Table 2.

Studies evaluating postdiagnosis total dietary fat in relation to breast cancer and all-cause mortality^a

Reference	Location	Design	Sample (n)	Dietary assessment method	Contrast	RR/HR (95% CI) for breast cancer mortality	RR/HR (95% CI) for all-cause mortality	Covariates
Newman et al. 1986 (42)	Canada	Prospective cohort study (follow-up of cases from a case-control study)	300 females with nonmetastatic disease Age: 3 5–74 years 87 deaths 73 breast cancer deaths	Diet history, 24-hour recall Diet record	RR of dying from breast cancer associated with greater than average daily total fat intake (77.7 g) near diagnosis	0.99 (p = 0.963)	Not available	Weight near time of diagnosis
Nomura et al. 1991 (43)	United States (Hawaii)	Prospective cohort study (follow-up of cases from a case-control study)	182 Japanese 161 Caucasian Age: 45–74 years	Diet history interview	High versus low fat intake (g/wk)	In Japanese women: 0.66 (0.25–1.76) In Caucasian women: 3.17 (1.17–8.55)	Not available	Disease stage, menopausal status, obesity index, estrogen use
Ewertz et al. 1991 (20)	Denmark	Prospective cohort study	2,445 patients with stage I—III invasive breast cancer Age: < 70 years 805 deaths	FFQ	Fat consumption (quartiles) Quartile 4 versus 1	Not available	0.96 (0.75–1.22)	Tumor size, skin invasion, number of positive lymph nodes, grade, and stratified for residence
Rohan et al. 1993 (50)	Australia	Prospective cohort study (follow-up of cases from a case-control study)	412 cases Age: 20–74 years 112 breast cancer deaths	FFQ	Total fat (g) Quintile 5 versus 1	1.40 (0.66–2.96)	Not available	Energy, age at menarche, BMI
Holmes et al. 1999 (25)	United States	Prospective cohort study	1,982 women with invasive breast cancer 686 premenopausal 1,267 postmenopausal	FFQ	Total fat (g) Quintile 5 versus 1	1.44 (1.01–2.04)	1.51 (1.02–2.24)	Age, diet interval, calendar year of diagnosis, BMI, oral contraceptive use, menopausal status, HRT, smoking, age at first birth and parity, number of metastatic lymph nodes, tumor size, energy
Goodwin et al. 2003 (22)	Canada	Prospective cohort study	477 women with surgically resected breast cancer Age <75 years 52 deaths 50 breast cancer deaths	FFQ	Quadratic form of: Total fat (g/d) Quintile 1 versus 5	Not available	2.9 (p = 0.10) 1.7 (p = 0.03)	Age, energy, BMI, tumor and nodule stage, HRT, adjuvant chemotherapy
					Total fat (% energy) Quintile 1 versus 5
Chlebowski et al. 2006 (15)	United States	RCT	2,437 women with resected early-stage breast cancer receiving conventional cancer management Intervention: n = 975 Control: n = 1,462 Age: 48–79 years	Intervention: low-fat diet postdiagno- sis (20% of energy from fat) Both groups had 30% of energy from fat at baseline	Overall survival in intervention versus control	Not available	0.89 (0.65–1.21)	Systemic adjuvant therapy, nodal status, tumor size, mastectomy
					Recurrence-free survival in intervention versus control	0.71 (0.53–0.94)
					Disease-free survival in intervention versus control	0.81 (0.65–0.99)
					Relapse-free survival in intervention versus control	0.76 (0.60–0.98)
Pierce et al. 2007 (46)	United States	RCT	3,088 women previously treated for early breast cancer Age: 18–70 years Intervention: n = 1,537 155 deaths 127 breast cancer deaths Control: n = 1,551 160 deaths 135 breast cancer Deaths	Intervention: Very high vegetable, fruit, and fiber and low-fat diet Control: 5-a-day dietary guidelines	Intervention effects: Fat (% energy) Quartile 4 versus 1	Not available	0.98 (0.64–1.49)	Anti-estrogen use, oophorectomy status, and stratification factors (tumor stage, clinic site, and age)
Beasley et al. 2011 (9)	United States	Prospective cohort study	4,441 women with history of invasive breast cancer and no history of recurrence Age: 29–70 years 525 breast cancer Deaths	FFQ	Total fat (% energy)			Age, state of residence, menopausal status, smoking, disease stage, alcohol, history of HRT, energy, treatment, BMI, physical activity
					Quintile 5 versus 1	0.92 (0.53–1.60)	1.05 (0.79–1.39)

^aAbbreviations: BMI, body mass index; FFQ, food frequency questionnaire; HR, hazard ratio; HRT, hormone replacement therapy; RCT, randomized controlled trial; RR, rate ratio.