Dietary patterns and breast cancer risk in the California Teachers Study cohort

Am J Clin Nutr. 2013 Dec;98(6):1524-32. doi: 10.3945/ajcn.113.061184. Epub 2013 Oct 9.


Background: Evidence that diet is associated with breast cancer risk is inconsistent. Most studies have examined risks associated with specific foods and nutrients, rather than measures of overall diet.

Objective: This study aimed to evaluate dietary patterns and their relation to breast cancer risk in a large cohort of women.

Design: Data from 91,779 women in the California Teachers Study cohort were analyzed, including data from 4140 women with a diagnosis of invasive breast cancer made between 1995 and 2009. Five predominant dietary patterns were identified by using principal components factor analysis: a plant-based diet, high in fruit and vegetables; a high-protein, high-fat diet, high in meats, eggs, fried foods, and high-fat condiments; a high-carbohydrate diet, high in convenience foods, pasta, and bread products; an ethnic diet, high in legumes, soy-based foods, rice, and dark-green leafy vegetables; and a salad and wine diet, high in lettuce, fish, wine, low-fat salad dressing, and coffee and tea.

Results: The plant-based pattern was associated with a reduction in breast cancer risk (RR: 0.85; 95% CI: 0.76, 0.95 for the highest compared with the lowest consumption quintile; P-trend = 0.003); risk reduction was greater for estrogen receptor-negative progesterone receptor-negative (ER-PR-) tumors (RR: 0.66; 95% CI: 0.48, 0.91; P-trend = 0.03). The salad and wine pattern was associated with an increased risk of estrogen receptor-positive progesterone receptor-positive tumors (RR: 1.29; 95% CI: 1.12, 1.49); this effect was only slightly attenuated after adjustment for alcohol consumption.

Conclusion: The finding that greater consumption of a plant-based dietary pattern is associated with a reduced breast cancer risk, particularly for ER-PR- tumors, offers a potential avenue for prevention.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Breast Neoplasms / epidemiology
  • Breast Neoplasms / etiology
  • Breast Neoplasms / metabolism
  • Breast Neoplasms / prevention & control*
  • California / epidemiology
  • Cohort Studies
  • Diet* / adverse effects
  • Diet, Vegetarian
  • Edible Grain*
  • Faculty
  • Female
  • Fruit*
  • Humans
  • Incidence
  • Middle Aged
  • Neoplasm Proteins / metabolism
  • Principal Component Analysis
  • Receptors, Estrogen / metabolism
  • Receptors, Progesterone / metabolism
  • Risk Factors
  • Surveys and Questionnaires
  • Vegetables*


  • Neoplasm Proteins
  • Receptors, Estrogen
  • Receptors, Progesterone