Determination of the effectiveness of beeswax in preventing nipple pain and cracks in primiparous breastfeeding mothers: A randomized controlled trial.

OBJECTIVE: Beeswax is a natural ingredient used effectively for wound healing. This study aimed to determine the effectiveness of beeswax and breast milk in preventing nipple pain and cracks in the early postpartum period. MATERIALS AND METHODS: This non-blinded, randomized controlled trial was carried out between November 15, 2019, and April 1, 2020, in the postpartum clinic of a state university hospital and at mothers' homes. Ninety primiparous mothers meeting the inclusion criteria were randomly divided into beeswax (n=30), breast milk (n=30), and control (n=30) groups using simple randomization. Mothers in the beeswax, breast milk, and control groups were assessed for nipple pain and cracks on postpartum days 1st, 3rd, 5th, 7th, and 10th. RESULTS: On postpartum day 10, nipple pain and cracks occurred highest in the control group (%53.3), whereas nipple pain and cracks were encountered least in the beeswax group (%20,0) on postpartum observation days. The differences between the groups in terms of nipple cracks and pain severity were statistically significant (p < 0.05, p=0.004, and p=0.000, respectively). CONCLUSION: Beeswax is more effective than breast milk in preventing nipple pain and crack formation. A beeswax barrier can be used to prevent nipple pain and cracks.

Effectiveness of aloe fomentation for nipple-related complications during the early puerperium period: a randomized, controlled, interventional study.

OBJECTIVE: Nipple-related complications are major factors that prevent breastfeeding for many new mothers. Hence, we tested the effects of aloe arborescens fomentation applied to the nipples as a treatment for nipple-related complications. RESULTS: This study included 60 women who breastfed for the first time on day 1 after delivery. Every 24 h, all women breastfed six times and bottle-fed two times (at night). Women were classified into an intervention group (aloe arborescens fomentation) and a control group (no treatment). Aloe fomentation was applied after breastfeeding six times per day. We observed the nipples three times per day for 5 days after delivery. The most common nipple-related complication in this study was redness. A significant decrease was observed for women in the intervention group. Trial Registration Retrospectively Registered to registry: UMIN; Registration no.: UMIN000044514; Registered on: 11th June 2021.

Status of breast care during pregnancy with milk production and disease.

BACKGROUND: Breast care is an important routine during pregnancy and breastfeeding. Its absence leads to inadequate milk production before and after childbirth. OBJECTIVE: This study aimed to determine the status of breast care during pregnancy, which is related to milk production and disease after childbirth in the Tinggede Health Center, Sigi Regency, Central Sulawesi. METHODS: The method used was an analytic survey with a cross-sectional approach and the samples were 82 breastfeeding mothers in the working area of the Tinggede Health Center. The sampling used a total population, and data were obtained by interview and observation. Furthermore, the analysis technique used Chi-Square. RESULTS: The results showed there was a relationship between breast care during pregnancy with milk production (p = 0.001), and breast care status with a disease (p = 0.012). The common diseases suffered by breastfeeding mothers due to inadequate care are non-protruding nipples, infections, blocked milk ducts, mastitis, and lumps. CONCLUSIONS: Breastfeeding mothers' failure to care for their breasts during pregnancy can lead to lack of milk production and diseases such as non-protruding nipples, infections, blocked milk ducts, mastitis, and lumps.

A combination of mupirocin and acidic fibroblast growth factor for nipple fissure and nipple pain in breastfeeding women: protocol for a randomised, double-blind, controlled trial.

INTRODUCTION: Nipple fissure and nipple pain are common complaints among breastfeeding mothers. Studies found that mupirocin was effective in preventing and treating infections of damaged nipple and nipple pain. Acidic fibroblast growth factor (aFGF) plays an important role in wound healing. However, current evidence on the efficacy and safety of mupirocin plus aFGF for nipple fissure and nipple pain in breastfeeding women is inconclusive due to the lack of well-designed randomised controlled trials on this topic. The purpose of this study is to test the hypothesis that mupirocin plus aFGF is more effective than mupirocin alone for nipple fissure and nipple pain in breastfeeding women. METHODS AND ANALYSIS: This study is a randomised, double-blind, single-centre, parallel-group clinical trial. A total of 120 breastfeeding women with nipple fissure and nipple pain will be randomly assigned to either mupirocin plus aFGF group or mupirocin plus placebo group according to a computer-generated random allocation sequence. The treatment period lasts 14 days. The primary outcome is nipple pain intensity measured by the Visual Analogue Scale on day 14 during the treatment period. Secondary outcome measures include time to complete nipple pain relief, changes in the Nipple Trauma Score, time to complete healing of nipple trauma, quality of life measured by the Maternal Postpartum Quality of Life (MAPP-QOL) Questionnaire, the frequency of breast feeding, the rate of breastfeeding discontinuation, weight change in infants and adverse events. ETHICS AND DISSEMINATION: The study has gained approval from the Ethics Review Committee of Tianjin Central Hospital of Gynaecology Obstetrics on 22 January 2018 (approval no. 2018KY001). We plan to publish our research findings in a peer-reviewed academic journal and disseminate these findings in international conferences. This study has been registered with the Chinese Clinical Trial Registry. TRIAL REGISTRATION NUMBER: ChiCTR1800017248.

Outbreak report of investigation and control of an outbreak of Panton-Valentine Leukocidin-positive methicillin-sensitive Staphylococcus aureus (PVL-MSSA) infection in neonates and mothers.

BACKGROUND: In January 2011, there was an outbreak of Panton-Valentine Leukocidin-positive methicillin-sensitive Staphylococcus aureus (PVL-MSSA) infection in a neonatal unit (NNU). We describe the investigation and control of an outbreak of PVL-MSSA infection in neonates. SETTING: Neonatal unit in West London. METHODS: We performed descriptive and analytical (case-control study) epidemiological investigations. Microbiological investigations including screening of MSSA isolates by PCR for the presence of the luk-PV, mecA and mecC genes and comparison of isolate with Pulsed field gel electrophoresis (PFGE). Control measures were also introduced. RESULTS: Sixteen babies were infected/colonised with the outbreak strain. Of these, one baby developed blood stream infection, 12 developed skin pustules and four babies were colonised. Four mothers developed breast abscesses. Eighty-seven babies in the unit were screened and 16 were found to have same PVL-MSSA strain (spa type t005, belonging to MLST clonal complex 22). Multivariate analysis showed gestational age was significantly lower in cases compared to controls (mean gestational age: 31.7 weeks v 35.6 weeks; P = 0.006). Length of stay was significantly greater for cases, with a median of 25 days, compared to only 6 days for controls (P = 0.01). Most (88%) cases were born through caesarean section, compared to less than half of controls. (P = 0.002). No healthcare worker carriers and environmental source was identified. The outbreak was controlled by stopping new admissions to unit and reinforcing infection control precautions. The outbreak lasted for seven weeks. No further cases were reported in the following year. CONCLUSIONS: Infection control teams have to be vigilant for rising prevalence of particular S. aureus clones in their local community as they may cause outbreaks in vulnerable populations in healthcare settings such as NNUs.

Complications associated with intimate body piercings.

Intimate body piercings involving the nipple and genitalia have increased in prevalence in both men and women. Despite this increase, there is a deficiency in the literature regarding the short and long-term complications of body piercings, including an increased risk of infection, malignancy, and structural damage to the associated tissue. Breast abscesses associated with nipple piercing can be mistaken as inflammatory carcinoma. Male genital piercings have been associated with urethral rupture, paraphimosis, urethral obstruction, scar formation, and squamous cell carcinoma, whereas female genital piercings may lead to a higher risk of pregnancy and sexually transmitted infections. There are additional problems related to piercings during pregnancy and thereafter. Nipple piercings can hinder breast feeding by inhibiting the milk letdown reflex, increasing nipple sensitivity, and causing discomfort to the infant. Removal of genital piercings during pregnancy could introduce bacteria into the piercing tract, but retaining the piercings could theoretically hinder childbirth. Prevention of complications is critical. Patients must understand the risks of piercings and disclose relevant medical conditions to the practitioner before the procedure. The piercings should be carried out in a hygienic and sterile manner. Finally, physicians should maintain a non-judgmental attitude to encourage patients to seek medical care for complications.

Ethical Considerations of Medical Photography in the Management of Breast Disease.

BACKGROUND: Medical photography has become an important component of the evaluation and management of patients across many specialties. It is increasingly utilized in contemporary practice with modern smartphones and enhanced digital media. Photography can enhance and improve treatment plans and communication between providers and patients. Additionally, photography supplements education, research, and marketing in both print and social media. Ethical and medicolegal standards for medical photography, specifically for patients with breast disease, have not been formally developed to guide medical providers. PURPOSE: To provide guidelines for breast care physicians using medical photography, the Ethics Committee of the American Society of Breast Surgeons presents an updated review of the literature and recommendations for ethical and practical use of photography in patient care. METHODS: An extensive PubMed review of articles in English was performed to identify studies and articles published prior to 2018 investigating the use of medical photography in patient care and the ethics of medical photography. After review of the literature, members of the Ethics Committee convened a panel discussion to identify best practices for the use of medical photography in the breast care setting. Results of the literature and panel discussion were then incorporated to provide the content of this article. CONCLUSION: The Ethics Committee of the American Society of Breast Surgeons acknowledges that photography of the breast has become an invaluable tool in the delivery of state-of-the-art care to our patients with breast disease, and we encourage the use of this important medium. Physicians must be well informed regarding the concerns associated with medical photography of the breast to optimize its safe and ethical use in clinical practice.

The Effects of Different Breastfeeding Training Techniques Given for Primiparous Mothers Before Discharge on the Incidence of Cracked Nipples.

OBJECTIVE: This research investigated the effects of different breastfeeding training techniques for primiparous mothers before discharge on the incidence of cracked nipples. MATERIALS AND METHODS: This was a controlled intervention study that was carried out between 2015 and 2016 on 90 mothers living in Izmir. The mothers were divided into three groups: the demonstration-based training group, brochure group, and routine care-receiving group. The mothers in the "brochure group" were provided with breastfeeding training brochures. Mothers in the demonstration-based training group received one-to-one training using designed doll and puppet tools. RESULTS: The rate of cracked nipples at age 2 weeks was 63.3% in the routine care-receiving group, 56.7% in the brochure group, and 20% in the demonstration-based training group. At the end of the fourth week, the rate was 30% in the routine care-receiving group and less than 10% in the other two groups (p < 0.005). The LATCH scores were higher in the demonstration-based training group than in the other two groups (p < 0.05). There was no significant difference between the groups in the percentage of exclusive breastfeeding. CONCLUSION: The results documented that breastfeeding training based on one-to-one demonstration utilizing specially designed audiovisual tools was more effective than the other two methods in the prevention of nipple cracks.

Efficacy of an internal teat seal associated with a dry cow intramammary antibiotic for prevention of intramammary infections in dairy cows during the dry and early lactation periods / Eficácia de um selante interno de tetos associado a antibiótico de vaca seca na prevenção de infecções intramamárias no período seco e início de lactação em vacas leiteiras

The present study aimed to evaluate the use of an internal dry period teat seal containing bismuth subnitrate (Teatseal®, Zoetis®, Florham Park, Nova Jersey, USA) associated with a long-acting cloxacilin preparation (Orbenin® Extra dry cow, Zoetis®, Florham Park, Nova Jersey, USA), in preventing new infections during the dry-off and early postpartum period. A total of 150 Holstein cows (average production of 9,000 kg of milk per lactation), with four functional udder quarters without clinical mastitis was included in the study. All animals were dried-off 60 days before the expected calving date. Two teats positioned diagonal-contralaterally received only dry cow antibiotic, control group C (n=300) and the other two teats, treatment group T (n=300) received dry cow antibiotic and infusion with an internal teat seal. Data from SCC variable were transformed by log base-10 transformation. Duncan's test was used accepting 5% as the level of statistical significance. The occurrence of intramammary infection (IMI) and chronicity rate, and frequency of microorganisms isolated at drying and immediately postpartum in teats of group C and group T were evaluated using a non-parametric Chi-square Test, accepting 10% as the statistical significance level. There was a decrease in the occurrence of new infections in the early postpartum in cows which the sealant was used (C=19.6%, T=11.4%). In the postpartum period, Gram-negative bacteria were isolated from 16 teats in C and seven in T. The greatest reduction was observed for Escherichia coli (8 vs 1) in group T. There was no effect using the internal sealant on the frequency of isolation of environmental Streptococus. The use of sealant reduced the prevalence of subclinical mastitis cows between drying-off and the early postpartum period (C=51% versus T=42%) and resulted in a lower somatic cell count (SCC) in the treatment group when compared with the control group (T=1,073x103, C=1,793x103). The use of the internal teat seal combined with dry cow antibiotic is effective in the prevention of IMI during the dry period and early lactation and results in the reduction of SCC in immediate postpartum period. The treatment is effective in reducing infection between dry-off and the immediate postpartum caused by major and minor pathogens. However, no effect on infections caused by contagious pathogens was observed.(AU)

Objetivou-se avaliar o uso de um selante interno de tetos contendo subnitrato de bismuto (Teatseal®, Zoetis®, Florham Park, Nova Jersey, EUA) associado a um antibiótico de longa ação contendo cloxacilina (Orbenin® Extra dry cow, Zoetis®, Florham Park, Nova Jersey, EUA) em prevenir novas infecções durante o período seco e pós-parto imediato. Foram utilizadas 150 vacas Holandesas (produção média de 9,000 kg de leite por lactação), com os quatro quartos mamários funcionais e sem mastite clínica, que foram secas 60 dias antes da data prevista para o parto. O teto constituiu a unidade experimental. O grupo controle (C) foi representado por dois tetos diagonais-contralaterais (n=300), que receberam somente o antibiótico de vaca seca. Os outros dois tetos (n=300) constituíam o grupo tratado (T) e recebiam o antibiótico de vaca seca associado ao selante interno. Dados da variável contagem de células somáticas (CCS) passaram por transformação logarítmica na base 10 e foram submetidos ao teste de Duncan, aceitando-se nível de 5% de significância estatística. A ocorrência de infecções intramamárias (IIM), taxa de cronicidade e frequência de microrganismos isolados na secagem e imediatamente pós-parto nos tetos do grupo controle e tratados com selante interno foram avaliados utilizando o teste não paramétrico qui-quadrado, aceitando 10% de nível de significância. Houve redução na ocorrência de novas infecções no pós-parto imediato nos animais em que se utilizou o selante (C=19,6%, T=11,4%). No período pós-parto, foram isolados microrganismos Gram-negativo de 16 tetos no C e sete no T. A maior redução ocorreu para Escherichia coli, (8 versus 1) no grupo T. Não houve efeito da utilização do selante interno na frequência de isolamento de Streptococcus ambientais. O uso do selante reduziu a prevalência de mastite subclínica das vacas no pós-parto imediato (C=51% versus T=42%) e resultou em menor CCS no grupo tratado (T = 1.073 x 103) quando comparado com o grupo controle (C=1.793x103). O uso do selante interno combinado com antibiótico de vacas secas é eficaz na prevenção de infecções intramamárias no período seco e início de lactação e resulta na redução da CCS no período pós-parto imediato. O tratamento é eficaz na redução de infecção entre a secagem e o pós-parto imediato causada por patógenos maiores e menores. Entretanto, não tem efeito sobre infecções causadas por patógenos contagiosos.(AU)

Nipple Pain Incidence, the Predisposing Factors, the Recovery Period After Care Management, and the Exclusive Breastfeeding Outcome.

BACKGROUND: Nipple pain is the most common complaint of breastfeeding mothers during the immediate postpartum period. Persistent nipple pain is associated with low breastfeeding rate at 6 months postpartum. OBJECTIVE: To further explore the incidence of nipple pain, associated predisposing factors, time for recovery after management, and the impact on exclusive breastfeeding rates. MATERIALS AND METHODS: Included in this study were 1,649 singleton, pregnant women who delivered and had their 1-week follow-up at the breastfeeding clinic during the period of January 2013 to December 2015. The mothers who experienced nipple pain were analyzed for the incidence, the predisposing factors, and the recovery period after care management. The breastfeeding outcome comparison of both, mothers with and without pain, was measured by the exclusive breastfeeding rate at the sixth week postpartum. RESULTS: The incidence of nipple pain was at 9.6% by day 7. A predisposing factor of nipple pain was primiparity (relative risk = 1.8, 95% confidence interval 1.3-2.5). The reasons for nipple pain were inappropriate positioning and latching (72.3%), tongue-tie (23.2%), and oversupply (4.4%). The recovery period after care management was 1-2 weeks. There were no statistically significant differences between the 6-week exclusive breastfeeding rates of the mothers with nipple pain with treatment and the mothers without nipple pain. CONCLUSION: Persistent nipple pain was a common problem. The active management, including early detection and treatment, would help the mothers recover within a 2-week period and there was no significant difference of exclusive breastfeeding rates between the mothers who had early care management and the mothers without nipple pain.

Implementation of an education package on breast engorgement aimed at lactation consultants and midwives to prevent conflicting information for postnatal mothers.

AIM: The aim of this evidence-based practice project was to improve local practice in the treatment of breast engorgement in postnatal mothers and to ensure the treatment of engorgement in postnatal mothers is performed according to the best available evidence. METHODS: This evidence-based practice project took place in a 28-bed postnatal ward in a large metropolitan tertiary hospital. Twenty midwives and 20 in-patients were recruited for the project. The project utilized an audit and feedback design. Midwives were asked a series of questions to test their knowledge on engorgement, and mothers were asked questions relating to the breastfeeding and engorgement care they received. The project was conducted in three phases: preparation for quality audit, implementation of best practice and postimplementation audit. RESULTS: Comparison of Audit 1 (preimplementation) and Audit 2 (postimplementation) results shows significant improvements in all eight audit criteria. An increase of 80% was achieved for the criteria 'midwives received formal education on engorgement' on completion of the project. A 20% increase in 'consistency of education regarding latch' was reported by the mothers, and there was a 30% increase in 'information given to mothers on prevention and signs of engorgement'. Sixty-five percent of midwives were able to correctly identify and manage engorgement, a significant improvement from 5% at baseline. CONCLUSION: This evidence-based practice project successfully identified and utilized best practice in the management of breast engorgement care in mothers in our clinical setting. With effective breast engorgement interventions in place, mothers could continue to successfully breastfeed their babies. The major challenges identified during the conduct of the project included: time constraints on the midwives to attend education sessions and to educate mothers on prevention. At the completion of this project, a closer relationship was forged between the lactation consultant team and the midwives in the project setting. This increased the satisfaction and productivity of the midwives, and motivated them to deliver high-quality care, which contributed to an improvement in mother's confidence and reduction in conflicting information.

Dietary patterns and benign breast diseases: a case-control study.

Several studies have investigated the relation between benign breast diseases (BBD) and food intake. However, dietary patterns of these patients have not been taken into consideration up to now. The aim of this study is to determine the association between dietary patterns and BBD. In this case-control study, ninety-six patients with BBD and seventy controls were selected from women attending the Iranian Center for Breast Cancer affiliated with Academic Center for Education, Culture and Research. Demographic, physical activity and semi-quantitative FFQ were completed. The main dietary patterns were extracted by factor analysis. Two major dietary patterns emerged: Healthy dietary pattern including fish, poultry, eggs, low-fat dairy products, vegetables, legumes, nuts and seeds, whole grains, oil and mayonnaise, olives, fruits; and Unhealthy dietary pattern including red meats, organ and processed meats, high-fat dairy products, refined grains, sweets and desserts, animal and solid fats. After adjustment for age, BMI and energy intake, the participants in the highest tertile of Healthy dietary pattern (OR 0·44; 95 % CI 0·20, 0·99) were less likely to have BBD compared with those in the first tertile. After adjustment for other confounding variables, this relationship still remained close to significant level. However, higher consumption of Unhealthy dietary pattern was not associated with the risk of BBD. In conclusion, Healthy dietary pattern might be inversely associated with the risk of BBD; however, this result should be interpreted with caution. Future studies are needed to confirm our findings.

Milk Fistula: Diagnosis, Prevention, and Treatment.

Milk fistula is an uncommon condition which occurs when there is an abnormal connection that forms between the skin surface and the duct in the breast of a lactating woman, resulting in spontaneous and often constant drainage of milk from this path of least resistance. A milk fistula is usually a complication that results from a needle biopsy or surgical intervention in a lactating patient. Here, the authors present an unusual case of a spontaneous milk fistula which developed from an abscess in the breast of a lactating woman. The patient initially presented to the office with a large open wound on her breast, formed from skin breakdown, within which milk was pooling. She was treated with local wound care and cessation of breastfeeding, with appropriate healing of the wound and closure of the fistula with 6 weeks. Diagnosis, prevention, and treatment of milk fistula were reviewed.

Immune cell-mediated protection of the mammary gland and the infant during breastfeeding.

Breastfeeding has been regarded first and foremost as a means of nutrition for infants, providing essential components for their unique growth and developmental requirements. However, breast milk is also rich in immunologic factors, highlighting its importance as a mediator of protection. In accordance with its evolutionary origin, the mammary gland offers via the breastfeeding route continuation of the maternal to infant immunologic support established in utero. At birth, the infant's immune system is immature, and although it was exposed to the maternal microbial flora during pregnancy, it experiences an abrupt change in its microbial environment during and after birth, which is challenging and renders the infant highly susceptible to infection. Active and passive immunity protects the infant via breast milk, which is rich in immunoglobulins, lactoferrin, lysozyme, cytokines, and numerous other immunologic factors, including maternal leukocytes. Breast milk leukocytes provide active immunity and promote development of immunocompetence in the infant. Additionally, it has been speculated that they play a role in the protection of the mammary gland from infection. Leukocytes are thought to exert these functions via phagocytosis, secretion of antimicrobial factors and/or antigen presentation in both the mammary gland and the gastrointestinal tract of the infant, and also in other infant tissues, where they are transported via the systemic circulation. Recently, it has been demonstrated that breast milk leukocytes respond dynamically to maternal as well as infant infections, and are fewer in nonexclusively compared with exclusively breastfeeding dyads, further emphasizing their importance for both the mother and infant. This review summarizes the current knowledge of human milk leukocytes and factors influencing them, and presents recent novel findings supporting their potential as a diagnostic marker for infections of the lactating breast and of the breastfed infant.

Reducing postoperative infections and red breast syndrome in patients with acellular dermal matrix-based breast reconstruction: the relative roles of product sterility and lower body mass index.

PURPOSE: The use of human acellular dermal matrices (ADM) has become routinely used in implant-based breast surgery. Notwithstanding the many benefits for tissue support, the morbidity associated with its use includes seroma and infection, among other potential complications. Some patients experience a specific complication called red breast syndrome (RBS), which has been linked to ADM use, but its exact etiology remains elusive. In our institution, AlloDerm aseptic regenerative tissue matrix was recently replaced with a ready-to-use sterile version that undergoes terminal sterilization, eliminating the need for rehydration. We want to determine if this change in processing affected complications, including RBS. METHODS: We conducted a retrospective chart review analyzing patients from January 1, 2011, to June 1, 2013, who underwent breast surgery with human ADM. Patients with aseptic AlloDerm were compared to patients with sterile AlloDerm. Data were analyzed using the Fisher exact test. RESULTS: A total of 167 reconstructed breasts from 105 patients met inclusion criteria: 56% (n=93) with aseptic ADM, 44% (n=74) with sterile ADM. When comparing the two, patients had a decrease in overall necrosis, infection, seroma, and RBS with sterile ADM. However, the rates did not reach statistical significance. For example, the incidence of RBS decreased from 7.5% to 2.7% (P=0.301) and seroma decreased from 8.6% to 2.7% (P=0.188). The infection rate proved to be equivocal at 11.8% with aseptic ADM to 10.8% with sterile ADM (P=1.000). The only statistically significant change was a decrease in the total complication rate from 41.9% to 27.0% (P=0.046). The absolute risk reduction for total complications was 14.9% with a number-needed-to-treat of 7. CONCLUSION: According to our study, sterile AlloDerm has a clinically decreased incidence of complications compared to aseptic AlloDerm. Whereas RBS decreased, it was interesting to see that it was not eliminated altogether. This suggests that the etiology may be unrelated to ADM processing and warrants further investigation. Overall, the most notable difference was the statistically significant decrease in the total complication rate. Therefore, the change to sterile AlloDerm seems to be beneficial. Further benefit arises from ease of preparation in the operating room.

Intakes of fat and micronutrients between ages 13 and 18 years and the incidence of proliferative benign breast disease.

PURPOSE: Dietary exposures during adolescence may exert important effects on breast development and future breast cancer risk. This study evaluated the associations between high school intakes of fat and micronutrients and the incidence of proliferative benign breast disease (BBD), a marker of increased breast cancer risk. METHODS: 29,480 women (mean age 43.3 years, range 33.6-52.9) completed a high school food frequency questionnaire in 1998 in the Nurses' Health Study II. Between 1991 and 2001, 682 women (follow-up time: 259,828 person-years) were diagnosed with proliferative BBD whose biopsy slides were reviewed and confirmed by the study pathologists. RESULTS: In multivariate Cox proportional hazards models, high school intakes of total fat and types of fat were not associated with proliferative BBD. Women in the highest quintile of total retinol activity equivalents (RAEs), which incorporate retinol, α- and ß-carotene, and ß-cryptoxanthin intakes, had a 17 % lower risk of proliferative BBD than those in the lowest quintile [multivariate hazard ratio (HR) 95 % CI 0.83 (0.64, 1.07), p trend = 0.01]; however, additional adjustment for high school dietary factors (vitamin D, nuts, and fiber) rendered the association nonsignificant [0.99 (0.73, 1.34), p trend = 0.32]. Results were similar with additional adjustment for adult RAE intake. Intakes of vitamin E and individual carotenoids were not associated with proliferative BBD, although an inverse association cannot be ruled out. CONCLUSIONS: In this study, adolescent fat and micronutrient intakes were not associated with risk of proliferative BBD.