© 1997 by Oxford University Press
Journal Of The National Cancer Institute, Vol 89, 488-496, Copyright © 1997 by Oxford University Press
NF Boyd, C Greenberg, G Lockwood, L Little, L Martin, J Byng, M Yaffe and D Tritchler
BACKGROUND: The appearance of breast tissue on mammography varies according
to its composition. Fat is radiolucent and appears dark on mammography,
while stromal and epithelial tissue has greater optical density and appears
light. Extensive areas of radiologically dense breast tissue seen on
mammography are associated with an increased risk of breast cancer.
PURPOSE: The purpose of the present study was to determine whether the
adoption of a low-fat, high-carbohydrate diet for 2 years would reduce
breast density. METHODS: Women with radiologic densities in more than 50%
of the breast area on mammography were recruited and randomly allocated to
an intervention group taught to reduce intake of dietary fat (mean, 21% of
calories) and increase complex carbohydrate (mean, 61% of calories) or to a
control group (mean, 32% of calories from fat and 50% of calories from
carbohydrates). Mammographic images from 817 subjects were taken at
baseline and compared with those taken 2 years after random allocation by
use of a quantitative image analysis system, without knowledge of the
dietary group of the subjects or of the sequence in which pairs of images
had been taken. The effects of the intervention on the mammographic
features of breast area, area of dense tissues in the breast, and the
percent of the breast occupied by dense tissue were examined using t tests.
Multiple regression was used to examine these effects while accounting for
age at trial entry, weight change, and menopausal status. RESULTS: After 2
years, the total area of the breast was reduced by an average of 233.7 mm2
(2.4%) (95% confidence interval [CI] = 106.9-360.6) in the intervention
group compared with an average increase of 26.3 mm2 (0.3%) (95% CI =
-108.0-160.5) in the control group (P = .01). The area of density was
reduced by 374.4 mm2 (6.1%) (95% CI = 235.1-513.8) in the intervention
group compared with an average of 127.7 mm2 (2.1%) (95% CI = 8.6-246.7) in
the control group (P = .01). Weight loss was associated with a reduction in
breast area. The effect of the intervention on breast area was only
marginally statistically significant after weight change, menopausal
status, and age at trial entry were taken into account (P = .06). Greater
weight loss and becoming postmenopausal were associated with statistically
significant reductions in the area of density on the mammographic image at
2 years (P = .04 and P<.001, respectively). Age at entry into the trial
was marginally significant in the same direction (P = .06). The effect of
the intervention on area of density remained statistically significant
after controlling for weight loss, age at entry, and menopausal status (P =
.03). The change in the percentage of dense tissue in the mammographic
image was not significantly different between the two groups (P = .71).
CONCLUSIONS AND IMPLICATIONS: These results show that after 2 years, a
low-fat, high-carbohydrate diet reduced the area of mammographic density, a
radiographic feature of the breast that is a risk factor for breast cancer.
Longer observation of a larger number of subjects will be required to
determine whether these effects are associated with changes in risk of
breast cancer.
ARTICLES
Effects at two years of a low-fat, high-carbohydrate diet on radiologic features of the breast: results from a randomized trial. Canadian Diet and Breast Cancer Prevention Study Group
Division of Epidemiology and Statistics, Ontario Cancer Institute, Toronto, Canada.
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