Phytonutrients and outcomes following breast cancer: a systematic review and meta-analysis of observational studies

Author:

van Die M Diana1ORCID,Bone Kerry M23,Visvanathan Kala45,Kyrø Cecile6ORCID,Aune Dagfinn789ORCID,Ee Carolyn1,Paller Channing J4ORCID

Affiliation:

1. NICM Health Research Institute, Western Sydney University , Penrith, NSW, Australia

2. Integria (MediHerb) , Warwick, QLD, Australia

3. Northeast College of Health Sciences , Seneca Falls, NY, USA

4. Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Medicine , Baltimore, MD, USA

5. Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health , Baltimore, MD, USA

6. Department of Diet, Cancer and Health, Danish Cancer Institute, Danish Cancer Society , Copenhagen, Denmark

7. Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London , London, UK

8. Department of Nutrition, Oslo New University College , Oslo, Norway

9. Department of Research, The Cancer Registry of Norway , Oslo, Norway

Abstract

Abstract Background Phytonutrient intakes may improve outcomes following breast cancer, but the impact of postdiagnosis introduction vs established prediagnostic exposure as well as optimum doses has not been established. Evidence from observational studies for key exposures was evaluated, including dosage and intake time frames. Methods MEDLINE, EMBASE, CINAHL, Cochrane Library, ClinicalTrials.gov, and the ISRCTN registry were searched for prospective and retrospective observational studies investigating the impact of soybean, lignans, cruciferous (cabbage-family) vegetables, green tea, or their phytonutrients on breast cancer survival outcomes. A random-effects model was used to calculate summary hazard ratios (HRs) and 95% confidence intervals (CIs). Nonlinear dose-response analyses were conducted using restricted cubic splines. Results Thirty-two articles were included. Soy isoflavones were associated with a 26% reduced risk of recurrence (HR = 0.74, 95% CI = 0.60 to 0.92), particularly among postmenopausal (HR = 0.72, 95% CI = 0.55 to 0.94) and estrogen receptor–positive survivors (HR = 0.82, 95% CI = 0.70 to 0.97), with the greatest risk reduction at 60 mg/day. In mortality outcomes, the reduction was mostly at 20 to 40 mg/day. Soy protein and products were inversely associated with cancer-specific mortality for estrogen receptor–positive disease (HR = 0.75, 95% CI = 0.60 to 0.92). An inverse association was observed for serum or plasma enterolactone, measured prediagnosis and early postdiagnosis, with cancer-specific mortality (HR = 0.72, 95% CI = 0.58 to 0.90) and all-cause mortality (HR = 0.69, 95% CI = 0.57 to 0.83). No effects were observed for cruciferous vegetables. There was a 44% reduced risk of recurrence with prediagnostic green tea for stage I and II breast cancer (HR = 0.56, 95% CI = 0.38 to 0.83). Conclusions Soy, enterolactone, and green tea demonstrated significant risk reductions in outcomes following breast cancer. Evidence is needed regarding the impact of postdiagnostic introduction or substantial increase of these exposures.

Publisher

Oxford University Press (OUP)

Subject

Cancer Research,Oncology

Reference96 articles.

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