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Intake of Fruits and Vegetables and Risk of Breast Cancer A Pooled Analysis of Cohort Studies

Stephanie A. Smith-Warner, PhD; Donna Spiegelman, ScD; Shiaw-Shyuan Yaun, MPH; Hans-Olov Adami, MD; W. Lawrence Beeson, DrPH; Piet A. van den Brandt, PhD; Aaron R. Folsom, MD; Gary E. Fraser, MB, ChB; Jo L. Freudenheim, PhD; R. Alexandra Goldbohm, PhD; Saxon Graham, PhD; Anthony B. Miller, MB, BCh; John D. Potter, MB, BS; Thomas E. Rohan, MB, BS; Frank E. Speizer, MD; Paolo Toniolo, MD; Walter C. Willett, MD; Alicja Wolk, DSc; Anne Zeleniuch-Jacquotte, MD; David J. Hunter, MB, BS
JAMA. 2001;285(6):769-776. doi:10.1001/jama.285.6.769.
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Context Some epidemiologic studies suggest that elevated fruit and vegetable consumption is associated with a reduced risk of breast cancer. However, most have been case-control studies in which recall and selection bias may influence the results. Additionally, publication bias may have influenced the literature on associations for specific fruit and vegetable subgroups.

Objective To examine the association between breast cancer and total and specific fruit and vegetable group intakes using standardized exposure definitions.

Data Sources/Study Selection Eight prospective studies that had at least 200 incident breast cancer cases, assessed usual dietary intake, and completed a validation study of the diet assessment method or a closely related instrument were included in these analyses.

Data Extraction Using the primary data from each of the studies, we calculated study-specific relative risks (RRs) that were combined using a random-effects model.

Data Synthesis The studies included 7377 incident invasive breast cancer cases occurring among 351 825 women whose diet was analyzed at baseline. For comparisons of the highest vs lowest quartiles of intake, weak, nonsignificant associations were observed for total fruits (pooled multivariate RR, 0.93; 95% confidence interval [CI], 0.86-1.00; P for trend = .08), total vegetables (RR, 0.96; 95% CI, 0.89-1.04; P for trend = .54), and total fruits and vegetables (RR, 0.93; 95% CI, 0.86-1.00; P for trend = .12). No additional benefit was apparent in comparisons of the highest and lowest deciles of intake. No associations were observed for green leafy vegetables, 8 botanical groups, and 17 specific fruits and vegetables.

Conclusion These results suggest that fruit and vegetable consumption during adulthood is not significantly associated with reduced breast cancer risk.

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