© 2002 by Oxford University Press
Journal of the National Cancer Institute, Vol. 94, No. 17, 1301-1310,
September 4, 2002
© 2002 Oxford University Press
ARTICLE |
Intake of Dairy Products, Calcium, and Vitamin D and Risk of Breast Cancer
Affiliations of authors: M.-H. Shin, Department of Nutrition, Harvard School of Public Health, Boston, MA, and Department of Preventive Medicine, Sungkyunkwan University School of Medicine, Suwon, Korea; M. D. Holmes, Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston; S. E. Hankinson, Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, and Department of Epidemiology, Harvard School of Public Health; K. Wu, Department of Nutrition, Harvard School of Public Health; G. A. Colditz, Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, and Department of Epidemiology, Harvard School of Public Health, and Harvard Center for Cancer Prevention, Boston; W. C. Willett, Department of Nutrition, Harvard School of Public Health, and Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, and Department of Epidemiology, Harvard School of Public Health.
Correspondence to: Walter C. Willett, M.D., Dr.P.H., Department of Nutrition, Harvard School of Public Health, 665 Huntington Ave., Bldg. 2, Boston, MA 02115 (email: wwillett{at}hsph.harvard.edu).
Background: Laboratory data suggest that calcium and vitamin D, found at high levels in dairy products, might reduce breast carcinogenesis. However, epidemiologic studies regarding dairy products and breast cancer have yielded inconsistent results. We examined data from a large, long-term cohort study to evaluate whether high intake of dairy products, calcium, or vitamin D is associated with reduced risk of breast cancer. Methods: We followed 88 691 women in the Nurses' Health Study cohort from the date of return of their food-frequency questionnaire in 1980 until May 31, 1996. Dietary information was collected in 1980 and updated in 1984, 1986, 1990, and 1994. We identified 3482 women (premenopausal = 827, postmenopausal = 2345, and uncertain menopausal status = 310) with incident invasive breast cancer. We used pooled logistic regression to estimate multivariable relative risks (RRs) using 2-year time increments. The RRs and 95% confidence intervals (CIs) were calculated for each category of intake compared with the lowest intake group. All statistical tests were two-sided. Results: Intakes of dairy products, calcium, or vitamin D were not statistically significantly associated with breast cancer risk in postmenopausal women. In premenopausal women, however, consumption of dairy products, especially of low-fat dairy foods and skim/low-fat milk, was inversely associated with risk of breast cancer. The multivariable RRs comparing highest (>1 serving/day) and lowest (
3 servings/month) intake categories were 0.68 (95% CI = 0.55 to 0.86) for low-fat dairy foods and 0.72 (95% CI = 0.56 to 0.91) for skim/low-fat milk. Dairy calcium (>800 mg/day versus 200 mg/day; RR = 0.69, 95% CI = 0.48 to 0.98), total vitamin D (>500 IU/day versus 150 IU/day; RR = 0.72, 95% CI = 0.55 to 0.94), and lactose (quintile 5 versus quintile 1; RR = 0.68, 95% CI = 0.54 to 0.86] also had inverse associations with premenopausal breast cancer risk. By taking into account supplemental calcium and vitamin D intake, we found that association with calcium was due mainly to dairy sources whereas the association with vitamin D may be independent of dairy intake. Conclusions: We found no association between intake of dairy products and breast cancer in postmenopausal women. Among premenopausal women, high intake of low-fat dairy foods, especially skim/low-fat milk, was associated with reduced risk of breast cancer. Similar inverse associations were seen with components (calcium and vitamin D) of dairy foods, but their independent associations with breast cancer are difficult to distinguish.
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