• Seungyoun Jung, Donna Spiegelman, Laura Baglietto, Leslie Bernstein, Deborah A Boggs, Piet A van den Brandt, Julie E Buring, James R Cerhan, Mia M Gaudet, Graham G Giles, Gary Goodman, Niclas Hakansson, Susan E Hankinson, Kathy Helzlsouer, Pamela L Horn-Ross, Manami Inoue, Vittorio Krogh, Marie Lof, Marjorie L McCullough, Anthony B Miller, Marian L Neuhouser, Julie R Palmer, Yikyung Park, Kim Robien, Thomas E Rohan, Stephanie Scarmo, Catherine Schairer, Leo J Schouten, James M Shikany, Sabina Sieri, Schoichiro Tsugane, Kala Visvanathan, Elisabete Weiderpass, Walter C Willett, Alicja Wolk, Anne Zeleniuch-Jacquotte, Shumin M Zhang, Xuehong Zhang, Regina G Ziegler, and Stephanie A Smith-Warner.
• Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Longwood Avenue, Boston, MA 02115, USA. pojun@channing.harvard.edu
• J. Natl. Cancer Inst. 2013 Feb 6; 105 (3): 219-36.

BackgroundEstrogen receptor-negative (ER(-)) breast cancer has few known or modifiable risk factors. Because ER(-) tumors account for only 15% to 20% of breast cancers, large pooled analyses are necessary to evaluate precisely the suspected inverse association between fruit and vegetable intake and risk of ER(-) breast cancer.MethodsAmong 993 466 women followed for 11 to 20 years in 20 cohort studies, we documented 19 869 estrogen receptor positive (ER(+)) and 4821 ER(-) breast cancers. We calculated study-specific multivariable relative risks (RRs) and 95% confidence intervals (CIs) using Cox proportional hazards regression analyses and then combined them using a random-effects model. All statistical tests were two-sided.ResultsTotal fruit and vegetable intake was statistically significantly inversely associated with risk of ER(-) breast cancer but not with risk of breast cancer overall or of ER(+) tumors. The inverse association for ER(-) tumors was observed primarily for vegetable consumption. The pooled relative risks comparing the highest vs lowest quintile of total vegetable consumption were 0.82 (95% CI = 0.74 to 0.90) for ER(-) breast cancer and 1.04 (95% CI = 0.97 to 1.11) for ER(+) breast cancer (P (common-effects) by ER status < .001). Total fruit consumption was non-statistically significantly associated with risk of ER(-) breast cancer (pooled multivariable RR comparing the highest vs lowest quintile = 0.94, 95% CI = 0.85 to 1.04).ConclusionsWe observed no association between total fruit and vegetable intake and risk of overall breast cancer. However, vegetable consumption was inversely associated with risk of ER(-) breast cancer in our large pooled analyses.

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