Fruit and vegetable intake and risk of breast cancer by hormone receptor status

Seungyoun Jung, Donna Spiegelman, Laura Baglietto, Leslie Bernstein, Deborah A. Boggs, Piet A. Van Den Brandt, Julie E. Buring, James R. Cerhan, Mia M. Gaudet, Graham G. Giles, Gary Goodman, Niclas Hakansson, Susan E. Hankinson, Kathy Helzlsouer, Pamela L. Horn-Ross, Manami Inoue, Vittorio Krogh, Marie Lof, Marjorie L. McCullough, Anthony B. MillerMarian L. Neuhouser, Julie R. Palmer, Yikyung Park, Kim Robien, Thomas E. Rohan, Stephanie Scarmo, Catherine Schairer, Leo J. Schouten, James M. Shikany, Sabina Sieri, Schoichiro Tsugane, Kala Visvanathan, Elisabete Weiderpass, Walter C. Willett, Alicja Wolk, Anne Zeleniuch-Jacquotte, Shumin M. Zhang, Xuehong Zhang, Regina G. Ziegler, Stephanie A. Smith-Warner

Research output: Contribution to journalArticlepeer-review

123 Scopus citations


Background Estrogen receptor-negative (ER-) breast cancer has few known or modifiable risk factors. Because ER- tumors account for only 15% to 20% of breast cancers, large pooled analyses are necessary to evaluate precisely the suspected inverse association between fruit and vegetable intake and risk of ER- breast cancer. Methods Among 993 466 women followed for 11 to 20 years in 20 cohort studies, we documented 19 869 estrogen receptor positive (ER+) and 4821 ER- breast cancers. We calculated study-specific multivariable relative risks (RRs) and 95% confidence intervals (CIs) using Cox proportional hazards regression analyses and then combined them using a random-effects model. All statistical tests were two-sided. Results Total fruit and vegetable intake was statistically significantly inversely associated with risk of ER- breast cancer but not with risk of breast cancer overall or of ER+ tumors. The inverse association for ER- tumors was observed primarily for vegetable consumption. The pooled relative risks comparing the highest vs lowest quintile of total vegetable consumption were 0.82 (95% CI = 0.74 to 0.90) for ER - breast cancer and 1.04 (95% CI = 0.97 to 1.11) for ER+ breast cancer (Pcommon-effects by ER status <. 001). Total fruit consumption was non-statistically significantly associated with risk of ER - breast cancer (pooled multivariable RR comparing the highest vs lowest quintile = 0.94, 95% CI = 0.85 to 1.04). Conclusions We observed no association between total fruit and vegetable intake and risk of overall breast cancer. However, vegetable consumption was inversely associated with risk of ER- breast cancer in our large pooled analyses.

Original languageEnglish (US)
Pages (from-to)219-236
Number of pages18
JournalJournal of the National Cancer Institute
Issue number3
StatePublished - Feb 6 2013
Externally publishedYes

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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