Mediterranean diet adherence and risk of postmenopausal breast cancer: results of a cohort study and meta-analysis

Piet A. van den Brandt*, Maya Schulpen

*Corresponding author for this work

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The Mediterranean Diet (MD) has been associated with reduced mortality and risk of cardiovascular diseases, but there is only limited evidence on cancer. We investigated the relationship between adherence to MD and risk of postmenopausal breast cancer (and estrogen/progesterone receptor subtypes, ER/PR). In the Netherlands Cohort Study, 62,573 women aged 55-69 years provided information on dietary and lifestyle habits in 1986. Follow-up for cancer incidence until 2007 (20.3 years) consisted of record linkages with the Netherlands Cancer Registry and the Dutch Pathology Registry PALGA. Adherence to MD was estimated through the alternate Mediterranean Diet Score excluding alcohol. Multivariate case-cohort analyses were based on 2,321 incident breast cancer cases and 1,665 subcohort members with complete data on diet and potential confounders. We also conducted meta-analyses of our results with those of other published cohort studies. We found a statistically significant inverse association between MD adherence and risk of ER negative (ER-) breast cancer, with a hazard ratio of 0.60 (95% Confidence Interval, 0.39-0.93) for high versus low MD adherence (p(trend)=0.032). MD adherence showed only nonsignificant weak inverse associations with ER positive (ER+) or total breast cancer risk. In meta-analyses, summary HRs for high versus low MD adherence were 0.94 for total postmenopausal breast cancer, 0.98 for ER+, 0.73 for ER- and 0.77 for ER-PR- breast cancer. Our findings support an inverse association between MD adherence and, particularly, receptor negative breast cancer. This may have important implications for prevention because of the poorer prognosis of these breast cancer subtypes.

What's new? When it comes to diet and breast cancer risk, dietary patterns may be of greater importance than individual foods or nutrients. It remains uncertain, however, whether specific dietary patterns impact breast cancer risk. The Mediterranean Diet (MD), which is linked to reduced cardiovascular disease risk, is of particular interest. Here, MD adherence was investigated for potential associations with risk of postmenopausal breast cancer. Analyses of data on 62,573 women ages 55-69 enrolled in the Netherlands Cohort Study show that increased MD adherence is associated with reduced risk of estrogen receptor-negative breast cancer. A meta-analysis of cohort studies confirmed the finding.

Original languageEnglish
Pages (from-to)2220-2231
Number of pages12
JournalInternational Journal of Cancer
Issue number10
Publication statusPublished - 15 May 2017


  • breast cancer
  • Mediterranean diet
  • cohort study

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