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Adherence to the Western, Prudent and Mediterranean dietary patterns and breast cancer risk: MCC-Spain study

  • Adela Castelló
    Correspondence
    Corresponding author at: Cancer Epidemiology Unit, National Center for Epidemiology, Instituto de Salud Carlos III, Avenida Monforte de Lemos, 5, 28029, Madrid, Spain.
    Affiliations
    Cancer Epidemiology Unit, National Centre for Epidemiology, Carlos III Institute of Health, Avenida Monforte de Lemos 5, 28029, Madrid, Spain

    Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Carlos III Institute of Health, Avenida Monforte de Lemos 5, 28029, Madrid, Spain

    Cancer Epidemiology Research Group, Oncology and Hematology Area, IIS Puerta de Hierro (IDIPHIM), Manuel de Falla 1, 28222, Madrid, Spain
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  • Elena Boldo
    Affiliations
    Cancer Epidemiology Unit, National Centre for Epidemiology, Carlos III Institute of Health, Avenida Monforte de Lemos 5, 28029, Madrid, Spain

    Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Carlos III Institute of Health, Avenida Monforte de Lemos 5, 28029, Madrid, Spain

    Cancer Epidemiology Research Group, Oncology and Hematology Area, IIS Puerta de Hierro (IDIPHIM), Manuel de Falla 1, 28222, Madrid, Spain
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  • Beatriz Pérez-Gómez
    Affiliations
    Cancer Epidemiology Unit, National Centre for Epidemiology, Carlos III Institute of Health, Avenida Monforte de Lemos 5, 28029, Madrid, Spain

    Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Carlos III Institute of Health, Avenida Monforte de Lemos 5, 28029, Madrid, Spain

    Cancer Epidemiology Research Group, Oncology and Hematology Area, IIS Puerta de Hierro (IDIPHIM), Manuel de Falla 1, 28222, Madrid, Spain
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  • Virginia Lope
    Affiliations
    Cancer Epidemiology Unit, National Centre for Epidemiology, Carlos III Institute of Health, Avenida Monforte de Lemos 5, 28029, Madrid, Spain

    Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Carlos III Institute of Health, Avenida Monforte de Lemos 5, 28029, Madrid, Spain

    Cancer Epidemiology Research Group, Oncology and Hematology Area, IIS Puerta de Hierro (IDIPHIM), Manuel de Falla 1, 28222, Madrid, Spain
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  • Jone M. Altzibar
    Affiliations
    Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Carlos III Institute of Health, Avenida Monforte de Lemos 5, 28029, Madrid, Spain

    Breast Cancer Screening Program, Osakidetza-Health Basque Region Service, Avenida Navarra, 4, 20013, San Sebastián, Spain
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  • Vicente Martín
    Affiliations
    Grupo de Investigación en Interacciones Gen-Ambiente y Salud, Universidad de León, Campus Vegazana, s/n, 24071, León, Spain
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  • Gemma Castaño-Vinyals
    Affiliations
    Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Carlos III Institute of Health, Avenida Monforte de Lemos 5, 28029, Madrid, Spain

    ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Carrer del Doctor Aiguader 88, 08003, Barcelona, Spain

    Universitat Pompeu Fabra (UPF), Carrer del Doctor Aiguader 88, 08003, Barcelona, Spain

    IMIM (Hospital del Mar Medical Research Institute), Carrer del Doctor Aiguader 88, 08003, Barcelona, Spain
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  • Marcela Guevara
    Affiliations
    Early Detection Section, Public Health Institute of Navarra, Calle Leyre 15, 31003, Pamplona, Spain
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  • Trinidad Dierssen-Sotos
    Affiliations
    Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Carlos III Institute of Health, Avenida Monforte de Lemos 5, 28029, Madrid, Spain

    Universidad de Cantabria – IDIVAL, Avenida Cardenal Herrera Oria s/n, 39011 Santander, Spain
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  • Adonina Tardón
    Affiliations
    Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Carlos III Institute of Health, Avenida Monforte de Lemos 5, 28029, Madrid, Spain

    Instituto Universitario de Oncología, Universidad de Oviedo, Facultad de Medicina, Planta 7, Campus de El Cristo B, 33006, Oviedo, Spain
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  • Víctor Moreno
    Affiliations
    Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Carlos III Institute of Health, Avenida Monforte de Lemos 5, 28029, Madrid, Spain

    IDIBELL-Catalan Institute of Oncology, Gran Via km 2.7, 08907, L’Hospitalet de Llobregat, Spain

    Department of Clinical Sciences, Faculty of Medicine, University of Barcelona, Campus de Bellvitge, Pavelló de Govern, Feixa Llarga s/n, 08907, L'Hospitalet del Llobregat, Spain
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  • Montserrat Puig-Vives
    Affiliations
    Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health, Autonomous Government of Catalonia, Catalan Institute of Oncology, Girona Biomedical Research Institute (IdiBGi), Carrer del Sol 15, 17004 Girona, Spain
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  • Cristóbal Llorens-Ivorra
    Affiliations
    Centro de Salud Pública de Dénia, Consellería de Sanidad Universal y Salud Pública, Plaza Jaime I, 5, 03700, Denia, Spain

    Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Avda. Cataluña, 21, 46020, Valencia, Spain
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  • Juan Alguacil
    Affiliations
    Centro de Investigación en Salud y Medio Ambiente (CYSMA), Universidad de Huelva, Campus Universitario de El Carmen, 21071, Huelva, Spain
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  • Inés Gómez-Acebo
    Affiliations
    Universidad de Cantabria – IDIVAL, Avenida Cardenal Herrera Oria s/n, 39011 Santander, Spain
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  • Jesús Castilla
    Affiliations
    Early Detection Section, Public Health Institute of Navarra, Calle Leyre 15, 31003, Pamplona, Spain
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  • Esther Gràcia-Lavedán
    Affiliations
    Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Carlos III Institute of Health, Avenida Monforte de Lemos 5, 28029, Madrid, Spain

    ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Carrer del Doctor Aiguader 88, 08003, Barcelona, Spain

    Universitat Pompeu Fabra (UPF), Carrer del Doctor Aiguader 88, 08003, Barcelona, Spain
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  • Verónica Dávila-Batista
    Affiliations
    Grupo de Investigación en Interacciones Gen-Ambiente y Salud, Universidad de León, Campus Vegazana, s/n, 24071, León, Spain
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  • Manolis Kogevinas
    Affiliations
    Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Carlos III Institute of Health, Avenida Monforte de Lemos 5, 28029, Madrid, Spain

    ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Carrer del Doctor Aiguader 88, 08003, Barcelona, Spain

    Universitat Pompeu Fabra (UPF), Carrer del Doctor Aiguader 88, 08003, Barcelona, Spain

    IMIM (Hospital del Mar Medical Research Institute), Carrer del Doctor Aiguader 88, 08003, Barcelona, Spain
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  • Nuria Aragonés
    Affiliations
    Cancer Epidemiology Unit, National Centre for Epidemiology, Carlos III Institute of Health, Avenida Monforte de Lemos 5, 28029, Madrid, Spain

    Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Carlos III Institute of Health, Avenida Monforte de Lemos 5, 28029, Madrid, Spain

    Cancer Epidemiology Research Group, Oncology and Hematology Area, IIS Puerta de Hierro (IDIPHIM), Manuel de Falla 1, 28222, Madrid, Spain
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  • Pilar Amiano
    Affiliations
    Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Carlos III Institute of Health, Avenida Monforte de Lemos 5, 28029, Madrid, Spain

    Public Health Department of Gipuzkoa, Government of the Basque Country, Avenida Navarra, 4, 20013, San Sebastian, Spain

    Biodonostia Research Institute, Paseo Dr Beguiristain s/n, 20014, San Sebastian, Spain
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  • Marina Pollán
    Affiliations
    Cancer Epidemiology Unit, National Centre for Epidemiology, Carlos III Institute of Health, Avenida Monforte de Lemos 5, 28029, Madrid, Spain

    Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Carlos III Institute of Health, Avenida Monforte de Lemos 5, 28029, Madrid, Spain

    Cancer Epidemiology Research Group, Oncology and Hematology Area, IIS Puerta de Hierro (IDIPHIM), Manuel de Falla 1, 28222, Madrid, Spain
    Search for articles by this author

      Highlights

      • The association of three dietary patterns with breast cancer risk was evaluated in a case-control study. The dietary patterns were Western, Prudent and Mediterranean.
      • Greater adherence to the Western dietary pattern seems to increase breast cancer risk in both premenopausal and postmenopausal women.
      • While greater adherence to the Prudent pattern did not show any effect on breast cancer risk, the Mediterranean dietary pattern could be protective, but only in postmenopausal women.
      • Tumour subtype was unaffected by dietary pattern.
      • Dietary recommendations based on a departure from the Western dietary pattern in favour of the Mediterranean diet could reduce breast cancer risk in the general population.

      Abstract

      Objective

      To externally validate the previously identified effect on breast cancer risk of the Western, Prudent and Mediterranean dietary patterns.

      Study design

      MCC-Spain is a multicase-control study that collected epidemiological information on 1181 incident cases of female breast cancer and 1682 healthy controls from 10 Spanish provinces. Three dietary patterns derived in another Spanish case-control study were analysed in the MCC-Spain study. These patterns were termed Western (high intakes of fatty and sugary products and red and processed meat), Prudent (high intakes of low-fat dairy products, vegetables, fruits, whole grains and juices) and Mediterranean (high intake of fish, vegetables, legumes, boiled potatoes, fruits, olives, and vegetable oil, and a low intake of juices). Their association with breast cancer was assessed using logistic regression models with random province-specific intercepts considering an interaction with menopausal status. Risk according to tumour subtypes – based on oestrogen (ER), progesterone (PR) and human epidermal growth factor 2 (HER2) receptors (ER+/PR+ & HER2−; HER2+; ER−/PR− & HER2−) – was evaluated with multinomial regression models.

      Main outcome measures

      Breast cancer and histological subtype.

      Results

      Our results confirm most of the associations found in the previous case-control study. A high adherence to the Western dietary pattern seems to increase breast cancer risk in both premenopausal women (OR4thvs.1stquartile (95% CI):1.68 (1.02;2.79); OR1SD-increase (95% CI):1.19 (1.02;1.40)) and postmenopausal women (OR4thvs.1stquartile(95% CI):1.48(1.07;2.05); OR1SD-increase(95% CI): 1.14 (1.01;1.29)). While high adherence to the Prudent pattern did not show any effect on breast cancer, the Mediterranean dietary pattern seemed to be protective, but only among postmenopausal women (OR4thvs.1stquartile (95% CI): 0.72 (95% CI 0.53;0.98); p-int = 0.075). There were no significant differences by tumour subtype.

      Conclusion

      Dietary recommendations based on a departure from the Western dietary pattern in favour of the Mediterranean diet could reduce breast cancer risk in the general population.

      Abbreviations:

      BC (breast cancer), EpiGEICAM (epidemiological study of the Spanish Group for Breast Cancer Research (Grupo Español de Investigación en Cáncer de Mama)), MCC-Spain (multicase-control study on common tumours in Spain), OR (odds ratio), 95%CI (95% Confidence Interval), FFQ (food frequency questionnaire), ER (oestrogen receptor), PR (progesterone receptor), HER2 (human epidermal growth factor receptor 2), TN (triple negative), SD (standard deviation), IQI (interquartile interval), BMI (body mass index), METs (metabolic equivalents), Kcal (kilocalories), PAF (population attributable fraction), n (number of individuals), p-int (p-value for the interaction), p-het (p-value for the heterogeneity), p-trend (p-value for trend)

      Keywords

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