Association of Low-Fat Dietary Pattern with Breast Cancer Overall Survival

A Secondary Analysis of the Women's Health Initiative Randomized Clinical Trial

Rowan T. Chlebowski, Aaron K. Aragaki, Garnet L. Anderson, Michael S. Simon, Joann E. Manson, Marian L. Neuhouser, Kathy Pan, Marcia L. Stefanic, Thomas E. Rohan, Dorothy Lane, Lihong Qi, Linda Snetselaar, Ross L. Prentice

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Importance: In a randomized clinical trial, a low-fat eating pattern was associated with lower risk of death after breast cancer. However, the extent to which results were driven by dietary influence on survival after breast cancer diagnosis was unknown. Objective: To determine the association of a low-fat dietary pattern with breast cancer overall survival (breast cancer followed by death from any cause measured from cancer diagnosis). Design, Setting, and Participants: This is a secondary analysis of the Women's Health Initiative randomized clinical trial that was conducted at 40 US clinical centers enrolling participants from 1993 through 1998. Participants were 48835 postmenopausal women with no previous breast cancer and dietary fat intake of greater than 32% by food frequency questionnaire. Interventions: Participants were randomized to a dietary intervention group (40%; n = 19541) with goals to reduce fat intake to 20% of energy and increase fruit, vegetable, and grain intake or a usual-diet comparison group (60%; n = 29294). Dietary group participants with incident breast cancers continued to participate in subsequent dietary intervention activities. Main Outcomes and Measures: Breast cancer overall survival for incident breast cancers diagnosed during the 8.5-year (median) dietary intervention, examined in post hoc analyses after 11.5 years (median) postdiagnosis follow-up. Results: Of 1764 women diagnosed with breast cancer during the dietary intervention period, mean (SD) age at screening was 62.7 (6.7) years and age at diagnosis was 67.6 (6.9) years. With 516 total deaths, breast cancer overall survival was significantly greater for women in the dietary intervention group than in the usual-diet comparison group (10-year survival of 82% and 78%, respectively; hazard ratio [HR], 0.78; 95% CI, 0.65-0.94; P =.01). In the dietary group there were fewer deaths from breast cancer (68 vs 120; HR, 0.86; 95% CI, 0.64-1.17), other cancers (36 vs 65; HR, 0.76; 95% CI, 0.50-1.17), and cardiovascular disease (27 vs 64; HR, 0.62; 95% CI, 0.39-0.99). Conclusions and Relevance: In women who received a diagnosis of breast cancer during the dietary intervention period, those in the dietary group had increased overall survival. The increase is due, in part, to better survival from several causes of death. Trial Registration: ClinicalTrials.gov Identifier: NCT00000611.

Original languageEnglish (US)
Article numbere181212
JournalJAMA oncology
Volume4
Issue number10
DOIs
StatePublished - Oct 1 2018

Fingerprint

Dietary Fats
Women's Health
Randomized Controlled Trials
Breast Neoplasms
Survival
Cause of Death
Fats
Diet
Vegetables
Fruit
Neoplasms
Cardiovascular Diseases
Eating
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Chlebowski, R. T., Aragaki, A. K., Anderson, G. L., Simon, M. S., Manson, J. E., Neuhouser, M. L., ... Prentice, R. L. (2018). Association of Low-Fat Dietary Pattern with Breast Cancer Overall Survival: A Secondary Analysis of the Women's Health Initiative Randomized Clinical Trial. JAMA oncology, 4(10), [e181212]. https://doi.org/10.1001/jamaoncol.2018.1212

Association of Low-Fat Dietary Pattern with Breast Cancer Overall Survival : A Secondary Analysis of the Women's Health Initiative Randomized Clinical Trial. / Chlebowski, Rowan T.; Aragaki, Aaron K.; Anderson, Garnet L.; Simon, Michael S.; Manson, Joann E.; Neuhouser, Marian L.; Pan, Kathy; Stefanic, Marcia L.; Rohan, Thomas E.; Lane, Dorothy; Qi, Lihong; Snetselaar, Linda; Prentice, Ross L.

In: JAMA oncology, Vol. 4, No. 10, e181212, 01.10.2018.

Research output: Contribution to journalArticle

Chlebowski, RT, Aragaki, AK, Anderson, GL, Simon, MS, Manson, JE, Neuhouser, ML, Pan, K, Stefanic, ML, Rohan, TE, Lane, D, Qi, L, Snetselaar, L & Prentice, RL 2018, 'Association of Low-Fat Dietary Pattern with Breast Cancer Overall Survival: A Secondary Analysis of the Women's Health Initiative Randomized Clinical Trial', JAMA oncology, vol. 4, no. 10, e181212. https://doi.org/10.1001/jamaoncol.2018.1212
Chlebowski, Rowan T. ; Aragaki, Aaron K. ; Anderson, Garnet L. ; Simon, Michael S. ; Manson, Joann E. ; Neuhouser, Marian L. ; Pan, Kathy ; Stefanic, Marcia L. ; Rohan, Thomas E. ; Lane, Dorothy ; Qi, Lihong ; Snetselaar, Linda ; Prentice, Ross L. / Association of Low-Fat Dietary Pattern with Breast Cancer Overall Survival : A Secondary Analysis of the Women's Health Initiative Randomized Clinical Trial. In: JAMA oncology. 2018 ; Vol. 4, No. 10.
@article{b5b93f332cd64cb8a062d17db571458b,
title = "Association of Low-Fat Dietary Pattern with Breast Cancer Overall Survival: A Secondary Analysis of the Women's Health Initiative Randomized Clinical Trial",
abstract = "Importance: In a randomized clinical trial, a low-fat eating pattern was associated with lower risk of death after breast cancer. However, the extent to which results were driven by dietary influence on survival after breast cancer diagnosis was unknown. Objective: To determine the association of a low-fat dietary pattern with breast cancer overall survival (breast cancer followed by death from any cause measured from cancer diagnosis). Design, Setting, and Participants: This is a secondary analysis of the Women's Health Initiative randomized clinical trial that was conducted at 40 US clinical centers enrolling participants from 1993 through 1998. Participants were 48835 postmenopausal women with no previous breast cancer and dietary fat intake of greater than 32{\%} by food frequency questionnaire. Interventions: Participants were randomized to a dietary intervention group (40{\%}; n = 19541) with goals to reduce fat intake to 20{\%} of energy and increase fruit, vegetable, and grain intake or a usual-diet comparison group (60{\%}; n = 29294). Dietary group participants with incident breast cancers continued to participate in subsequent dietary intervention activities. Main Outcomes and Measures: Breast cancer overall survival for incident breast cancers diagnosed during the 8.5-year (median) dietary intervention, examined in post hoc analyses after 11.5 years (median) postdiagnosis follow-up. Results: Of 1764 women diagnosed with breast cancer during the dietary intervention period, mean (SD) age at screening was 62.7 (6.7) years and age at diagnosis was 67.6 (6.9) years. With 516 total deaths, breast cancer overall survival was significantly greater for women in the dietary intervention group than in the usual-diet comparison group (10-year survival of 82{\%} and 78{\%}, respectively; hazard ratio [HR], 0.78; 95{\%} CI, 0.65-0.94; P =.01). In the dietary group there were fewer deaths from breast cancer (68 vs 120; HR, 0.86; 95{\%} CI, 0.64-1.17), other cancers (36 vs 65; HR, 0.76; 95{\%} CI, 0.50-1.17), and cardiovascular disease (27 vs 64; HR, 0.62; 95{\%} CI, 0.39-0.99). Conclusions and Relevance: In women who received a diagnosis of breast cancer during the dietary intervention period, those in the dietary group had increased overall survival. The increase is due, in part, to better survival from several causes of death. Trial Registration: ClinicalTrials.gov Identifier: NCT00000611.",
author = "Chlebowski, {Rowan T.} and Aragaki, {Aaron K.} and Anderson, {Garnet L.} and Simon, {Michael S.} and Manson, {Joann E.} and Neuhouser, {Marian L.} and Kathy Pan and Stefanic, {Marcia L.} and Rohan, {Thomas E.} and Dorothy Lane and Lihong Qi and Linda Snetselaar and Prentice, {Ross L.}",
year = "2018",
month = "10",
day = "1",
doi = "10.1001/jamaoncol.2018.1212",
language = "English (US)",
volume = "4",
journal = "JAMA oncology",
issn = "2374-2437",
publisher = "American Medical Association",
number = "10",

}

TY - JOUR

T1 - Association of Low-Fat Dietary Pattern with Breast Cancer Overall Survival

T2 - A Secondary Analysis of the Women's Health Initiative Randomized Clinical Trial

AU - Chlebowski, Rowan T.

AU - Aragaki, Aaron K.

AU - Anderson, Garnet L.

AU - Simon, Michael S.

AU - Manson, Joann E.

AU - Neuhouser, Marian L.

AU - Pan, Kathy

AU - Stefanic, Marcia L.

AU - Rohan, Thomas E.

AU - Lane, Dorothy

AU - Qi, Lihong

AU - Snetselaar, Linda

AU - Prentice, Ross L.

PY - 2018/10/1

Y1 - 2018/10/1

N2 - Importance: In a randomized clinical trial, a low-fat eating pattern was associated with lower risk of death after breast cancer. However, the extent to which results were driven by dietary influence on survival after breast cancer diagnosis was unknown. Objective: To determine the association of a low-fat dietary pattern with breast cancer overall survival (breast cancer followed by death from any cause measured from cancer diagnosis). Design, Setting, and Participants: This is a secondary analysis of the Women's Health Initiative randomized clinical trial that was conducted at 40 US clinical centers enrolling participants from 1993 through 1998. Participants were 48835 postmenopausal women with no previous breast cancer and dietary fat intake of greater than 32% by food frequency questionnaire. Interventions: Participants were randomized to a dietary intervention group (40%; n = 19541) with goals to reduce fat intake to 20% of energy and increase fruit, vegetable, and grain intake or a usual-diet comparison group (60%; n = 29294). Dietary group participants with incident breast cancers continued to participate in subsequent dietary intervention activities. Main Outcomes and Measures: Breast cancer overall survival for incident breast cancers diagnosed during the 8.5-year (median) dietary intervention, examined in post hoc analyses after 11.5 years (median) postdiagnosis follow-up. Results: Of 1764 women diagnosed with breast cancer during the dietary intervention period, mean (SD) age at screening was 62.7 (6.7) years and age at diagnosis was 67.6 (6.9) years. With 516 total deaths, breast cancer overall survival was significantly greater for women in the dietary intervention group than in the usual-diet comparison group (10-year survival of 82% and 78%, respectively; hazard ratio [HR], 0.78; 95% CI, 0.65-0.94; P =.01). In the dietary group there were fewer deaths from breast cancer (68 vs 120; HR, 0.86; 95% CI, 0.64-1.17), other cancers (36 vs 65; HR, 0.76; 95% CI, 0.50-1.17), and cardiovascular disease (27 vs 64; HR, 0.62; 95% CI, 0.39-0.99). Conclusions and Relevance: In women who received a diagnosis of breast cancer during the dietary intervention period, those in the dietary group had increased overall survival. The increase is due, in part, to better survival from several causes of death. Trial Registration: ClinicalTrials.gov Identifier: NCT00000611.

AB - Importance: In a randomized clinical trial, a low-fat eating pattern was associated with lower risk of death after breast cancer. However, the extent to which results were driven by dietary influence on survival after breast cancer diagnosis was unknown. Objective: To determine the association of a low-fat dietary pattern with breast cancer overall survival (breast cancer followed by death from any cause measured from cancer diagnosis). Design, Setting, and Participants: This is a secondary analysis of the Women's Health Initiative randomized clinical trial that was conducted at 40 US clinical centers enrolling participants from 1993 through 1998. Participants were 48835 postmenopausal women with no previous breast cancer and dietary fat intake of greater than 32% by food frequency questionnaire. Interventions: Participants were randomized to a dietary intervention group (40%; n = 19541) with goals to reduce fat intake to 20% of energy and increase fruit, vegetable, and grain intake or a usual-diet comparison group (60%; n = 29294). Dietary group participants with incident breast cancers continued to participate in subsequent dietary intervention activities. Main Outcomes and Measures: Breast cancer overall survival for incident breast cancers diagnosed during the 8.5-year (median) dietary intervention, examined in post hoc analyses after 11.5 years (median) postdiagnosis follow-up. Results: Of 1764 women diagnosed with breast cancer during the dietary intervention period, mean (SD) age at screening was 62.7 (6.7) years and age at diagnosis was 67.6 (6.9) years. With 516 total deaths, breast cancer overall survival was significantly greater for women in the dietary intervention group than in the usual-diet comparison group (10-year survival of 82% and 78%, respectively; hazard ratio [HR], 0.78; 95% CI, 0.65-0.94; P =.01). In the dietary group there were fewer deaths from breast cancer (68 vs 120; HR, 0.86; 95% CI, 0.64-1.17), other cancers (36 vs 65; HR, 0.76; 95% CI, 0.50-1.17), and cardiovascular disease (27 vs 64; HR, 0.62; 95% CI, 0.39-0.99). Conclusions and Relevance: In women who received a diagnosis of breast cancer during the dietary intervention period, those in the dietary group had increased overall survival. The increase is due, in part, to better survival from several causes of death. Trial Registration: ClinicalTrials.gov Identifier: NCT00000611.

UR - http://www.scopus.com/inward/record.url?scp=85054537803&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85054537803&partnerID=8YFLogxK

U2 - 10.1001/jamaoncol.2018.1212

DO - 10.1001/jamaoncol.2018.1212

M3 - Article

VL - 4

JO - JAMA oncology

JF - JAMA oncology

SN - 2374-2437

IS - 10

M1 - e181212

ER -