Fruit and vegetable consumption in adolescence and early adulthood and risk of breast cancer: population based cohort study

doi:10.1136/bmj.i2343

. 2016 May 11:353:i2343.

doi: 10.1136/bmj.i2343.

Fruit and vegetable consumption in adolescence and early adulthood and risk of breast cancer: population based cohort study

Maryam S Farvid¹, Wendy Y Chen², Karin B Michels³, Eunyoung Cho⁴, Walter C Willett⁵, A Heather Eliassen⁶

Affiliations

¹ Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA Harvard/Massachusetts General Hospital Center on Genomics, Vulnerable Populations, and Health Disparities, Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA, USA mfarvid@hsph.harvard.edu.
² Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
³ Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA Obstetrics and Gynecology Epidemiology Center, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
⁴ Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
⁵ Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
⁶ Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.

PMID: 27170029
PMCID: PMC5068921
DOI: 10.1136/bmj.i2343

Fruit and vegetable consumption in adolescence and early adulthood and risk of breast cancer: population based cohort study

Maryam S Farvid et al. BMJ. 2016.

. 2016 May 11:353:i2343.

doi: 10.1136/bmj.i2343.

Authors

Maryam S Farvid¹, Wendy Y Chen², Karin B Michels³, Eunyoung Cho⁴, Walter C Willett⁵, A Heather Eliassen⁶

Affiliations

¹ Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA Harvard/Massachusetts General Hospital Center on Genomics, Vulnerable Populations, and Health Disparities, Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA, USA mfarvid@hsph.harvard.edu.
² Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
³ Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA Obstetrics and Gynecology Epidemiology Center, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
⁴ Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
⁵ Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
⁶ Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.

PMID: 27170029
PMCID: PMC5068921
DOI: 10.1136/bmj.i2343

Abstract

Objective: To evaluate the association between fruit and vegetable intake during adolescence and early adulthood and risk of breast cancer.

Design: Prospective cohort study.

Setting: Health professionals in the United States.

Participants: 90 476 premenopausal women aged 27-44 from the Nurses' Health Study II who completed a questionnaire on diet in 1991 as well as 44 223 of those women who completed a questionnaire about their diet during adolescence in 1998.

Main outcome measure: Incident cases of invasive breast cancer, identified through self report and confirmed by pathology report.

Results: There were 3235 cases of invasive breast cancer during follow-up to 2013. Of these, 1347 cases were among women who completed a questionnaire about their diet during adolescence (ages 13-18). Total fruit consumption during adolescence was associated with a lower risk of breast cancer. The hazard ratio was 0.75 (95% confidence interval 0.62 to 0.90; P=0.01 for trend) for the highest (median intake 2.9 servings/day) versus the lowest (median intake 0.5 serving/day) fifth of intake. The association for fruit intake during adolescence was independent of adult fruit intake. There was no association between risk and total fruit intake in early adulthood and total vegetable intake in either adolescence or early adulthood. Higher early adulthood intake of fruits and vegetables rich in α carotene was associated with lower risk of premenopausal breast cancer. The hazard ratio was 0.82 (0.70 to 0.96) for the highest fifth (median intake 0.5 serving/day) versus the lowest fifth (median intake 0.03 serving/day) intake. The association with adolescent fruit intake was stronger for both estrogen and progesterone receptor negative cancers than estrogen and progesterone receptor positive cancers (P=0.02 for heterogeneity). For individual fruits and vegetables, greater consumption of apple, banana, and grapes during adolescence and oranges and kale during early adulthood was significantly associated with a reduced risk of breast cancer. Fruit juice intake in adolescence or early adulthood was not associated with risk.

Conclusion: There is an association between higher fruit intake and lower risk of breast cancer. Food choices during adolescence might be particularly important.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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Conflict of interest statement

All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organization for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years, no other relationships or activities that could appear to have influenced the submitted work.

Figures

None — **Fig 1** Multivariate hazard ratios for every two servings/week of specific fruits and vegetables during adolescence and early adulthood and risk of breast cancer

See this image and copyright information in PMC

Comment in

Alcohol, diet, and risk of breast cancer.
Key TJ, Reeves GK. Key TJ, et al. BMJ. 2016 May 11;353:i2503. doi: 10.1136/bmj.i2503. BMJ. 2016. PMID: 27170004 No abstract available.
Poor quality data from diet studies may dilute better quality evidence.
Henderson GD. Henderson GD. BMJ. 2016 Aug 15;354:i4219. doi: 10.1136/bmj.i4219. BMJ. 2016. PMID: 27527094 No abstract available.
Authors' reply to Henderson.
Farvid MS, Willett WC, Eliassen AH. Farvid MS, et al. BMJ. 2016 Aug 15;354:i4226. doi: 10.1136/bmj.i4226. BMJ. 2016. PMID: 27527095 No abstract available.

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References

1. World Cancer Research Fund/American Institute for Cancer Research. Food, Nutrition, Physical Activity and the Prevention of Cancer: A Global Perspective.AICR, 2007.
1. Eliassen AH, Hendrickson SJ, Brinton LA, et al. Circulating carotenoids and risk of breast cancer: pooled analysis of eight prospective studies. J Natl Cancer Inst 2012;104:1905-16. 10.1093/jnci/djs461 pmid:23221879. - DOI - PMC - PubMed
1. Farvid MS, Eliassen AH, Cho E, Liao X, Chen WY, Willett WC. Dietary fiber intake in young adults and breast cancer risk. Pediatrics 2016;137:1-11. 10.1542/peds.2015-1226 pmid:26908709. - DOI - PMC - PubMed
1. Shibata A, Paganini-Hill A, Ross RK, Henderson BE. Intake of vegetables, fruits, beta-carotene, vitamin C and vitamin supplements and cancer incidence among the elderly: a prospective study. Br J Cancer 1992;66:673-9. 10.1038/bjc.1992.336 pmid:1419605. - DOI - PMC - PubMed
1. Rohan TE, Howe GR, Friedenreich CM, Jain M, Miller AB. Dietary fiber, vitamins A, C, and E, and risk of breast cancer: a cohort study. Cancer Causes Control 1993;4:29-37. 10.1007/BF00051711 pmid:8381678. - DOI - PubMed

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[1] World Cancer Research Fund/American Institute for Cancer Research. Food, Nutrition, Physical Activity and the Prevention of Cancer: A Global Perspective.AICR, 2007.

[2] World Cancer Research Fund/American Institute for Cancer Research. Food, Nutrition, Physical Activity and the Prevention of Cancer: A Global Perspective.AICR, 2007.

[3] Eliassen AH, Hendrickson SJ, Brinton LA, et al. Circulating carotenoids and risk of breast cancer: pooled analysis of eight prospective studies. J Natl Cancer Inst 2012;104:1905-16. 10.1093/jnci/djs461 pmid:23221879. - DOI - PMC - PubMed

[4] Eliassen AH, Hendrickson SJ, Brinton LA, et al. Circulating carotenoids and risk of breast cancer: pooled analysis of eight prospective studies. J Natl Cancer Inst 2012;104:1905-16. 10.1093/jnci/djs461 pmid:23221879. - DOI - PMC - PubMed

[5] Farvid MS, Eliassen AH, Cho E, Liao X, Chen WY, Willett WC. Dietary fiber intake in young adults and breast cancer risk. Pediatrics 2016;137:1-11. 10.1542/peds.2015-1226 pmid:26908709. - DOI - PMC - PubMed

[6] Farvid MS, Eliassen AH, Cho E, Liao X, Chen WY, Willett WC. Dietary fiber intake in young adults and breast cancer risk. Pediatrics 2016;137:1-11. 10.1542/peds.2015-1226 pmid:26908709. - DOI - PMC - PubMed

[7] Shibata A, Paganini-Hill A, Ross RK, Henderson BE. Intake of vegetables, fruits, beta-carotene, vitamin C and vitamin supplements and cancer incidence among the elderly: a prospective study. Br J Cancer 1992;66:673-9. 10.1038/bjc.1992.336 pmid:1419605. - DOI - PMC - PubMed

[8] Shibata A, Paganini-Hill A, Ross RK, Henderson BE. Intake of vegetables, fruits, beta-carotene, vitamin C and vitamin supplements and cancer incidence among the elderly: a prospective study. Br J Cancer 1992;66:673-9. 10.1038/bjc.1992.336 pmid:1419605. - DOI - PMC - PubMed

[9] Rohan TE, Howe GR, Friedenreich CM, Jain M, Miller AB. Dietary fiber, vitamins A, C, and E, and risk of breast cancer: a cohort study. Cancer Causes Control 1993;4:29-37. 10.1007/BF00051711 pmid:8381678. - DOI - PubMed

[10] Rohan TE, Howe GR, Friedenreich CM, Jain M, Miller AB. Dietary fiber, vitamins A, C, and E, and risk of breast cancer: a cohort study. Cancer Causes Control 1993;4:29-37. 10.1007/BF00051711 pmid:8381678. - DOI - PubMed

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Fruit and vegetable consumption in adolescence and early adulthood and risk of breast cancer: population based cohort study

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Fruit and vegetable consumption in adolescence and early adulthood and risk of breast cancer: population based cohort study

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