Treatment failure and dietary habits in women with breast cancer.

BACKGROUND: Epidemiological and experimental evidence suggests that breast cancer risk can be reduced by dietary measures. Study of the relationships between dietary habits and prognosis in patients with breast cancer is essential to the design of diet intervention trials. PURPOSE: Our purpose was to determine whether dietary habits are associated with disease-free survival in patients with breast cancer who have undergone treatment. METHODS: We interviewed 240 women about their dietary histories. These women were 50-65 years old and had pathological stage I-II breast cancer with subsequent follow-up for 4 years; 209 of these women were postmenopausal. Differences in dietary variables between groups of patients were analyzed with bivariate and multivariate statistical methods. RESULTS: Cancers were classified as estrogen receptor (ER) rich (> or = 0.10 fmol/micrograms of DNA) in 149 patients and as ER poor (< 0.10 fmol/micrograms of DNA) in 71 patients. Fifty-two patients had treatment failure during follow-up. The 30 patients with ER-rich tumors who had treatment failure reported higher intakes of total fat, saturated fatty acids, and polyunsaturated fatty acids than did the 119 patients with ER-rich tumors who did not have treatment failure. The multiple-odds ratio (OR) for treatment failure in these women was 1.08 for each 1% increment in percentage of total energy (E%) from total fat. For treatment failure within the first 2 years, the OR was 1.19 for each 1-mg increase in vitamin E intake per 10 megajoules of energy. In women with treatment failure 2-4 years after diagnosis, ORs were 1.13 and 1.23 for each E% increment in total fat or saturated fatty acids, respectively. No association between dietary habits and treatment failure was found for women with ER-poor cancers. There was a tendency to a dose-response relationship (in quartiles) between intake of saturated fatty acids and disease-free survival, but the observed differences were not statistically significant. CONCLUSIONS: Dietary habits at the time of diagnosis may affect prognosis, at least for patients with ER-rich breast cancers. Dietary fat may have an effect on growth or spread of breast cancer, both of which may vary according to type of fat. Total fat and saturated fatty acids were the dietary parameters most strongly associated with risk for treatment failure. IMPLICATIONS: Dietary intervention might serve as an adjuvant treatment to improve breast cancer prognosis.

DNA pattern and dietary habits in patients with breast cancer.

An association between dietary fat, micronutrients and breast cancer aetiology and prognosis has been found in studies of experimental animals and in epidemiological studies. The relationship between dietary habits and the nuclear DNA content of breast cancer cells was studied in 82 women aged 50-65 years. A dietary history interview was conducted within 4 months following surgery. Patients having tumours with euploid DNA pattern reported lower mean intake of saturated fatty acids (FA) in absolute terms, lower mean intake of total fat, saturated FA, and monounsaturated FA, in percentage of total energy intake (E%), a higher E% from protein, and a higher intake of vitamin D, and selenium per 10 MJ than did patients having tumours with aneuploid DNA pattern. In the stepwise logistic regression analysis, the multivariate odds ratios (OR) for having a tumour with aneuploid DNA pattern was 1.16 (95% confidence interval, 1.04-1.28) for each 1 g increase in intake of total fat (E%) and 0.95 (95% confidence interval, 0.92-0.99) for each mg increase in selenium intake per 10 MJ. When total fat was substituted with types of fat, the OR for having a tumour with aneuploid DNA pattern was 1.30 (95% confidence interval, 1.07-1.59) for each 1 g increase in intake of saturated FA (E%). These results suggest a correlation between a diet rich in fat and protein and the DNA content of breast cancer cells.

Dietary intervention in breast cancer patients: effects on dietary habits and nutrient intake.

Effects of dietary intervention on dietary habits and nutrient levels were studied in 240 women aged 50-65 years who had been operated for a stage I-II breast cancer. Following surgery the women who had participated in a dietary history interview were randomly assigned to one of two groups. The intervention group (n = 121) received individual dietary counselling aimed at reducing dietary fat intake to 20-25 per cent of energy (E per cent) while increasing intake of carbohydrates. No dietary advice was given to women assigned to the control group (n = 119). There was no significant difference between the groups in terms of base-line nutrient intake except for a higher energy intake in the control group (P less than 0.05). Sixty-three (52 per cent) of the women in the intervention group and 106 (89 per cent) of the women in the control group completed the 2-year follow-up. Energy intake decreased after 2 years in both groups and the difference between the groups remained (P less than 0.01). Total fat intake decreased in the intervention group by 12.9-23.3 E per cent after 2 years and by 3.1 E per cent in the control group. The intake of carbohydrates increased from 46.2 to 57.2 E per cent in the intervention group and from 46.2 to 48.9 E per cent in the control group. The study shows that dietary habits and intake of nutrients can be altered through dietary counselling to breast cancer patients, and that such changes are long lasting.

Dietary intervention in breast cancer patients: effects on food choice.

Effects of dietary intervention on food choice were studied in 240 women aged 50-65 years who had been operated for a stage I-II breast cancer. Following surgery, the women participated in a dietary history interview and were then randomized to one of two groups. The intervention group (n = 121) received individual dietary counselling aimed at reducing dietary fat intake to 20-25% energy (E%), whereas no dietary advice was given to women in the control group (n = 119). For the 52% of the women in the intervention group that completed the study the total fat intake decreased from 36 to 23 E% (P less than or equal to 0.01) and from 37 to 34 E% (P less than or equal to 0.01) for the control group. There were significant reductions in the intake of table fat, high-fat milk products, pork and sausages (containing greater than 11% fat), eggs, rice, pasta, cakes and chocolate for the intervention group. Concurrently the intake of vegetables, fruits, potatoes, bread, cereals, low-fat milk products, low-fat meat, sausages and fish increased significantly. For the control group there was a significant decrease in the consumption of total milk products, total meats, rice, pasta, cakes, and butter intake while the consumption of vegetables, fruits, cereals and fish increased (P less than or equal to 0.01). Reduction of high-fat foods and increases of carbohydrate-rich foods were more pronounced for the intervention group than for the control group. Formal education influenced dietary changes, and dietary counselling should therefore ideally be adapted to education level. This study showed that dietary counselling can bring about significant changes in consumption of high-fat foods for at least a 2-year period for women operated for breast cancer.

Discrepancy between estimated energy intake and requirement in female dancers.

Dietary intake of energy, protein, fat and carbohydrates in female dance students compared to female music students was estimated by a dietary history method. Energy requirement was estimated from body weight and physical activity both by a standard formula and from the measured work intensity during dance training. Meal patterns showed significant differences in four types of meals on week-days and in one type on weekends. The intake of protein, fat and carbohydrates in absolute amounts and the percentage of energy derived from protein were not significantly different between the two groups. The fraction of energy derived from carbohydrates was higher and that from fat was lower in the dancers than in the musicians. Energy intake was of similar magnitude for the dancers and the musicians (8.3 +/- 1.9 MJ vs. 8.3 +/- 1.7 MJ), while the estimated energy requirement was greater for the dancers (10.3 +/- 0.7 MJ vs. 8.9 +/- 0.4 MJ). The reason for the apparent discrepancy between energy intake and energy requirement of approximately 2 MJ in the dancers is not obvious. The energy intake may have been underestimated. Alternatively, the energy requirement may have been overestimated. The resting metabolic rate may have been depressed by years of low energy intake. In addition, as suggested by some authors, training as such may lower the resting metabolic rate as well as the diet-induced thermogenesis.

Dietary habits and mammographic patterns in patients with breast cancer.

Between 1983 and 1986, dietary history interviews were conducted with 238 women aged 50-65 years who had surgery for stage I-II breast cancer. Diagnostic mammograms were coded in line with Wolfe's criteria in N1, P1, P2, and Dy patterns. Women with Dy pattern reported significantly higher intake of total fat, monounsaturated fatty acids (FA), polyunsaturated FA, n-3 FA, n-6 FA in per cent of energy (E%), and alpha-tocopherol in mg/10 MJ. Fat intake was lowest in women with N1 pattern and highest in those having Dy pattern. Patients having ER-rich cancers and Dy pattern reported significantly higher intake of total fat, monounsaturated FA, polyunsaturated FA, n-6 FA (E%), and alpha-tocopherol (mg/10 MJ), as well as significantly lower intake of carbohydrate (E%) and calcium (g/10 MJ). In the stepwise multivariate analysis, the multivariate-odds ratio (OR) for having P2 + Dy patterns was 1.06 (95% confidence interval (CI), 1.02-1.12) for each increment in E% of total fat. In women with ER-rich tumors this OR was 1.09 (95% CI, 1.02-1.16). The highest self-reported body mass index (BMI) was observed in women with N1 + P1 patterns. OR for having P2 + Dy patterns was 0.91 (95% CI, 0.83-0.98) for each increment in 1 kg/m2 of BMI. The results suggest that dietary habits affect the mammographic parenchymal pattern in women with breast cancer and that a high fat intake is associated with a higher proportion of mammograms with Dy pattern in such patients.

Dietary intervention as adjuvant therapy in breast cancer patients--a feasibility study.

To evaluate the feasibility of using a low-fat diet (i.e. 20-25% of energy (E%) as fat) as a component of adjuvant therapy for breast cancer patients, 240 females aged 50-65 years and operated for a stage I-II breast cancer were entered into a randomized study. The intervention group (n = 121) was to reduce dietary fat intake to 20-25 E% and to increase the intake of carbohydrates. Dietary counselling complemented other adjuvant treatments and the patients were followed for two years. No dietary advice was given to patients in the control group (n = 119). There was no significant difference between the groups in terms of base-line nutrient intake except for higher energy intake in the control group (p less than 0.05). Only 52% of the patients in the intervention group followed through with the dietary regimen for two years, and 89% of the patients in the control group had a two-year follow-up. Energy intake decreased in both groups after two years, and the difference between the two groups remained (p less than 0.01). Total fat intake decreased from 36.2 E% to 22.2 E% after one year in the intervention group and remained at that level after two years. Total fat intake in the control group decreased by 3.6 E% after two years. The low compliance raises concern about the protocol design. The study nevertheless indicates that a long-term reduction of dietary fat intake can be implemented in breast cancer patients.