TABLE 4.
Associations (HRs and 95% CIs) between quartiles of the Alternative Mediterranean Diet (AMED) and risk of breast cancer outcomes in the Sister Study1
| Q1 | Q2 | Q3 | Q4 | P for trend2 | |
|---|---|---|---|---|---|
| Total invasive breast cancer | |||||
| Cases, n | 346 | 579 | 285 | 490 | |
| Age-adjusted | 1.00 (reference) | 1.03 (0.90, 1.17) | 1.00 (0.85, 1.17) | 1.02 (0.88, 1.17) | 0.84 |
| MV-adjusted3 | 1.00 (reference) | 0.98 (0.86, 1.13) | 0.92 (0.78, 1.08) | 0.90 (0.77, 1.06) | 0.07 |
| MV-adjusted excluding alcohol3, 4 | 1.00 (reference) | 1.03 (0.88, 1.19) | 0.91 (0.80, 1.05) | 0.89 (0.76, 1.05) | 0.02 |
| ER+ breast cancer | |||||
| Cases, n | 259 | 426 | 211 | 373 | |
| Age-adjusted | 1.00 (reference) | 1.00 (0.86, 1.17) | 0.98 (0.81, 1.17) | 1.02 (0.87, 1.20) | 0.98 |
| MV-adjusted2 | 1.00 (reference) | 0.95 (0.81, 1.11) | 0.88 (0.73, 1.06) | 0.87 (0.73, 1.05) | 0.05 |
| MV-adjusted excluding alcohol3, 4 | 1.00 (reference) | 0.95 (0.79, 1.13) | 0.86 (0.74, 1.01) | 0.86 (0.71, 1.03) | 0.02 |
| ER– breast cancer | |||||
| Cases, n | 46 | 73 | 37 | 61 | |
| Age-adjusted | 1.00 (reference) | 0.99 (0.68, 1.43) | 1.01 (0.65, 1.55) | 0.97 (0.66, 1.43) | 0.82 |
| MV-adjusted3 | 1.00 (reference) | 0.93 (0.64, 1.36) | 0.90 (0.57, 1.42) | 0.83 (0.54, 1.29) | 0.33 |
| MV-adjusted excluding alcohol3, 4 | 1.00 (reference) | 1.07 (0.69, 1.64) | 0.99 (0.68, 1.45) | 0.86 (0.55, 1.35) | 0.24 |
| ER+/PR+ breast cancer | |||||
| Cases, n | 214 | 366 | 175 | 306 | |
| Age-adjusted | 1.00 (reference) | 1.05 (0.89, 1.25) | 1.00 (0.81, 1.22) | 1.03 (0.87, 1.23) | 0.98 |
| MV-adjusted3 | 1.00 (reference) | 1.00 (0.84, 1.19) | 0.90 (0.73, 1.11) | 0.90 (0.73, 1.10) | 0.12 |
| MV-adjusted excluding alcohol3, 4 | 1.00 (reference) | 1.01 (0.83, 1.23) | 0.91 (0.76, 1.08) | 0.87 (0.72, 1.07) | 0.06 |
| ER–/PR– breast cancer | |||||
| Cases, n | 42 | 64 | 36 | 57 | |
| Age-adjusted | 1.00 (reference) | 0.95 (0.64, 1.40) | 1.07 (0.69, 1.68) | 1.00 (0.67, 1.49) | 0.92 |
| MV-adjusted3 | 1.00 (reference) | 0.88 (0.59, 1.30) | 0.92 (0.58, 1.48) | 0.80 (0.51, 1.27) | 0.25 |
| MV-adjusted excluding alcohol3, 4 | 1.00 (reference) | 1.05 (0.67, 1.65) | 0.94 (0.63, 1.41) | 0.80 (0.50, 1.29) | 0.18 |
| ER–/PR–/HER2– breast cancer | |||||
| Cases, n | 28 | 51 | 28 | 33 | |
| Age-adjusted | 1.00 (reference) | 1.14 (0.72, 1.82) | 1.27 (0.75, 2.14) | 0.88 (0.53, 1.46) | 0.51 |
| MV-adjusted3 | 1.00 (reference) | 1.03 (0.64, 1.66) | 1.05 (0.60, 1.82) | 0.68 (0.38, 1.20) | 0.11 |
| MV-adjusted excluding alcohol3, 4 | 1.00 (reference) | 1.28 (0.76, 2.16) | 1.03 (0.64, 1.66) | 0.66 (0.37, 1.19) | 0.07 |
Values are HRs (95% CIs) unless otherwise indicated. ER, estrogen receptor; HER2, human epidermal growth factor receptor-2; MET, metabolic equivalent of task; MV, multivariable; PR, progesterone receptor.
P value for the continuous AMED score (Wald test).
Adjusted for total energy intake (kcal/d, continuous), race/ethnicity (white [reference], black, other), income (<$50,000 [reference], $50,000 to <$100,000, ≥$100,000/y), smoking (0, >0 to <10, 10 to <20, 20 to <30, ≥30 pack-years), BMI (<18.5, 18.5 to <25 [reference], 25 to <30, 30 to <35, ≥35 kg/m2), physical activity (MET-h/wk, continuous), height (inches, continuous), education (high school or less [reference], some college, college graduate or more), mother diagnosed with breast cancer (yes vs. no [reference]), age at first live birth (nulliparous [reference], <21, 21 to <25, 25 to <29, 29–32, >32 y), parity (0 or 1 [reference], 2 or 3, 4 or more), hormone replacement therapy (none [reference], estrogen only, estrogen and progesterone, both estrogen and progesterone), age at menopause (premenopausal [reference], <40, 40 to <50, 50 to <55, ≥55 y), oral contraception use (yes [reference] vs. no), age at menarche (<12 [reference], 12 to <12.5, 12.5 to <13.5, 13.5 to <14.5, ≥14.5 y), lifetime duration of breastfeeding (0 [reference], >0 to <50, 50 to <100, ≥100 wk), and time of last mammogram (<1 [reference], 1 to <2, ≥2 y ago).
Additionally adjusted for alcohol intake (none [reference], <0.5, ≥0.5 to 1, ≥1 to 2, ≥2 drinks/d).