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Pre-diagnostic polyphenol intake and breast cancer survival: the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort

Kyrø C 1 , Zamora-Ros R 2 , Scalbert A 2 , Tjønneland A 3 , Dossus L 4 , Johansen C 3 Show all authors , Bidstrup PE 3 , Weiderpass E 5 , Christensen J 3 , Ward H 6 , Aune D 6 , Riboli E 6 , His M 4 , Clavel-Chapelon F 4 , Baglietto L 4 , Katzke V 7 , Kühn T 7 , Boeing H 8 , Floegel A 8 , Overvad K 9 , Lasheras C 10 , Travier N 11 , Sánchez MJ 12 , Amiano P 13 , Chirlaque MD 13 , Ardanaz E 13 , Khaw KT 14 , Wareham N 15 , Perez-Cornago A 16 , Trichopoulou A 17 , Lagiou P 17 , Vasilopoulou E 17 , Masala G 18 , Grioni S 19 , Berrino F 19 , Tumino R 20 , Sacerdote C 21 , Mattiello A 22 , Bueno-de-Mesquita HB 6 , Peeters PH 6 , van Gils C 23 , Borgquist S 24 , Butt S 25 , Zeleniuch-Jacquotte A 26 , Sund M 27 , Hjartåker A 28 , Skeie G 5 , Olsen A 3 , Romieu I 2

Affiliations 

  • 1 Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark. ceciliek@cancer.dk
  • 2 International Agency for Research on Cancer (WHO-IARC), Lyon, France
  • 3 Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark
  • 4 Inserm, CESP Centre for Research in Epidemiology and Population Health, Villejuif, France
  • 5 Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
  • 6 Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
  • 7 Division of Cancer Epidemiology, German Cancer Research Center, DKFZ, Heidelberg, Germany
  • 8 Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
  • 9 Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
  • 10 Department of Functional Biology, Faculty of Medicine, University of Oviedo, Asturias, Spain
  • 11 Unit of Nutrition and Cancer, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain
  • 12 Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs.GRANADA, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
  • 13 CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
  • 14 Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
  • 15 MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
  • 16 Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
  • 17 Hellenic Health Foundation, Athens, Greece
  • 18 Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy
  • 19 Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
  • 20 Cancer Registry and Histopathology Unit, "Civile-M.P. Arezzo" Hospital, ASP, Ragusa, Italy
  • 21 Cancer Epidemiology Unit, San Giovanni Battista Hospital, CPO Piemonte and University of Turin, Turin, Italy
  • 22 Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy
  • 23 Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
  • 24 Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
  • 25 Department of Surgery, Clinical Sciences, Skåne University Hospital, Lund University, Malmö, Sweden
  • 26 Department of Population Health, NYU School of Medicine, New York, NY, USA
  • 27 Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
  • 28 Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
Breast Cancer Res Treat, 2015 Nov;154(2):389-401.
PMID: 26531755 DOI: 10.1007/s10549-015-3595-9

Abstract

The aim was to investigate the association between pre-diagnostic intakes of polyphenol classes (flavonoids, lignans, phenolic acids, stilbenes, and other polyphenols) in relation to breast cancer survival (all-cause and breast cancer-specific mortality). We used data from the European Prospective Investigation into Cancer and Nutrition cohort. Pre-diagnostic usual diet was assessed using dietary questionnaires, and polyphenol intakes were estimated using the Phenol-Explorer database. We followed 11,782 breast cancer cases from time of diagnosis until death, end of follow-up or last day of contact. During a median of 6 years, 1482 women died (753 of breast cancer). We related polyphenol intake to all-cause and breast cancer-specific mortality using Cox proportional hazard models with time since diagnosis as underlying time and strata for age and country. Among postmenopausal women, an intake of lignans in the highest versus lowest quartile was related to a 28 % lower risk of dying from breast (adjusted model: HR, quartile 4 vs. quartile 1, 0.72, 95 % CI 0.53; 0.98). In contrast, in premenopausal women, a positive association between lignan intake and all-cause mortality was found (adjusted model: HR, quartile 4 vs. quartile 1, 1.63, 95 % CI 1.03; 2.57). We found no association for other polyphenol classes. Intake of lignans before breast cancer diagnosis may be related to improved survival among postmenopausal women, but may on the contrary worsen the survival for premenopausal women. This suggests that the role of phytoestrogens in breast cancer survival is complex and may be dependent of menopausal status.

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