Fiber intake modulates the association of alcohol intake with breast cancer.
Alcohol intake has been related to an increased risk of breast cancer (BC) while dietary fiber intake has been inversely associated to BC risk. A beneficial effect of fibers on ethanol carcinogenesis through their impact on estrogen levels is still controversial. We investigated the role of dietary fiber as a modifying factor of the association of alcohol and BC using data from the European Prospective Investigation into Cancer and Nutrition (EPIC). This study included 334,850 women aged 35-70 years at baseline enrolled in the ten countries of the EPIC study and followed up for 11.0 years on average. Information on fiber and alcohol intake at baseline and average lifetime alcohol intake were calculated from country-specific dietary and lifestyle questionnaires. Hazard ratios (HR) of developing invasive BC according to different levels of alcohol and fiber intake were computed. During 3,670,439 person-years, 11,576 incident BC cases were diagnosed. For subjects with low intake of fiber (<18.5 g/day), the risk of BC per 10 g/day of alcohol intake was 1.06 (1.03-1.08) while among subjects with high intake of fiber (>24.2 g/day) the risk of BC was 1.02 (0.99-1.05) (test for interaction p = 0.011). This modulating effect was stronger for fiber from vegetables. Our results suggest that fiber intake may modulate the positive association of alcohol intake and BC. Alcohol is well known to increase the risk for BC, while a fiber-rich diet has the opposite effect. Here the authors find a significant interaction between both lifestyle factors indicating that high fiber intake can ease the adverse effects associated with alcohol consumption. Consequently, women with high alcohol intake and low fiber intake (<18.5 g/day) had the highest risk for BC. Specific benefits were associated with fibers from vegetable, warranting further investigations into specific fiber sources and their mechanistic interactions with alcohol-induced BC risk.
International Agency for Research on Cancer (IARC), Lyon, France.
Isabelle
I
Romieu
International Agency for Research on Cancer (IARC), Lyon, France.
Pietro
P
Ferrari
International Agency for Research on Cancer (IARC), Lyon, France.
Veronique
V
Chajès
International Agency for Research on Cancer (IARC), Lyon, France.
Jordi
J
de Batlle
International Agency for Research on Cancer (IARC), Lyon, France.
Carine
C
Biessy
International Agency for Research on Cancer (IARC), Lyon, France.
Chiara
C
Scoccianti
Inserm, Centre for research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health team, Villejuif, F-94805, France.|Univ Paris Sud, UMRS 1018, Villejuif, F-94805, France.|IGR, F-94805, Villejuif, France.
Laure
L
Dossus
Inserm, Centre for research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health team, Villejuif, F-94805, France.|Univ Paris Sud, UMRS 1018, Villejuif, F-94805, France.|IGR, F-94805, Villejuif, France.
Marie
M
Christine Boutron
Inserm, Centre for research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health team, Villejuif, F-94805, France.|Univ Paris Sud, UMRS 1018, Villejuif, F-94805, France.|IGR, F-94805, Villejuif, France.
Nadia
N
Bastide
Department of Epidemiology, School of Public Health, Aarhus University, Aarhus, Denmark.
Kim
K
Overvad
Research Diet, Genes and Environment Danish Cancer Society Research Center Strandboulevarden, Copenhagen, Denmark.
Anja
A
Olsen
Research Diet, Genes and Environment Danish Cancer Society Research Center Strandboulevarden, Copenhagen, Denmark.
Anne
A
Tjønneland
Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
Rudolf
R
Kaaks
Deutsches Institut für Ernährungsforschung Potsdam-Rehbrücke German, Institute of Human Nutrition Potsdam-Rehbrücke.
Heiner
H
Boeing
Hellenic Health Foundation, 13 Kaisareias Street, Athens, GR-115 27, Greece.|WHO Collaborating Center for Food and Nutrition Policies, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece.
Antonia
A
Trichopoulou
WHO Collaborating Center for Food and Nutrition Policies, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece.|Department of Epidemiology, Harvard School of Public Health, Boston.|Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece.
Pagona
P
Lagiou
Department of Epidemiology, Harvard School of Public Health, Boston.|Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece.|Hellenic Health Foundation, Athens, Greece.
Dimitrios
D
Trichopoulos
Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy.
Domenico
D
Palli
Epidemiology and Prevention Unit, Department of Preventive & Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
Sabina
S
Sieri
Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, ASP Ragusa, Italy.
Rosario
R
Tumino
School of Public Health, Imperial College London, London, HuGeF Foundation Torino Italy.
Paolo
P
Vineis
Dipartimento di Medicina Clinica e Chirurgia Federico II University, Naples, Italy.
Salvatore
S
Panico
National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.|Department of Gastroenterology and Hepatology University Medical Centre, Utrecht, The Netherlands.|The School of Public Health, Imperial College London, London, United Kingdom.|Department of Social & Preventive Medicine, Faculty of Medicine University of Malaya, Kuala Lumpur, Malaysia.
H B As
HB
Bueno-de-Mesquita
Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.
Carla H
CH
Gils
Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.|Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College, London, United Kingdom.
Petra H
PH
Peeters
Department of community medicine, University of Tromsø - the Arctic University of Norway, Tromsø, Norway.
Eiliv
E
Lund
Department of community medicine, University of Tromsø - the Arctic University of Norway, Tromsø, Norway.
Guri
G
Skeie
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, Folkhalsän Research Center, Samfundet Folkhälsan, Helsinki, Finland.
Elisabete
E
Weiderpass
Public Health Directorate, Asturias, Spain.
J
J
Ramón Quirós
Department of Epidemiology, Murcia Regional Health Authority, Murcia, Spain, CIBER Epidemiology and Public Health CIBERESP, Spain.
María-Dolores
MD
Chirlaque
Navarre Public Health Institute, Pamplona, Spain, CIBER Epidemiology and Public Health CIBERESP, Spain.
Eva
E
Ardanaz
Escuela Andaluza de Salud Pública, Granada, Spain, CIBERESP, Spain, Instituto de Investigación Biosanitaria de Granada, Granada, Spain.
María-José
MJ
Sánchez
Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain.
Eric J
EJ
Duell
Public Health Division of Gipuzkoa, BioDonostia Research Institute, San Sebastian, Spain.|CIBER Epidemiology and Public Health CIBERESP, Spain.
Pilar
P
Amiano Etxezarreta
Division of Oncology, Department of Clinical Sciences, Lund University Lund, Sweden.
Signe
S
Borgquist
Department of Public Health and Clinical Medicine, Nutritional Research, Umeå University, Umeå, Sweden.
Göran
G
Hallmans
Department of Odontology, Umeå University, Umeå, Sweden.
Ingegerd
I
Johansson
Public Health and Clinical Medicine/Nutritional research, Umeå university, Umeå, Sweden.
Lena
L
Maria Nilsson
University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom.
Kay-Tee
KT
Khaw
MRC Epidemiology Unit and University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom.
Nick
N
Wareham
Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom.
Timothy J
TJ
Key
Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom.
Ruth C
RC
Travis
Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom.
Neil
N
Murphy
Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom.
Petra A
PA
Wark
Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom.
Elio
E
Riboli
D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000209:etiology* / Q000378:metabolism / Q000517:prevention & control*; D004032:Diet / Q000379:methods; D004043:Dietary Fiber / Q000008:administration & dosage*; D004967:Estrogens / Q000378:metabolism; D000431:Ethanol / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008019:Life Style; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D014675:Vegetables
D004043:Dietary Fiber; D004967:Estrogens; D000431:Ethanol
alcohol; breast cancer; epidemiology; nutrition