Skip to main content
PMC home page
Journal of Epidemiology and Community Health logoLink to Journal of Epidemiology and Community Health
. 1998 Feb;52(2):105–110. doi: 10.1136/jech.52.2.105

Case-control study of breast cancer in south east England: nutritional factors

J Cade, E Thomas, A Vail
PMCID: PMC1756672  PMID: 9578857

Abstract

OBJECTIVES: To explore dietary risk factors, in particular fat intake, for breast cancer, using an approach to reduce recall bias of subjects and so provide a more reliable estimate of dietary intake than previous similar studies. DESIGN: A case-control study of women aged 50-65 years attending the breast assessment clinics of the breast screening programme in Southampton and Portsmouth, southern England. Data were analysed for all women requiring further clinical procedures; all women recalled to have an early rescreen; and a random sample of women found to be normal and referred for a routine rescreening appointment (standard recall). MEASUREMENTS: An interview obtained information on various lifestyle characteristics including smoking and alcohol intake, weight, waist, and hip measurements were also taken at the clinic. Women were given a detailed questionnaire on food intake to complete at home and return by post. RESULTS: 1577 women were included in the study: 220 with breast cancer (cases); 179 with benign breast disease; 353 early rescreen and 825 given a standard recall appointment. There were few differences in nutritional intake between the four groups. Logistic regression analyses were carried out comparing the dietary intake of cases with that of each control group adjusting for important demographic and reproductive factors. Results for the case and standard recall comparison are presented. The only non-calorific nutrient to reach significance was iron, which was negatively associated with risk (p = 0.03). For fat intake, the odds decreased with increasing polyunsaturated fat (p = 0.15), showed no trend with monounsaturated fat (p = 0.37) and increased (p = 0.10) with increasing saturated fat. No pattern was clear for the other calorie providing nutrients. CONCLUSIONS: In line with recent cohort studies, this study has shown no evidence to support the hypothesis that dietary fat is an important contributor to breast cancer rates. Biases should have been reduced by studying subjects from the screening programme who were at an early stage of disease.

 

Full Text

The Full Text of this article is available as a PDF (132.6 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Armstrong B., Doll R. Environmental factors and cancer incidence and mortality in different countries, with special reference to dietary practices. Int J Cancer. 1975 Apr 15;15(4):617–631. doi: 10.1002/ijc.2910150411. [DOI] [PubMed] [Google Scholar]
  2. Böing H., Martinez L., Frentzel-Beyme R., Oltersdorf U. Regional nutritional pattern and cancer mortality in the Federal Republic of Germany. Nutr Cancer. 1985;7(3):121–130. doi: 10.1080/01635588509513847. [DOI] [PubMed] [Google Scholar]
  3. Cade J. E., Barker D. J., Margetts B. M., Morris J. A. Diet and inequalities in health in three English towns. Br Med J (Clin Res Ed) 1988 May 14;296(6633):1359–1362. doi: 10.1136/bmj.296.6633.1359. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Chen J., Geissler C., Parpia B., Li J., Campbell T. C. Antioxidant status and cancer mortality in China. Int J Epidemiol. 1992 Aug;21(4):625–635. doi: 10.1093/ije/21.4.625. [DOI] [PubMed] [Google Scholar]
  5. Dunn J. E. Cancer epidemiology in populations of the United States--with emphasis on Hawaii and California--and Japan. Cancer Res. 1975 Nov;35(11 Pt 2):3240–3245. [PubMed] [Google Scholar]
  6. Freedman L. S. Meta-analysis of animal experiments on dietary fat intake and mammary tumours. 1994 Mar 15-Apr 15Stat Med. 13(5-7):709–718. doi: 10.1002/sim.4780130531. [DOI] [PubMed] [Google Scholar]
  7. Friedenreich C. M., Howe G. R., Miller A. B. Recall bias in the association of micronutrient intake and breast cancer. J Clin Epidemiol. 1993 Sep;46(9):1009–1017. doi: 10.1016/0895-4356(93)90168-z. [DOI] [PubMed] [Google Scholar]
  8. Friedenreich C. M., Howe G. R., Miller A. B. The effect of recall bias on the association of calorie-providing nutrients and breast cancer. Epidemiology. 1991 Nov;2(6):424–429. doi: 10.1097/00001648-199111000-00006. [DOI] [PubMed] [Google Scholar]
  9. Garland M., Willett W. C., Manson J. E., Hunter D. J. Antioxidant micronutrients and breast cancer. J Am Coll Nutr. 1993 Aug;12(4):400–411. doi: 10.1080/07315724.1993.10718329. [DOI] [PubMed] [Google Scholar]
  10. Garland M., Willett W. C., Manson J. E., Hunter D. J. Antioxidant micronutrients and breast cancer. J Am Coll Nutr. 1993 Aug;12(4):400–411. doi: 10.1080/07315724.1993.10718329. [DOI] [PubMed] [Google Scholar]
  11. Giovannucci E., Stampfer M. J., Colditz G. A., Manson J. E., Rosner B. A., Longnecker M., Speizer F. E., Willett W. C. A comparison of prospective and retrospective assessments of diet in the study of breast cancer. Am J Epidemiol. 1993 Mar 1;137(5):502–511. doi: 10.1093/oxfordjournals.aje.a116703. [DOI] [PubMed] [Google Scholar]
  12. Graham S., Zielezny M., Marshall J., Priore R., Freudenheim J., Brasure J., Haughey B., Nasca P., Zdeb M. Diet in the epidemiology of postmenopausal breast cancer in the New York State Cohort. Am J Epidemiol. 1992 Dec 1;136(11):1327–1337. doi: 10.1093/oxfordjournals.aje.a116445. [DOI] [PubMed] [Google Scholar]
  13. Holmberg L., Ohlander E. M., Byers T., Zack M., Wolk A., Bergström R., Bergkvist L., Thurfjell E., Bruce A., Adami H. O. Diet and breast cancer risk. Results from a population-based, case-control study in Sweden. Arch Intern Med. 1994 Aug 22;154(16):1805–1811. doi: 10.1001/archinte.154.16.1805. [DOI] [PubMed] [Google Scholar]
  14. Holmberg L., Ohlander E. M., Byers T., Zack M., Wolk A., Bergström R., Bergkvist L., Thurfjell E., Bruce A., Adami H. O. Diet and breast cancer risk. Results from a population-based, case-control study in Sweden. Arch Intern Med. 1994 Aug 22;154(16):1805–1811. doi: 10.1001/archinte.154.16.1805. [DOI] [PubMed] [Google Scholar]
  15. Howe G. R., Hirohata T., Hislop T. G., Iscovich J. M., Yuan J. M., Katsouyanni K., Lubin F., Marubini E., Modan B., Rohan T. Dietary factors and risk of breast cancer: combined analysis of 12 case-control studies. J Natl Cancer Inst. 1990 Apr 4;82(7):561–569. doi: 10.1093/jnci/82.7.561. [DOI] [PubMed] [Google Scholar]
  16. Hunter D. J., Manson J. E., Colditz G. A., Stampfer M. J., Rosner B., Hennekens C. H., Speizer F. E., Willett W. C. A prospective study of the intake of vitamins C, E, and A and the risk of breast cancer. N Engl J Med. 1993 Jul 22;329(4):234–240. doi: 10.1056/NEJM199307223290403. [DOI] [PubMed] [Google Scholar]
  17. Hunter D. J., Spiegelman D., Adami H. O., Beeson L., van den Brandt P. A., Folsom A. R., Fraser G. E., Goldbohm R. A., Graham S., Howe G. R. Cohort studies of fat intake and the risk of breast cancer--a pooled analysis. N Engl J Med. 1996 Feb 8;334(6):356–361. doi: 10.1056/NEJM199602083340603. [DOI] [PubMed] [Google Scholar]
  18. Hunter D. J., Willett W. C. Diet, body size, and breast cancer. Epidemiol Rev. 1993;15(1):110–132. doi: 10.1093/oxfordjournals.epirev.a036096. [DOI] [PubMed] [Google Scholar]
  19. Ingram D. M. Trends in diet and breast cancer mortality in England and Wales 1928-1977. Nutr Cancer. 1981;3(2):75–80. doi: 10.1080/01635588109513705. [DOI] [PubMed] [Google Scholar]
  20. Ingram D. M. Trends in diet and breast cancer mortality in England and Wales 1928-1977. Nutr Cancer. 1981;3(2):75–80. doi: 10.1080/01635588109513705. [DOI] [PubMed] [Google Scholar]
  21. Jones D. Y., Schatzkin A., Green S. B., Block G., Brinton L. A., Ziegler R. G., Hoover R., Taylor P. R. Dietary fat and breast cancer in the National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study. J Natl Cancer Inst. 1987 Sep;79(3):465–471. [PubMed] [Google Scholar]
  22. Kelsey J. L. Breast cancer epidemiology: summary and future directions. Epidemiol Rev. 1993;15(1):256–263. doi: 10.1093/oxfordjournals.epirev.a036112. [DOI] [PubMed] [Google Scholar]
  23. Lee H. P., Gourley L., Duffy S. W., Estéve J., Lee J., Day N. E. Dietary effects on breast-cancer risk in Singapore. Lancet. 1991 May 18;337(8751):1197–1200. doi: 10.1016/0140-6736(91)92867-2. [DOI] [PubMed] [Google Scholar]
  24. Pryer J., Brunner E., Elliott P., Nichols R., Dimond H., Marmot M. Who complied with COMA 1984 dietary fat recommendations among a nationally representative sample of British adults in 1986-7 and what did they eat? Eur J Clin Nutr. 1995 Oct;49(10):718–728. [PubMed] [Google Scholar]
  25. Rohan T. E., Bain C. J. Diet in the etiology of breast cancer. Epidemiol Rev. 1987;9:120–145. doi: 10.1093/oxfordjournals.epirev.a036299. [DOI] [PubMed] [Google Scholar]
  26. Rohan T. E., Potter J. D. Retrospective assessment of dietary intake. Am J Epidemiol. 1984 Dec;120(6):876–887. doi: 10.1093/oxfordjournals.aje.a113959. [DOI] [PubMed] [Google Scholar]
  27. Thomas E., Cade J., Vail A. Risk factor analysis of data from assessment clinics in the UK breast screening programme: a case-control study in Portsmouth and Southampton. J Epidemiol Community Health. 1996 Apr;50(2):144–148. doi: 10.1136/jech.50.2.144. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Van't Veer P., Kok F. J., Brants H. A., Ockhuizen T., Sturmans F., Hermus R. J. Dietary fat and the risk of breast cancer. Int J Epidemiol. 1990 Mar;19(1):12–18. doi: 10.1093/ije/19.1.12. [DOI] [PubMed] [Google Scholar]
  29. Willett W. C., Sampson L., Stampfer M. J., Rosner B., Bain C., Witschi J., Hennekens C. H., Speizer F. E. Reproducibility and validity of a semiquantitative food frequency questionnaire. Am J Epidemiol. 1985 Jul;122(1):51–65. doi: 10.1093/oxfordjournals.aje.a114086. [DOI] [PubMed] [Google Scholar]
  30. Willett W. C., Stampfer M. J., Colditz G. A., Rosner B. A., Hennekens C. H., Speizer F. E. Dietary fat and the risk of breast cancer. N Engl J Med. 1987 Jan 1;316(1):22–28. doi: 10.1056/NEJM198701013160105. [DOI] [PubMed] [Google Scholar]
  31. Willett W. C., Stampfer M. J., Underwood B. A., Speizer F. E., Rosner B., Hennekens C. H. Validation of a dietary questionnaire with plasma carotenoid and alpha-tocopherol levels. Am J Clin Nutr. 1983 Oct;38(4):631–639. doi: 10.1093/ajcn/38.4.631. [DOI] [PubMed] [Google Scholar]
  32. Wynder E. L., Stellman S. D. The "over-exposed" control group. Am J Epidemiol. 1992 Mar 1;135(5):459–461. doi: 10.1093/oxfordjournals.aje.a116312. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Epidemiology and Community Health are provided here courtesy of BMJ Publishing Group

RESOURCES