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Breast Cancer Res Treat. 2015 Nov;154(2):389-401. doi: 10.1007/s10549-015-3595-9. Epub 2015 Nov 3.

Pre-diagnostic polyphenol intake and breast cancer survival: the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort.

Author information

  • 1Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark.
  • 2International Agency for Research on Cancer (WHO-IARC), Lyon, France.
  • 3International Agency for Research on Cancer (WHO-IARC), Lyon, France.
  • 4Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark.
  • 5Inserm, CESP Centre for Research in Epidemiology and Population Health, Villejuif, France.
  • 6Université Paris-Sud, Villejuif, France.
  • 75073, Oncology Clinic, Finsen Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
  • 8Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway.
  • 9Department of Research, Cancer Registry of Norway, Institute of Population Based Cancer Research, Oslo, Norway.
  • 10Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
  • 11Genetic Epidemiology Group, Folkhälsan Research Center, Samfundet Folkhälsan, Helsinki, Finland.
  • 12Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
  • 13Gustave Roussy, Villejuif, France.
  • 14Cancer Epidemiology Centre, Cancer Council of Victoria, Melbourne, VIC, Australia.
  • 15Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
  • 16Division of Cancer Epidemiology, German Cancer Research Center, DKFZ, Heidelberg, Germany.
  • 17Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany.
  • 18Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark.
  • 19Department of Functional Biology, Faculty of Medicine, University of Oviedo, Asturias, Spain.
  • 20Unit of Nutrition and Cancer, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain.
  • 21Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs.GRANADA, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain.
  • 22CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
  • 23Public Health Division of Gipuzkoa, BioDonostia Research Institute, San Sebastián, Spain.
  • 24Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia, Spain.
  • 25Department of Health and Social Sciences, Universidad de Murcia, Murcia, Spain.
  • 26Navarra Public Health Institute, Pamplona, Spain.
  • 27Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.
  • 28Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
  • 29MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.
  • 30Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
  • 31Hellenic Health Foundation, Athens, Greece.
  • 32WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece.
  • 33Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy.
  • 34Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
  • 35Cancer Registry and Histopathology Unit, "Civile-M.P. Arezzo" Hospital, ASP, Ragusa, Italy.
  • 36Cancer Epidemiology Unit, San Giovanni Battista Hospital, CPO Piemonte and University of Turin, Turin, Italy.
  • 37Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy.
  • 38Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
  • 39Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands.
  • 40Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
  • 41Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
  • 42Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden.
  • 43Department of Surgery, Clinical Sciences, Skåne University Hospital, Lund University, Malmö, Sweden.
  • 44Department of Population Health, NYU School of Medicine, New York, NY, USA.
  • 45Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden.
  • 46Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.


The aim was to investigate the association between pre-diagnostic intakes of polyphenol classes (flavonoids, lignans, phenolic acids, stilbenes, and other polyphenols) in relation to breast cancer survival (all-cause and breast cancer-specific mortality). We used data from the European Prospective Investigation into Cancer and Nutrition cohort. Pre-diagnostic usual diet was assessed using dietary questionnaires, and polyphenol intakes were estimated using the Phenol-Explorer database. We followed 11,782 breast cancer cases from time of diagnosis until death, end of follow-up or last day of contact. During a median of 6 years, 1482 women died (753 of breast cancer). We related polyphenol intake to all-cause and breast cancer-specific mortality using Cox proportional hazard models with time since diagnosis as underlying time and strata for age and country. Among postmenopausal women, an intake of lignans in the highest versus lowest quartile was related to a 28 % lower risk of dying from breast (adjusted model: HR, quartile 4 vs. quartile 1, 0.72, 95 % CI 0.53; 0.98). In contrast, in premenopausal women, a positive association between lignan intake and all-cause mortality was found (adjusted model: HR, quartile 4 vs. quartile 1, 1.63, 95 % CI 1.03; 2.57). We found no association for other polyphenol classes. Intake of lignans before breast cancer diagnosis may be related to improved survival among postmenopausal women, but may on the contrary worsen the survival for premenopausal women. This suggests that the role of phytoestrogens in breast cancer survival is complex and may be dependent of menopausal status.


Breast cancer; Lignans; Phytoestrogens; Polyphenols; Survivorship

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