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. 1993 Sep;68(3):627–636. doi: 10.1038/bjc.1993.398

A meta-analysis of studies of dietary fat and breast cancer risk.

N F Boyd 1, L J Martin 1, M Noffel 1, G A Lockwood 1, D L Trichler 1
PMCID: PMC1968413  PMID: 8353053

Abstract

There is strong evidence that breast cancer risk is influenced by environmental factors, and animal experiments and human ecological data suggest that increased dietary fat intake increases the incidence of the disease. Epidemiological evidence on the relationship of dietary fat to breast cancer from cohort and case control studies has however been inconsistent. To examine the available evidence we have carried out a meta-analysis to summarise quantitatively the large published literature on dietary fat in the aetiology of breast cancer. After assembling all of the published case control and cohort studies, we extracted the relative risk in each study that compared the highest to the lowest level of intake. We then calculated a summary relative risk for all studies. The summary relative risk for the 23 studies that examined fat as a nutrient was 1.12 (95% CI 1.04-1.21). Cohort studies had a summary relative risk of 1.01 (95% CI 0.90-1.13) and case control studies a relative risk of 1.21 (95% CI 1.10-1.34). Summary estimates of risk for specific types of fat excluded unity for only saturated fat. For the 19 studies that examined food intake, the summary relative risks were 1.18 (95% CI 1.06-1.32) for meat, 1.17 (95% CI 1.04-1.31) for milk, and 1.17 (95% CI 1.02-1.36) for cheese. Summary relative risks for total fat intake were examined for several potential modifying factors. Regression analysis showed that European studies were more likely than studies done in other countries to show an increased relative risk associated with dietary fat and breast cancer, after taking into account potential modifying factors that included study design and quality.

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Selected References

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  1. Bailar J. C., 3rd, Smith E. M. Progress against cancer? N Engl J Med. 1986 May 8;314(19):1226–1232. doi: 10.1056/NEJM198605083141905. [DOI] [PubMed] [Google Scholar]
  2. Boring C. C., Squires T. S., Tong T. Cancer statistics, 1993. CA Cancer J Clin. 1993 Jan-Feb;43(1):7–26. doi: 10.3322/canjclin.43.1.7. [DOI] [PubMed] [Google Scholar]
  3. Boyd N. F., Cousins M., Lockwood G., Tritchler D. The feasibility of testing experimentally the dietary fat-breast cancer hypothesis. Br J Cancer. 1990 Dec;62(6):878–881. doi: 10.1038/bjc.1990.400. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Cohen L. A., Thompson D. O., Maeura Y., Choi K., Blank M. E., Rose D. P. Dietary fat and mammary cancer. I. Promoting effects of different dietary fats on N-nitrosomethylurea-induced rat mammary tumorigenesis. J Natl Cancer Inst. 1986 Jul;77(1):33–42. [PubMed] [Google Scholar]
  5. DerSimonian R., Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986 Sep;7(3):177–188. doi: 10.1016/0197-2456(86)90046-2. [DOI] [PubMed] [Google Scholar]
  6. Ewertz M., Gill C. Dietary factors and breast-cancer risk in Denmark. Int J Cancer. 1990 Nov 15;46(5):779–784. doi: 10.1002/ijc.2910460505. [DOI] [PubMed] [Google Scholar]
  7. Fleiss J. L., Gross A. J. Meta-analysis in epidemiology, with special reference to studies of the association between exposure to environmental tobacco smoke and lung cancer: a critique. J Clin Epidemiol. 1991;44(2):127–139. doi: 10.1016/0895-4356(91)90261-7. [DOI] [PubMed] [Google Scholar]
  8. Freedman L. S., Clifford C., Messina M. Analysis of dietary fat, calories, body weight, and the development of mammary tumors in rats and mice: a review. Cancer Res. 1990 Sep 15;50(18):5710–5719. [PubMed] [Google Scholar]
  9. 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]
  10. Goodwin P. J., Boyd N. F. Critical appraisal of the evidence that dietary fat intake is related to breast cancer risk in humans. J Natl Cancer Inst. 1987 Sep;79(3):473–485. [PubMed] [Google Scholar]
  11. Graham S., Hellmann R., Marshall J., Freudenheim J., Vena J., Swanson M., Zielezny M., Nemoto T., Stubbe N., Raimondo T. Nutritional epidemiology of postmenopausal breast cancer in western New York. Am J Epidemiol. 1991 Sep 15;134(6):552–566. doi: 10.1093/oxfordjournals.aje.a116129. [DOI] [PubMed] [Google Scholar]
  12. Graham S., Marshall J., Mettlin C., Rzepka T., Nemoto T., Byers T. Diet in the epidemiology of breast cancer. Am J Epidemiol. 1982 Jul;116(1):68–75. doi: 10.1093/oxfordjournals.aje.a113403. [DOI] [PubMed] [Google Scholar]
  13. 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]
  14. Hirayama T. Epidemiology of breast cancer with special reference to the role of diet. Prev Med. 1978 Jun;7(2):173–195. doi: 10.1016/0091-7435(78)90244-x. [DOI] [PubMed] [Google Scholar]
  15. Hirohata T., Nomura A. M., Hankin J. H., Kolonel L. N., Lee J. An epidemiologic study on the association between diet and breast cancer. J Natl Cancer Inst. 1987 Apr;78(4):595–600. [PubMed] [Google Scholar]
  16. Hirohata T., Shigematsu T., Nomura A. M., Nomura Y., Horie A., Hirohata I. Occurrence of breast cancer in relation to diet and reproductive history: a case-control study in Fukuoka, Japan. Natl Cancer Inst Monogr. 1985 Dec;69:187–190. [PubMed] [Google Scholar]
  17. Hislop T. G., Coldman A. J., Elwood J. M., Brauer G., Kan L. Childhood and recent eating patterns and risk of breast cancer. Cancer Detect Prev. 1986;9(1-2):47–58. [PubMed] [Google Scholar]
  18. Hoel D. G., Wakabayashi T., Pike M. C. Secular trends in the distributions of the breast cancer risk factors--menarche, first birth, menopause, and weight--in Hiroshima and Nagasaki, Japan. Am J Epidemiol. 1983 Jul;118(1):78–89. doi: 10.1093/oxfordjournals.aje.a113619. [DOI] [PubMed] [Google Scholar]
  19. Howe G. R., Friedenreich C. M., Jain M., Miller A. B. A cohort study of fat intake and risk of breast cancer. J Natl Cancer Inst. 1991 Mar 6;83(5):336–340. doi: 10.1093/jnci/83.5.336. [DOI] [PubMed] [Google Scholar]
  20. 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]
  21. Ingram D. M., Nottage E., Roberts T. The role of diet in the development of breast cancer: a case-control study of patients with breast cancer, benign epithelial hyperplasia and fibrocystic disease of the breast. Br J Cancer. 1991 Jul;64(1):187–191. doi: 10.1038/bjc.1991.268. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Iscovich J. M., Iscovich R. B., Howe G., Shiboski S., Kaldor J. M. A case-control study of diet and breast cancer in Argentina. Int J Cancer. 1989 Nov 15;44(5):770–776. doi: 10.1002/ijc.2910440504. [DOI] [PubMed] [Google Scholar]
  23. 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]
  24. Kato I., Miura S., Kasumi F., Iwase T., Tashiro H., Fujita Y., Koyama H., Ikeda T., Fujiwara K., Saotome K. A case-control study of breast cancer among Japanese women: with special reference to family history and reproductive and dietary factors. Breast Cancer Res Treat. 1992;24(1):51–59. doi: 10.1007/BF01832358. [DOI] [PubMed] [Google Scholar]
  25. Katsouyanni K., Trichopoulos D., Boyle P., Xirouchaki E., Trichopoulou A., Lisseos B., Vasilaros S., MacMahon B. Diet and breast cancer: a case-control study in Greece. Int J Cancer. 1986 Dec 15;38(6):815–820. doi: 10.1002/ijc.2910380606. [DOI] [PubMed] [Google Scholar]
  26. Katsouyanni K., Willett W., Trichopoulos D., Boyle P., Trichopoulou A., Vasilaros S., Papadiamantis J., MacMahon B. Risk of breast cancer among Greek women in relation to nutrient intake. Cancer. 1988 Jan 1;61(1):181–185. doi: 10.1002/1097-0142(19880101)61:1<181::aid-cncr2820610130>3.0.co;2-j. [DOI] [PubMed] [Google Scholar]
  27. Kinlen L. J. Meat and fat consumption and cancer mortality: A study of strict religious orders in Britain. Lancet. 1982 Apr 24;1(8278):946–949. doi: 10.1016/s0140-6736(82)91943-2. [DOI] [PubMed] [Google Scholar]
  28. Knekt P., Albanes D., Seppänen R., Aromaa A., Järvinen R., Hyvönen L., Teppo L., Pukkala E. Dietary fat and risk of breast cancer. Am J Clin Nutr. 1990 Nov;52(5):903–908. doi: 10.1093/ajcn/52.5.903. [DOI] [PubMed] [Google Scholar]
  29. Kushi L. H., Sellers T. A., Potter J. D., Nelson C. L., Munger R. G., Kaye S. A., Folsom A. R. Dietary fat and postmenopausal breast cancer. J Natl Cancer Inst. 1992 Jul 15;84(14):1092–1099. doi: 10.1093/jnci/84.14.1092. [DOI] [PubMed] [Google Scholar]
  30. La Vecchia C., Decarli A., Franceschi S., Gentile A., Negri E., Parazzini F. Dietary factors and the risk of breast cancer. Nutr Cancer. 1987;10(4):205–214. doi: 10.1080/01635588709513958. [DOI] [PubMed] [Google Scholar]
  31. 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]
  32. Lubin F., Wax Y., Modan B. Role of fat, animal protein, and dietary fiber in breast cancer etiology: a case-control study. J Natl Cancer Inst. 1986 Sep;77(3):605–612. doi: 10.1093/jnci/77.3.605. [DOI] [PubMed] [Google Scholar]
  33. Lubin J. H., Burns P. E., Blot W. J., Ziegler R. G., Lees A. W., Fraumeni J. F., Jr Dietary factors and breast cancer risk. Int J Cancer. 1981 Dec;28(6):685–689. doi: 10.1002/ijc.2910280605. [DOI] [PubMed] [Google Scholar]
  34. Lê M. G., Moulton L. H., Hill C., Kramar A. Consumption of dairy produce and alcohol in a case-control study of breast cancer. J Natl Cancer Inst. 1986 Sep;77(3):633–636. doi: 10.1093/jnci/77.3.633. [DOI] [PubMed] [Google Scholar]
  35. Marshall J. R., Qu Y., Chen J., Parpia B., Campbell T. C. Additional ecological evidence: lipids and breast cancer mortality among women aged 55 and over in China. Eur J Cancer. 1992;28A(10):1720–1727. doi: 10.1016/0959-8049(92)90077-f. [DOI] [PubMed] [Google Scholar]
  36. Matos E. L., Thomas D. B., Sobel N., Vuoto D. Breast cancer in Argentina: case-control study with special reference to meat eating habits. Neoplasma. 1991;38(3):357–366. [PubMed] [Google Scholar]
  37. Miller A. B., Kelly A., Choi N. W., Matthews V., Morgan R. W., Munan L., Burch J. D., Feather J., Howe G. R., Jain M. A study of diet and breast cancer. Am J Epidemiol. 1978 Jun;107(6):499–509. doi: 10.1093/oxfordjournals.aje.a112569. [DOI] [PubMed] [Google Scholar]
  38. Mills P. K., Annegers J. F., Phillips R. L. Animal product consumption and subsequent fatal breast cancer risk among Seventh-day Adventists. Am J Epidemiol. 1988 Mar;127(3):440–453. doi: 10.1093/oxfordjournals.aje.a114821. [DOI] [PubMed] [Google Scholar]
  39. Nomura A., Henderson B. E., Lee J. Breast cancer and diet among the Japanese in Hawaii. Am J Clin Nutr. 1978 Nov;31(11):2020–2025. doi: 10.1093/ajcn/31.11.2020. [DOI] [PubMed] [Google Scholar]
  40. Prentice R. L., Kakar F., Hursting S., Sheppard L., Klein R., Kushi L. H. Aspects of the rationale for the Women's Health Trial. J Natl Cancer Inst. 1988 Aug 3;80(11):802–814. doi: 10.1093/jnci/80.11.802. [DOI] [PubMed] [Google Scholar]
  41. Prentice R. L., Pepe M., Self S. G. Dietary fat and breast cancer: a quantitative assessment of the epidemiological literature and a discussion of methodological issues. Cancer Res. 1989 Jun 15;49(12):3147–3156. [PubMed] [Google Scholar]
  42. Pritchard G. A., Jones D. L., Mansel R. E. Lipids in breast carcinogenesis. Br J Surg. 1989 Oct;76(10):1069–1073. doi: 10.1002/bjs.1800761028. [DOI] [PubMed] [Google Scholar]
  43. Pryor M., Slattery M. L., Robison L. M., Egger M. Adolescent diet and breast cancer in Utah. Cancer Res. 1989 Apr 15;49(8):2161–2167. [PubMed] [Google Scholar]
  44. Richardson S., Gerber M., Cenée S. The role of fat, animal protein and some vitamin consumption in breast cancer: a case control study in southern France. Int J Cancer. 1991 Apr 22;48(1):1–9. doi: 10.1002/ijc.2910480102. [DOI] [PubMed] [Google Scholar]
  45. Rogers A. E., Lee S. Y. Chemically-induced mammary gland tumors in rats: modulation by dietary fat. Prog Clin Biol Res. 1986;222:255–282. [PubMed] [Google Scholar]
  46. Rohan T. E., McMichael A. J., Baghurst P. A. A population-based case-control study of diet and breast cancer in Australia. Am J Epidemiol. 1988 Sep;128(3):478–489. doi: 10.1093/oxfordjournals.aje.a114996. [DOI] [PubMed] [Google Scholar]
  47. Sarin R., Tandon R. K., Paul S., Gandhi B. M., Kapur B. M., Kapur K. Diet, body fat & plasma lipids in breast cancer. Indian J Med Res. 1985 May;81:493–498. [PubMed] [Google Scholar]
  48. Sasaki S., Kesteloot H. Value of Food and Agriculture Organization data on food-balance sheets as a data source for dietary fat intake in epidemiologic studies. Am J Clin Nutr. 1992 Oct;56(4):716–723. doi: 10.1093/ajcn/56.4.716. [DOI] [PubMed] [Google Scholar]
  49. Spitzer W. O. Meta-meta-analysis: unanswered questions about aggregating data. J Clin Epidemiol. 1991;44(2):103–107. doi: 10.1016/0895-4356(91)90258-b. [DOI] [PubMed] [Google Scholar]
  50. Talamini R., La Vecchia C., Decarli A., Franceschi S., Grattoni E., Grigoletto E., Liberati A., Tognoni G. Social factors, diet and breast cancer in a northern Italian population. Br J Cancer. 1984 Jun;49(6):723–729. doi: 10.1038/bjc.1984.114. [DOI] [PMC free article] [PubMed] [Google Scholar]
  51. Toniolo P., Riboli E., Protta F., Charrel M., Cappa A. P. Calorie-providing nutrients and risk of breast cancer. J Natl Cancer Inst. 1989 Feb 15;81(4):278–286. doi: 10.1093/jnci/81.4.278. [DOI] [PubMed] [Google Scholar]
  52. Van 't Veer P., van Leer E. M., Rietdijk A., Kok F. J., Schouten E. G., Hermus R. J., Sturmans F. Combination of dietary factors in relation to breast-cancer occurrence. Int J Cancer. 1991 Mar 12;47(5):649–653. doi: 10.1002/ijc.2910470503. [DOI] [PubMed] [Google Scholar]
  53. 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]
  54. Vatten L. J., Solvoll K., Løken E. B. Frequency of meat and fish intake and risk of breast cancer in a prospective study of 14,500 Norwegian women. Int J Cancer. 1990 Jul 15;46(1):12–15. doi: 10.1002/ijc.2910460105. [DOI] [PubMed] [Google Scholar]
  55. Welsch C. W. Interrelationship between dietary fat and endocrine processes in mammary gland tumorigenesis. Prog Clin Biol Res. 1986;222:623–654. [PubMed] [Google Scholar]
  56. Willett W. C., Hunter D. J., Stampfer M. J., Colditz G., Manson J. E., Spiegelman D., Rosner B., Hennekens C. H., Speizer F. E. Dietary fat and fiber in relation to risk of breast cancer. An 8-year follow-up. JAMA. 1992 Oct 21;268(15):2037–2044. [PubMed] [Google Scholar]
  57. 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]
  58. 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]
  59. Yu S. Z., Lu R. F., Xu D. D., Howe G. R. A case-control study of dietary and nondietary risk factors for breast cancer in Shanghai. Cancer Res. 1990 Aug 15;50(16):5017–5021. [PubMed] [Google Scholar]
  60. Zaridze D., Lifanova Y., Maximovitch D., Day N. E., Duffy S. W. Diet, alcohol consumption and reproductive factors in a case-control study of breast cancer in Moscow. Int J Cancer. 1991 Jun 19;48(4):493–501. doi: 10.1002/ijc.2910480404. [DOI] [PubMed] [Google Scholar]
  61. van den Brandt P. A., van't Veer P., Goldbohm R. A., Dorant E., Volovics A., Hermus R. J., Sturmans F. A prospective cohort study on dietary fat and the risk of postmenopausal breast cancer. Cancer Res. 1993 Jan 1;53(1):75–82. [PubMed] [Google Scholar]
  62. van't Veer P., Dekker J. M., Lamers J. W., Kok F. J., Schouten E. G., Brants H. A., Sturmans F., Hermus R. J. Consumption of fermented milk products and breast cancer: a case-control study in The Netherlands. Cancer Res. 1989 Jul 15;49(14):4020–4023. [PubMed] [Google Scholar]

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