title: Healthy dietary patterns and risk of breast cancer by molecular subtype.
abstract: We examined associations between dietary quality indices and breast cancer risk by molecular subtype among 100,643 women in the prospective Nurses' Health Study (NHS) cohort, followed from 1984 to 2006. Dietary quality scores for the Alternative Healthy Eating Index (AHEI), alternate Mediterranean diet (aMED), and Dietary Approaches to Stop Hypertension (DASH) dietary patterns were calculated from semi-quantitative food frequency questionnaires collected every 2-4 years. Breast cancer molecular subtypes were defined according to estrogen receptor (ER), progesterone receptor, human epidermal growth factor 2 (HER2), cytokeratin 5/6 (CK5/6), and epidermal growth factor receptor status from immunostained tumor microarrays in combination with histologic grade. Cox proportional hazards models, adjusted for age and breast cancer risk factors, were used to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs). Competing risk analyses were used to assess heterogeneity by subtype. We did not observe any significant associations between the AHEI or aMED dietary patterns and risk of breast cancer by molecular subtype. However, a significantly reduced risk of HER2-type breast cancer was observed among women in 5th versus 1st quintile of the DASH dietary pattern [n = 134 cases, Q5 vs. Q1 HR (95 % CI) = 0.44 (0.25-0.77)], and the inverse trend across quintiles was significant (p trend = 0.02). We did not observe any heterogeneity in associations between AHEI (p het = 0.25), aMED (p het = 0.71), and DASH (p het = 0.12) dietary patterns and breast cancer by subtype. Adherence to the AHEI, aMED, and DASH dietary patterns was not strongly associated with breast cancer molecular subtypes.
authors.affiliation: Department of Epidemiology and Biostatistics, Michigan State University, 909 Fee Road, East Lansing, MI, 48824, USA. khirko@epi.msu.edu.
authors.forename: Kelly A
authors.identifier: http://orcid.org/0000-0002-0050-655X
authors.initials: KA
authors.lastname: Hirko
authors.affiliation: Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 909 Fee Road, Boston, MA, 02115, USA.|Department of Epidemiology, Harvard T.H. Chan School of Public Health, 909 Fee Road, Boston, MA, USA.|Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
authors.forename: Walter C
authors.initials: WC
authors.lastname: Willett
authors.affiliation: Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 909 Fee Road, Boston, MA, 02115, USA.|Department of Epidemiology, Harvard T.H. Chan School of Public Health, 909 Fee Road, Boston, MA, USA.|Department of Biostatistics and Epidemiology, University of Massachusetts, Amherst, MA, USA.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Hankinson
authors.affiliation: Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 909 Fee Road, Boston, MA, 02115, USA.
authors.forename: Bernard A
authors.initials: BA
authors.lastname: Rosner
authors.affiliation: Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Beck
authors.affiliation: Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 909 Fee Road, Boston, MA, 02115, USA.|Department of Epidemiology, Harvard T.H. Chan School of Public Health, 909 Fee Road, Boston, MA, USA.
authors.forename: Rulla M
authors.initials: RM
authors.lastname: Tamimi
authors.affiliation: Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 909 Fee Road, Boston, MA, 02115, USA.|Department of Epidemiology, Harvard T.H. Chan School of Public Health, 909 Fee Road, Boston, MA, USA.
authors.forename: A Heather
authors.initials: AH
authors.lastname: Eliassen
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000145:classification / Q000178:diet therapy* / Q000453:epidemiology* / Q000235:genetics; D004032:Diet; D005247:Feeding Behavior; D005260:Female; D015972:Gene Expression Regulation, Neoplastic; D006801:Humans; D008875:Middle Aged; D016016:Proportional Hazards Models; D014176:Protein Biosynthesis / Q000235:genetics; D012307:Risk Factors
keywords: Breast cancer; Diet; Molecular subtypes; Patterns