Skip to main content Accessibility help
×
Home

Fruit and vegetable intake and breast cancer prognosis: a meta-analysis of prospective cohort studies

  • Chen Peng (a1), Wei-Ping Luo (a1) (a2) and Cai-Xia Zhang (a1) (a3)

Abstract

The effect of fruit and vegetable intake on breast cancer prognosis is controversial. Thus, a meta-analysis was carried out to explore their associations. A comprehensive search was conducted in PubMed, Web of Science, OVID, ProQuest and Chinese databases from inception to April 2016. The summary hazard ratios (HR) and 95 % CI were estimated using a random effects model if substantial heterogeneity existed and using a fixed effects model if not. Subgroup analyses and sensitivity analyses were also performed. In total, twelve studies comprising 41 185 participants were included in the meta-analysis. Comparing the highest with the lowest, the summary HR for all-cause mortality were 1·01 (95 % CI 0·72, 1·42) for fruits and vegetables combined, 0·96 (95 % CI 0·83, 1·12) for total vegetable intake, 0·99 (95 % CI 0·89, 1·11) for cruciferous vegetable intake and 0·88 (95 % CI 0·74, 1·05) for fruit intake; those for breast cancer-specific mortality were 1·05 (95 % CI 0·77, 1·43) for total vegetable intake and 0·94 (95 % CI 0·69, 1·26) for fruit intake; and those for breast cancer recurrence were 0·89 (95 % CI 0·53, 1·50) for total vegetable intake and 0·98 (95 % CI 0·76, 1·26) for cruciferous vegetable intake. This meta-analysis found no significant associations between fruit and vegetable intake and breast cancer prognosis.

Copyright

Corresponding author

* Corresponding author: Professor C.-X. Zhang, fax +86 20 8733 0446, email zhangcx3@mail.sysu.edu.cn

References

Hide All
1. Yue, Y (2011) Research progress on risk factors of breast cancer. Oncology Progress 5, 520523.
2. McGuire, A, Brown, JA, Malone, C, et al. (2015) Effects of age on the detection and management of breast cancer. Cancers 7, 908929.
3. Torre, LA, Bray, F, Siegel, RL, et al. (2015) Global cancer statistics, 2012. CA Cancer J Clin 65, 87108.
4. Forman, D & Ferlay, J (2014) The global and regional burden of cancer. In World Cancer Report 2014, pp. 1653 [BW Stewart and CP Wild, editors]. Lyon, France: International Agency for Research on Cancer.
5. Brewster, A & Helzlsouer, K (2001) Breast cancer epidemiology, prevention, and early detection. Curr Opin Oncol 13, 420425.
6. Reuben, SC, Gopalan, A, Petit, DM, et al. (2012) Modulation of angiogenesis by dietary phytoconstituents in the prevention and intervention of breast cancer. Mol Nutr Food Res 56, 1429.
7. Chatterjee, M, Roy, K, Janarthan, M, et al. (2012) Biological activity of carotenoids: its implications in cancer risk and prevention. Curr Pharm Biotechnol 13, 180190.
8. Liu, J, Sun, XR, Dong, HW, et al. (2008) β-Ionone suppresses mammary carcinogenesis, proliferative activity and induces apoptosis in the mammary gland of the Sprague-Dawley rat. Int J Cancer 122, 26892698.
9. Liu, JR, Dong, HW, Sun, XR, et al. (2010) Effects of beta-ionone on mammary carcinogenesis and antioxidant status in rats treated with DMBA. Nutr Cancer 62, 5865.
10. Nechuta, S, Caan, BJ, Chen, WY, et al. (2013) Postdiagnosis cruciferous vegetable consumption and breast cancer outcomes: a report from the After Breast Cancer Pooling Project. Cancer Epidemiol Biomarkers Prev 22, 14511456.
11. Fimognari, C, Lenzi, M & Hrelia, P (2008) Chemoprevention of cancer by isothiocyanates and anthocyanins: mechanisms of action and structure-activity relationship. Curr Med Chem 15, 440447.
12. Azarenko, O (2009) Dietary isothiocyanates suppress microtubule dynamic instability in association with mitotic arrest and inhibition of tumor cell proliferation, pp. 206. University of California, Santa Barbara, Ann Arbor.
13. Ferguson, LR & Schlothauer, RC (2012) The potential role of nutritional genomics tools in validating high health foods for cancer control: broccoli as example. Mol Nutr Food Res 56, 126146.
14. Turrini, E, Ferruzzi, L & Fimognari, C (2015) Potential effects of pomegranate polyphenols in cancer prevention and therapy. Oxid Med Cell Longev 2015, 938475.
15. Seeram, NP, Adams, LS, Henning, SM, et al. (2005) In vitro antiproliferative, apoptotic and antioxidant activities of punicalagin, ellagic acid and a total pomegranate tannin extract are enhanced in combination with other polyphenols as found in pomegranate juice. J Nutr Biochem 16, 360367.
16. Pan, ZT (2003) Study on survival and prognostic factors of female breast cancer in urban Shanghai. Masters thesis, Fudan University, Shanghai, China.
17. Beasley, JM, Newcomb, PA, Trentham-Dietz, A, et al. (2011) Post-diagnosis dietary factors and survival after invasive breast cancer. Breast Cancer Res Treat 128, 229236.
18. Thomson, CA, Rock, CL, Thompson, PA, et al. (2011) Vegetable intake is associated with reduced breast cancer recurrence in tamoxifen users: a secondary analysis from the Women’s Healthy Eating and Living Study. Breast Cancer Res Treat 125, 519527.
19. Dal Maso, L, Zucchetto, A, Talamini, R, et al. (2008) Effect of obesity and other lifestyle factors on mortality in women with breast cancer. Int J Cancer 123, 21882194.
20. Pierce, JP, Stefanick, ML, Flatt, SW, et al. (2007) Greater survival after breast cancer in physically active women with high vegetable-fruit intake regardless of obesity. J Clin Oncol 25, 23452351.
21. McEligot, AJ, Largent, J, Ziogas, A, et al. (2006) Dietary fat, fiber, vegetable, and micronutrients are associated with overall survival in postmenopausal women diagnosed with breast cancer. Nutr Cancer 55, 132140.
22. Fink, BN, Gaudet, MM, Britton, JA, et al. (2006) Fruits, vegetables, and micronutrient intake in relation to breast cancer survival. Breast Cancer Res Treat 98, 199208.
23. Sauvaget, C, Nagano, J, Hayashi, M, et al. (2003) Vegetables and fruit intake and cancer mortality in the Hiroshima/Nagasaki Life Span Study. Br J Cancer 88, 689694.
24. Holmes, MD, Stampfer, MJ, Colditz, GA, et al. (1999) Dietary factors and the survival of women with breast carcinoma. Cancer 86, 826835.
25. Saxe, GA, Rock, CL, Wicha, MS, et al. (1999) Diet and risk for breast cancer recurrence and survival. Breast Cancer Res Treat 53, 241253.
26. Buck, K, Zaineddin, AK, Vrieling, A, et al. (2011) Estimated enterolignans, lignan-rich foods, and fibre in relation to survival after postmenopausal breast cancer. Br J Cancer 105, 11511157.
27. Pierce, JP, Natarajan, L, Caan, BJ, et al. (2007) Influence of a diet very high in vegetables, fruit, and fiber and low in fat on prognosis following treatment for breast cancer: the Women’s Healthy Eating and Living (WHEL) randomized trial. JAMA 298, 289298.
28. Hauner, D, Janni, W, Rack, B, et al. (2011) The effect of overweight and nutrition on prognosis in breast cancer. Dtsch Arztebl Int 108, 795801.
29. Li, B, Lu, Y, Wang, L, et al. (2015) Folate intake and breast cancer prognosis. Eur J Cancer Prev 24, 113121.
30. Aune, D, Chan, DS, Vieira, AR, et al. (2012) Fruits, vegetables and breast cancer risk: a systematic review and meta-analysis of prospective studies. Breast Cancer Res Treat 134, 479493.
31. Smith-Warner, SA, Spiegelman, D, Yaun, SS, et al. (2001) Intake of fruits and vegetables and risk of breast cancer: a pooled analysis of cohort studies. JAMA 285, 769776.
32. Gandini, S, Merzenich, H, Robertson, C, et al. (2000) Meta-analysis of studies on breast cancer risk and diet: the role of fruit and vegetable consumption and the intake of associated micronutrients. Eur J Cancer 36, 636646.
33. Zeng, XT, Liu, H, Chen, X, et al. (2012) The fourth of meta analyses series: the quality assessment tool of observational studies. Chin J Evid Cardiovasc Med 4, 297299.
34. Li, Y, Yang, H & Cao, J (2011) Association between alcohol consumption and cancers in the Chinese population—a systematic review and meta-analysis. PLoS ONE 6, 14511453.
35. Chak, E, Rutherford, GW & Steinmaus, C (2009) The role of breast-feeding in the prevention of Helicobacter pylori infection: a systematic review. Clin Infect Dis 48, 430437.
36. The Australasian Cochrane Centre (2008) Part 5 Data and analyses: using generic inverse variance. In Review Manager 5.3 Tutorial (revised in June 2014), pp. 33–35. [staff at the Australasian Cochrane Centre and the Thai Cochrane Network and the Information Management System team (now IKMD, the Cochrane Informatics and Knowledge Management Department), editors]. Melbourne, Australia. http://community.cochrane.org/tools/review-production-tools/revman-5/revman-5-download (accessed April 2016).
37. Higgins, JP, Thompson, SG, Deeks, JJ, et al. (2003) Measuring inconsistency in meta-analyses. BMJ 327, 557560.
38. DerSimonian, R & Laird, N (1986) Meta-analysis in clinical trials. Control Clin Trials 7, 177188.
39. Wells, GA, Shea, B, O’Connell, D, et al. (2016) The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. http://www.ohri.ca/programs/clinical_epidemiology/oxford.htm (accessed April 2016).
40. Sterne, JA & Egger, M (2001) Funnel plots for detecting bias in meta-analysis: guidelines on choice of axis. J Clin Epidemiol 54, 10461055.
41. Hill, MJ (1997) Nutrition and human cancer. Ann N Y Acad Sci 833, 6878.
42. Verhoeven, DT, Assen, N, Goldbohm, RA, et al. (1997) Vitamins C and E, retinol, beta-carotene and dietary fibre in relation to breast cancer risk: a prospective cohort study. Br J Cancer 75, 149155.
43. Erickson, KD (2011) Diabetes and breast cancer: the women’s healthy eating & living study, pp. 96. University of California, Ann Arbor.
44. George, SAM (2010) Energy balance, risk of breast cancer, and prognosis after breast cancer: investigating the complex roles of diet and physical activity, pp. 108. Yale University, Ann Arbor.
45. Thomson, CA (1998) The effect of a high fruit and vegetable, low fat dietary intervention on immune function, DNA adduct formation, and body composition among breast cancer survivors, pp. 332. The University of Arizona, Ann Arbor.
46. Assaf, AR, Beresford, S, Risica, PM, et al. (2016) Low-fat dietary pattern intervention and health-related quality of life: the women’s health initiative randomized controlled dietary modification trial. J Acad Nutr Diet 116, 259271.
47. Chlebowski, R (2007) Lifestyle change including dietary fat reduction and breast cancer outcome. J Nutr 137S, 233S235S.
48. Thomson, CA, Rock, CL, Giuliano, AR, et al. (2005) Longitudinal changes in body weight and body composition among women previously treated for breast cancer consuming a high-vegetable, fruit and fiber, low-fat diet. Eur J Nutr 44, 1825.
49. Donegan, WL, Hartz, AJ & Rimm, AA (1978) The association of body weight with recurrent cancer of the breast. Cancer 41, 15901594.
50. Reeves, MM, Terranova, CO, Eakin, EG, et al. (2014) Weight loss intervention trials in women with breast cancer: a systematic review. Obes Rev 15, 749768.
51. Rodriguez, SFM, Aguilar, MA & Manuel-y-Keenoy, B (2013) [Influence of body weight on the prognosis of breast cancer survivors; nutritional approach after diagnosis]. Nutr Hosp 28, 18291841.
52. Champ, CE, Volek, JS, Siglin, J, et al. (2012) Weight gain, metabolic syndrome, and breast cancer recurrence: are dietary recommendations supported by the data? Int J Breast Cancer 2012, 506868.
53. McTiernan, A, Irwin, M & Vongruenigen, V (2010) Weight, physical activity, diet, and prognosis in breast and gynecologic cancers. J Clin Oncol 28, 40744080.
54. Stokes, SA (2014) Dietary behaviors and nutrition intervention preferences of breast cancer survivors, pp. 73. Clemson University, Ann Arbor.
55. Hauner, H & Hauner, D (2009) The impact of nutrition on the development and prognosis of breast cancer. Breast Care (Basel) 5, 377381.
56. Key, TJ, Verkasalo, PK & Banks, E (2001) Epidemiology of breast cancer. Lancet Oncol 2, 133140.
57. Bernstein, L & Ross, RK (1993) Endogenous hormones and breast cancer risk. Epidemiol Rev 15, 4865.
58. Liu, MM, Huang, Y & Wang, J (2012) Developing phytoestrogens for breast cancer prevention. Anticancer Agents Med Chem 12, 13061313.
59. Xiao, JJ, Tao, M, Duan, WM, et al. (2009) Expressions of c-erbB-2, ER, PR and their prognostic correlation in premenopausal and postmenopausal patients with breast cancer. Cancer Res Prev Treat 36, 666668.
60. Jung, W, Yu, O, Lau, SM, et al. (2000) Identification and expression of isoflavone synthase, the key enzyme for biosynthesis of isoflavones in legumes. Nat Biotechnol 18, 208212.
61. Turner, JV, Agatonovic-Kustrin, S & Glass, BD (2007) Molecular aspects of phytoestrogen selective binding at estrogen receptors. J Pharm Sci 96, 18791885.
62. Williams, LD, Twaddle, NC, Churchwell, MI, et al. (2006) Quantification of tamoxifen and metabolites and soy isoflavones in human plasma using liquid chromatography with electrospray ionization tandem mass spectrometry. J Aoac Int 89, 11681173.
63. Malejka-Giganti, D, Parkin, DR, Bennett, KK, et al. (2007) Suppression of mammary gland carcinogenesis by post-initiation treatment of rats with tamoxifen or indole-3-carbinol or their combination. Eur J Cancer Prev 16, 130141.
64. Wang, TT, Milner, MJ, Milner, JA, et al. (2006) Estrogen receptor alpha as a target for indole-3-carbinol. J Nutr Biochem 17, 659664.
65. Ramirez, MC & Singletary, K (2009) Regulation of estrogen receptor alpha expression in human breast cancer cells by sulforaphane. J Nutr Biochem 20, 195201.
66. Labriola, D & Livingston, R (1999) Possible interactions between dietary antioxidants and chemotherapy. Oncology (Williston Park) 13, 10031008.
67. Lamson, DW & Brignall, MS (1999) Antioxidants in cancer therapy; their actions and interactions with oncologic therapies. Altern Med Rev 4, 304329.
68. Velentzis, LS, Keshtgar, MR, Woodside, JV, et al. (2011) Significant changes in dietary intake and supplement use after breast cancer diagnosis in a UK multicentre study. Breast Cancer Res Treat 128, 473482.
69. Izano, MA, Fung, TT, Chiuve, SS, et al. (2013) Are diet quality scores after breast cancer diagnosis associated with improved breast cancer survival? Nutr Cancer 65, 820826.
70. Rohan, TE, Hiller, JE & McMichael, AJ (1993) Dietary factors and survival from breast cancer. Nutr Cancer 20, 167177.
71. Russo, J & Russo, IH (1994) Toward a physiological approach to breast cancer prevention. Cancer Epidemiol Biomarkers Prev 3, 353364.
72. Harris, HR, Orsini, N & Wolk, A (2014) Vitamin C and survival among women with breast cancer: a meta-analysis. Eur J Cancer 50, 12231231.
73. Rock, CL, Flatt, SW, Natarajan, L, et al. (2005) Plasma carotenoids and recurrence-free survival in women with a history of breast cancer. J Clin Oncol 23, 66316638.
74. Tsubura, A, Uehara, N, Kiyozuka, Y, et al. (2005) Dietary factors modifying breast cancer risk and relation to time of intake. J Mammary Gland Biol Neoplasia 10, 87100.
75. Kim, SH, Sehrawat, A & Singh, SV (2013) Dietary chemopreventative benzyl isothiocyanate inhibits breast cancer stem cells in vitro and in vivo . Cancer Prev Res (Phila) 6, 782790.
76. Koh, MS, Hwang, JS & Moon, A (2010) Lycopene inhibits proliferation, invasion and migration of human breast cancer cells. Biomol Ther (Seoul) 18, 9298.
77. Xu, M, Bower, KA, Wang, S, et al. (2010) Cyanidin-3-glucoside inhibits ethanol-induced invasion of breast cancer cells overexpressing ErbB2. Mol Cancer 9, 114.

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed