation: Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway.|Department of Research, Cancer Registry of Norway, Institute of Population Based Cancer Research, Oslo, Norway.|Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.|Genetic Epidemiology Group, Folkhälsan Research Center, Samfundet Folkhälsan, Helsinki, Finland.
authors.forename: Elisabete
authors.initials: E
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authors.affiliation: Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark.
authors.forename: Jane
authors.initials: J
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authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
authors.forename: Heather
authors.initials: H
authors.lastname: Ward
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
authors.forename: Dagfinn
authors.initials: D
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authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
authors.forename: Elio
authors.initials: E
authors.lastname: Riboli
authors.affiliation: Inserm, CESP Centre for Research in Epidemiology and Population Health, Villejuif, France.|Université Paris-Sud, Villejuif, France.|Gustave Roussy, Villejuif, France.
authors.forename: Mathilde
authors.initials: M
authors.lastname: His
authors.affiliation: Inserm, CESP Centre for Research in Epidemiology and Population Health, Villejuif, France.|Université Paris-Sud, Villejuif, France.|Gustave Roussy, Villejuif, France.
authors.forename: Françoise
authors.initials: F
authors.lastname: Clavel-Chapelon
authors.affiliation: Inserm, CESP Centre for Research in Epidemiology and Population Health, Villejuif, France.|Université Paris-Sud, Villejuif, France.|Gustave Roussy, Villejuif, France.|Cancer Epidemiology Centre, Cancer Council of Victoria, Melbourne, VIC, Australia.|Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
authors.forename: Laura
authors.initials: L
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authors.affiliation: Division of Cancer Epidemiology, German Cancer Research Center, DKFZ, Heidelberg, Germany.
authors.forename: Verena
authors.initials: V
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authors.affiliation: Division of Cancer Epidemiology, German Cancer Research Center, DKFZ, Heidelberg, Germany.
authors.forename: Tilman
authors.initials: T
authors.lastname: Kühn
authors.affiliation: Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany.
authors.forename: Heiner
authors.initials: H
authors.lastname: Boeing
authors.affiliation: Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany.
authors.forename: Anna
authors.initials: A
authors.lastname: Floegel
authors.affiliation: Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark.
authors.forename: Kim
authors.initials: K
authors.lastname: Overvad
authors.affiliation: Department of Functional Biology, Faculty of Medicine, University of Oviedo, Asturias, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Lasheras
authors.affiliation: Unit of Nutrition and Cancer, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain.
authors.forename: Noémie
authors.initials: N
authors.lastname: Travier
authors.affiliation: Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs.GRANADA, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain.|CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
authors.forename: Maria-José
authors.initials: MJ
authors.lastname: Sánchez
authors.affiliation: CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.|Public Health Division of Gipuzkoa, BioDonostia Research Institute, San Sebastián, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Amiano
authors.affiliation: CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.|Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia, Spain.|Department of Health and Social Sciences, Universidad de Murcia, Murcia, Spain.
authors.forename: Maria-Dolores
authors.initials: MD
authors.lastname: Chirlaque
authors.affiliation: CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.|Navarra Public Health Institute, Pamplona, Spain.|Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.
authors.forename: Eva
authors.initials: E
authors.lastname: Ardanaz
authors.affiliation: Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
authors.forename: Kay-Tee
authors.initials: KT
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authors.affiliation: MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.
authors.forename: Nick
authors.initials: N
authors.lastname: Wareham
authors.affiliation: Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
authors.forename: Aurora
authors.initials: A
authors.lastname: Perez-Cornago
authors.affiliation: Hellenic Health Foundation, Athens, Greece.|WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece.
authors.forename: Antonia
authors.initials: A
authors.lastname: Trichopoulou
authors.affiliation: Hellenic Health Foundation, Athens, Greece.|WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece.
authors.forename: Pagona
authors.initials: P
authors.lastname: Lagiou
authors.affiliation: Hellenic Health Foundation, Athens, Greece.|WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece.
authors.forename: Effie
authors.initials: E
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authors.affiliation: Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy.
authors.forename: Giovanna
authors.initials: G
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authors.affiliation: Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
authors.forename: Sara
authors.initials: S
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authors.affiliation: Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
authors.forename: Franco
authors.initials: F
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authors.affiliation: Cancer Registry and Histopathology Unit, "Civile-M.P. Arezzo" Hospital, ASP, Ragusa, Italy.
authors.forename: Rosario
authors.initials: R
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authors.affiliation: Cancer Epidemiology Unit, San Giovanni Battista Hospital, CPO Piemonte and University of Turin, Turin, Italy.
authors.forename: Carlotta
authors.initials: C
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authors.affiliation: Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy.
authors.forename: Amalia
authors.initials: A
authors.lastname: Mattiello
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.|Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.|Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands.|Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: H Bas
authors.initials: HB
authors.lastname: Bueno-de-Mesquita
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.|Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Petra H
authors.initials: PH
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authors.affiliation: Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Carla
authors.initials: C
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authors.affiliation: Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden.
authors.forename: Signe
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authors.affiliation: Department of Surgery, Clinical Sciences, Skåne University Hospital, Lund University, Malmö, Sweden.
authors.forename: Salma
authors.initials: S
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authors.affiliation: Department of Population Health, NYU School of Medicine, New York, NY, USA.
authors.forename: Anne
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authors.lastname: Zeleniuch-Jacquotte
authors.affiliation: Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden.
authors.forename: Malin
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authors.affiliation: Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.
authors.forename: Anette
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authors.affiliation: Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway.
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authors.affiliation: Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark.
authors.forename: Anja
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mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor; D001943:Breast Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D004032:Diet; D019587:Dietary Supplements; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006306:Health Surveys; D006801:Humans; D008019:Life Style; D008875:Middle Aged; D009026:Mortality; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D009749:Nutrition Surveys; D059808:Polyphenols / Q000008:administration & dosage; D016016:Proportional Hazards Models; D012307:Risk Factors
chemical_list: D014408:Biomarkers, Tumor; D059808:Polyphenols
keywords: Breast cancer; Lignans; Phytoestrogens; Polyphenols; Survivorship