title: Vegetarian dietary patterns and the risk of breast cancer in a low-risk population.
abstract: Among cancers in American women, breast cancer (BC) has the second highest incidence and mortality. The association of BC with diet has been inconsistent. Studies that evaluate associations with dietary patterns are less common and reflect an individual's whole diet. We associated dietary patterns with the risk of BC in American women of the Adventist Health Study-2 (AHS-2), a prospective cohort of 96 001 subjects recruited between 2002 and 2007. Answers to a previously validated FFQ were used to classify subjects to vegan, lacto-ovo-vegetarian, pesco-vegetarian, semi-vegetarian and non-vegetarian dietary patterns. Incident BC were identified by matching AHS-2 subjects to data from forty-eight state cancer registries. Statistical analyses used proportional hazard regression analyses with covariates that were chosen a priori. From 50 404 female participants (26 193 vegetarians), we identified 892 incident BC cases, with 478 cases among vegetarians. As compared with non-vegetarians, all vegetarians combined did not have a significantly lower risk (hazard ratio (HR) 0·97; CI 0·84, 1·11; P=0·64). However, vegans showed consistently lower (but non-significant) point estimates when compared with non-vegetarians (all cases: HR 0·78; CI 0·58, 1·05; P=0·09). In summary, participants in this cohort who follow a vegetarian dietary pattern did not experience a lower risk of BC as compared with non-vegetarians, although lower risk in vegans is possible. These findings add to the very limited literature associating vegetarian diets with BC risk and can assist nutritionists when evaluating the impact of these diets. The findings will also motivate further evaluation of vegan diets and their special characteristics.
authors.affiliation: Adventist Health Study-2,Loma Linda University,Loma Linda,CA 92350,USA.
authors.forename: Jason A
authors.initials: JA
authors.lastname: Penniecook-Sawyers
authors.affiliation: Adventist Health Study-2,Loma Linda University,Loma Linda,CA 92350,USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Jaceldo-Siegl
authors.affiliation: Adventist Health Study-2,Loma Linda University,Loma Linda,CA 92350,USA.
authors.forename: Jing
authors.initials: J
authors.lastname: Fan
authors.affiliation: Adventist Health Study-2,Loma Linda University,Loma Linda,CA 92350,USA.
authors.forename: Larry
authors.initials: L
authors.lastname: Beeson
authors.affiliation: Adventist Health Study-2,Loma Linda University,Loma Linda,CA 92350,USA.
authors.forename: Synnove
authors.initials: S
authors.lastname: Knutsen
authors.affiliation: Adventist Health Study-2,Loma Linda University,Loma Linda,CA 92350,USA.
authors.forename: Patti
authors.initials: P
authors.lastname: Herring
authors.affiliation: Adventist Health Study-2,Loma Linda University,Loma Linda,CA 92350,USA.
authors.forename: Gary E
authors.initials: GE
authors.lastname: Fraser
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000517:prevention & control*; D014676:Diet, Vegetarian; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008019:Life Style; D008875:Middle Aged; D015596:Nutrition Assessment; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D000066988:Vegetarians
keywords: AHS-2 Adventist Health Study-2; Adventists; BC breast cancer; Breast cancer; Dietary patterns; ER oestrogen receptor; HR hazard ratio; PR progesterone receptor; Vegetarians