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J Clin Oncol. 2017 Sep 1;35(25):2919-2926. doi: 10.1200/JCO.2016.72.0326. Epub 2017 Jun 27.

Low-Fat Dietary Pattern and Breast Cancer Mortality in the Women's Health Initiative Randomized Controlled Trial.

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Rowan T. Chlebowski, Los Angeles Biomedical Research Institute, Torrance; Lihong Qi, University of California, Davis, Davis, CA; Aaron K. Aragaki, Garnet L. Anderson, Wendy Barrington, and Ross L. Prentice, Fred Hutchinson Cancer Research Center, Seattle, WA; Cynthia A. Thomson, University of Arizona Cancer Center, Tucson, AZ; JoAnn E. Manson, Brigham and Women's Hospital, Boston, MA; Michael S. Simon, Wayne State University, Detroit, MI; Barbara V. Howard, MedStar Health Research Institute; Barbara V. Howard, Georgetown-Howard Universities Center for Clinical and Translational Sciences, Washington, DC; Thomas E. Rohan, Albert Einstein College of Medicine, New York City; Dorothy Lane, Stony Brook University, Stony Brook, NY; Linda Snetselar, University of Iowa, Iowa City, IA; Catherine Womack, Methodist Healthcare; Fridtjof Thomas, University of Tennessee Health Science Center, Memphis, TN; Mara Z. Vitolins, Wake Forest School of Medicine, Winston-Salem, NC; and Lifang Hou, Northwestern University, Chicago, IL.


Purpose Earlier Women's Health Initiative Dietary Modification trial findings suggested that a low-fat eating pattern may reduce breast cancers with greater mortality. Therefore, as a primary outcome-related analysis from a randomized prevention trial, we examined the long-term influence of this intervention on deaths as a result of and after breast cancer during 8.5 years (median) of dietary intervention and cumulatively for all breast cancers diagnosed during 16.1 years (median) of follow-up. Patients and Methods The trial randomly assigned 48,835 postmenopausal women with normal mammograms and without prior breast cancer from 1993 to 1998 at 40 US clinical centers to a dietary intervention with goals of a reduction of fat intake to 20% of energy and an increased intake of fruits, vegetables, and grains (40%; n = 19,541) or to a usual diet comparison (60%; n = 29,294). Results In the dietary group, fat intake and body weight decreased (all P < .001). During the 8.5-year dietary intervention, with 1,764 incident breast cancers, fewer deaths occurred as a result of breast cancer in the dietary group, which was not statistically significant (27 deaths [0.016% per year] v 61 deaths [0.024% per year]; hazard ratio [HR], 0.67; 95% CI, 0.43 to 1.06; P = .08). During the same period, deaths after breast cancer (n = 134) were significantly reduced (40 deaths [0.025% per year] v 94 deaths [0.038% per year]; HR, 0.65; 95% CI, 0.45 to 0.94; P = .02) by the dietary intervention. During the 16.1-year follow-up, with 3,030 incident breast cancers, deaths after breast cancer also were significantly reduced (234 deaths [0.085% per year] v 443 deaths [0.11% per year]; HR, 0.82; 95% CI, 0.70 to 0.96; P = .01) in the dietary group. Conclusion Compared with a usual diet comparison group, a low-fat dietary pattern led to a lower incidence of deaths after breast cancer.

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