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Nutritional Epidemiology

Dietary Phytoestrogens Are Not Associated with Risk of Overall Breast Cancer But Diets Rich in Coumestrol Are Inversely Associated with Risk of Estrogen Receptor and Progesterone Receptor Negative Breast Tumors in Swedish Women^1,2

³ Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, SE-171 77 Stockholm, Sweden; ⁴ Department of Genetic Epidemiology, Samfundet Folkhälsan, SE-00250 Helsinki, Finland; ⁵ Institute for Preventive Medicine, Nutrition and Cancer, Folkhälsan Research Center and Division of Clinical Chemistry, University of Helsinki, FIN-00014 Helsinki, Finland; and ⁶ Cancer Registry of Norway, NO-0310 Oslo, Norway

^* To whom correspondence should be addressed. E-mail: maria.hedelin{at}ki.se.

Results from epidemiological and experimental studies indicate that phytoestrogens may protect against breast cancer. Because one of the biological effects of phytoestrogens is probably estrogenic, it's possible that the preventive effect on breast cancer differs by estrogen receptor (ER) or progesterone receptor (PR) status of the tumor. We evaluated the associations between dietary phytoestrogen (isoflavonoids, lignans, and coumestrol) intake and risk of breast cancer and whether the ER/PR statuses of the tumor influence this relationship. In 1991–2 a prospective population-based cohort study among Swedish pre- and postmenopausal women was performed, making questionnaire data available for 45,448 women. A total of 1014 invasive breast cancers were diagnosed until December 2004. Cox proportional hazards models were performed to estimate multivariate risk ratios, 95% CI for associations with risk of breast cancer. Intakes of lignan, isoflavonoid, or coumestrol were not associated with breast cancer risk overall or before or after 50 y of age. The effects of lignans or isoflavonoids were independent of receptor status. However, intake of coumestrol was associated with decreased risk of receptor negative tumors (ER–PR–) but not positive tumors. The risk of ER–PR– tumors was significantly lower (50%) in women with intermediate coumestrol intake compared with those who did not consume any. In conclusion, we found no association between intake of isoflavonoids or lignans and breast cancer risk. Our results of a decreased risk of ER–PR– tumors in women with intermediate intake of coumestrol could be due to chance because of the low intake. The results should be confirmed in other studies.