title: Vegetable and fruit consumption and the risk of hormone receptor-defined breast cancer in the EPIC cohort.
abstract: BACKGROUND
  The recent literature indicates that a high vegetable intake and not a high fruit intake could be associated with decreased steroid hormone receptor-negative breast cancer risk.
  
  
  OBJECTIVE
  This study aimed to investigate the association between vegetable and fruit intake and steroid hormone receptor-defined breast cancer risk.
  
  
  METHODS
  A total of 335,054 female participants in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort were included in this study (mean ± SD age: 50.8 ± 9.8 y). Vegetable and fruit intake was measured by country-specific questionnaires filled out at recruitment between 1992 and 2000 with the use of standardized procedures. Cox proportional hazards models were stratified by age at recruitment and study center and were adjusted for breast cancer risk factors.
  
  
  RESULTS
  After a median follow-up of 11.5 y (IQR: 10.1-12.3 y), 10,197 incident invasive breast cancers were diagnosed [3479 estrogen and progesterone receptor positive (ER+PR+); 1021 ER and PR negative (ER-PR-)]. Compared with the lowest quintile, the highest quintile of vegetable intake was associated with a lower risk of overall breast cancer (HRquintile 5-quintile 1: 0.87; 95% CI: 0.80, 0.94). Although the inverse association was most apparent for ER-PR- breast cancer (ER-PR-: HRquintile 5-quintile 1: 0.74; 95% CI: 0.57, 0.96; P-trend = 0.03; ER+PR+: HRquintile 5-quintile 1: 0.91; 95% CI: 0.79, 1.05; P-trend = 0.14), the test for heterogeneity by hormone receptor status was not significant (P-heterogeneity = 0.09). Fruit intake was not significantly associated with total and hormone receptor-defined breast cancer risk.
  
  
  CONCLUSIONS
  This study supports evidence that a high vegetable intake is associated with lower (mainly hormone receptor-negative) breast cancer risk.
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands;
authors.forename: Marleen J
authors.initials: MJ
authors.lastname: Emaus
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom;
authors.forename: Petra H M
authors.initials: PH
authors.lastname: Peeters
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands;
authors.forename: Marije F
authors.initials: MF
authors.lastname: Bakker
authors.affiliation: Section of Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark;
authors.forename: Kim
authors.initials: K
authors.lastname: Overvad
authors.affiliation: Danish Cancer Society Research Center, Copenhagen, Denmark;
authors.forename: Anne
authors.initials: A
authors.lastname: Tjønneland
authors.affiliation: Danish Cancer Society Research Center, Copenhagen, Denmark;
authors.forename: Anja
authors.initials: A
authors.lastname: Olsen
authors.affiliation: International Agency for Research on Cancer, Lyon, France;
authors.forename: Isabelle
authors.initials: I
authors.lastname: Romieu
authors.affiliation: International Agency for Research on Cancer, Lyon, France;
authors.forename: Pietro
authors.initials: P
authors.lastname: Ferrari
authors.affiliation: INSERM, Center for Research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones, and Women's Health Team, Villejuif, France; University Paris Sud, UMRS 1018, Villejuif, France; Gustave Roussy Institute, Villejuif, France;
authors.forename: Laure
authors.initials: L
authors.lastname: Dossus
authors.affiliation: INSERM, Center for Research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones, and Women's Health Team, Villejuif, France; University Paris Sud, UMRS 1018, Villejuif, France; Gustave Roussy Institute, Villejuif, France;
authors.forename: Marie Christine
authors.initials: MC
authors.lastname: Boutron-Ruault
authors.affiliation: Cancer Epidemiology Centre, Cancer Council of Victoria, Melbourne, Australia; Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Australia;
authors.forename: Laura
authors.initials: L
authors.lastname: Baglietto
authors.affiliation: Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany;
authors.forename: Renée T
authors.initials: RT
authors.lastname: Fortner
authors.affiliation: Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany;
authors.forename: Rudolf
authors.initials: R
authors.lastname: Kaaks
authors.affiliation: Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany;
authors.forename: Heiner
authors.initials: H
authors.lastname: Boeing
authors.affiliation: Hellenic Health Foundation, Athens, Greece; Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Goudi, Athens, Greece; Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece;
authors.forename: Antonia
authors.initials: A
authors.lastname: Trichopoulou
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Goudi, Athens, Greece; Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece; Department of Epidemiology, Harvard School of Public Health, Boston, MA;
authors.forename: Pagona
authors.initials: P
authors.lastname: Lagiou
authors.affiliation: Hellenic Health Foundation, Athens, Greece; Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece; Department of Epidemiology, Harvard School of Public Health, Boston, MA;
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Trichopoulos
authors.affiliation: Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute-ISPO, Florence, Italy;
authors.forename: Giovanna
authors.initials: G
authors.lastname: Masala
authors.affiliation: Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy;
authors.forename: Valeria
authors.initials: V
authors.lastname: Pala
authors.affiliation: Dipartimento Di Medicina Clinica E Chirurgia, Federico II University, Naples, Italy;
authors.forename: Salvatore
authors.initials: S
authors.lastname: Panico
authors.affiliation: Cancer Registry and Histopathology Unit, Civic-M.P. Arezzo Hospital, ASP Ragusa, Italy;
authors.forename: Rosario
authors.initials: R
authors.lastname: Tumino
authors.affiliation: Human Genetic Foundation (HuGeF), Turin, Italy;
authors.forename: Silvia
authors.initials: S
authors.lastname: Polidoro
authors.affiliation: Department of Community Medicine, School of Health Sciences, University of Tromso, The Arctic University of Norway, Tromso, Norway;
authors.forename: Guri
authors.initials: G
authors.lastname: Skeie
authors.affiliation: Department of Community Medicine, School of Health Sciences, University of Tromso, The Arctic University of Norway, Tromso, Norway;
authors.forename: Eiliv
authors.initials: E
authors.lastname: Lund
authors.affiliation: Department of Community Medicine, School of Health Sciences, University of Tromso, The Arctic University of Norway, Tromso, Norway; Department of Research, The Cancer Registry of Norway, Oslo, Norway; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Folkhälsan Research Center, Samfundet Folkhälsan, Helsinki, Finland;
authors.forename: Elisabete
authors.initials: E
authors.lastname: Weiderpass
authors.affiliation: Public Health Directorate, Asturias, Spain;
authors.forename: J Ramón
authors.initials: JR
authors.lastname: Quirós
authors.affiliation: Unit of Nutrition, Environment, 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: María-José
authors.initials: MJ
authors.lastname: Sánchez
authors.affiliation: CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Epidemiology Department, Regional Health Council, Murcia, Spain;
authors.forename: Maria-Dolores
authors.initials: MD
authors.lastname: Chirlaque
authors.affiliation: CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Navarre Public Health Institute, Pamplona, Spain;
authors.forename: Eva
authors.initials: E
authors.lastname: Ardanaz
authors.affiliation: Public Health Direction and Biodonostia-Ciberesp Basque Regional Health Department, San Sebastian, Spain;
authors.forename: Miren
authors.initials: M
authors.lastname: Dorronsoro
authors.affiliation: Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Public Health and Clinical Medicine, Nutritional Research, Umeå University, Umeå, Sweden;
authors.forename: Anna
authors.initials: A
authors.lastname: Winkvist
authors.affiliation: Department of Public Health and Clinical Medicine, Nutritional Research, Umeå University, Umeå, Sweden;
authors.forename: Maria
authors.initials: M
authors.lastname: Wennberg
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom; Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands; Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, Netherlands; Department of Social and 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: University of Cambridge, Cambridge, United Kingdom; and.
authors.forename: Kay-Tee
authors.initials: KT
authors.lastname: Khaw
authors.affiliation: Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
authors.forename: Ruth C
authors.initials: RC
authors.lastname: Travis
authors.affiliation: Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Key
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom;
authors.forename: Dagfinn
authors.initials: D
authors.lastname: Aune
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom;
authors.forename: Marc
authors.initials: M
authors.lastname: Gunter
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom;
authors.forename: Elio
authors.initials: E
authors.lastname: Riboli
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands; c.vangils@umcutrecht.nl.
authors.forename: Carla H
authors.initials: CH
authors.lastname: van Gils
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000378:metabolism / Q000517:prevention & control*; D004032:Diet; D005247:Feeding Behavior; D005260:Female; D005638:Fruit; D006801:Humans; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011960:Receptors, Estrogen / Q000378:metabolism*; D011980:Receptors, Progesterone / Q000378:metabolism*; D012307:Risk Factors; D014675:Vegetables
chemical_list: D011960:Receptors, Estrogen; D011980:Receptors, Progesterone
keywords: breast cancer; estrogen receptor; fruit; progesterone receptor; vegetables