Dairy foods, calcium, and risk of breast cancer overall and for subtypes defined by estrogen receptor status: a pooled analysis of 21 cohort studies.

May 10, 2021

Contributor: You Wu,Ruyi Huang,Molin Wang,Leslie Bernstein,Traci N Bethea,Chu Chen,Yu Chen,A Heather Eliassen,Neal D Freedman,Mia M Gaudet,Gretchen L Gierach,Graham G Giles,Vittorio Krogh,Susanna C Larsson,Linda M Liao,Marjorie L McCullough,Anthony B Miller,Roger L Milne,Kristine R Monroe,Marian L Neuhouser,Julie R Palmer,Anna Prizment,Peggy Reynolds,Kim Robien,Thomas E Rohan,Sven Sandin,Norie Sawada,Sabina Sieri,Rashmi Sinha,Rachael Z Stolzenberg-Solomon,Shoichiro Tsugane,Piet A van den Brandt,Kala Visvanathan,Elisabete Weiderpass,Lynne R Wilkens,Walter C Willett,Alicja Wolk,Anne Zeleniuch-Jacquotte,Regina G Ziegler,Stephanie A Smith-Warner

Dairy foods, calcium, and risk of breast cancer overall and for subtypes defined by estrogen receptor status: a pooled analysis of 21 cohort studies.

Epidemiologic studies examining the relations between dairy product and calcium intakes and breast cancer have been inconclusive, especially for tumor subtypes.
To evaluate the associations between intakes of specific dairy products and calcium and risk of breast cancer overall and for subtypes defined by estrogen receptor (ER) status.
We pooled the individual-level data of over 1 million women who were followed for a maximum of 8-20 years across studies. Associations were evaluated for dairy product and calcium intakes and risk of incident invasive breast cancer overall (n = 37,861 cases) and by subtypes defined by ER status. Study-specific multivariable hazard ratios (HRs) were estimated and then combined using random-effects models.
Overall, no clear association was observed between the consumption of specific dairy foods, dietary (from foods only) calcium, and total (from foods and supplements) calcium, and risk of overall breast cancer. Although each dairy product showed a null or very weak inverse association with risk of overall breast cancer (P, test for trend >0.05 for all), differences by ER status were suggested for yogurt and cottage/ricotta cheese with associations observed for ER-negative tumors only (pooled HR = 0.90, 95% CI: 0.83, 0.98 comparing ≥60 g/d with <1 g/d of yogurt and 0.85, 95% CI: 0.76, 0.95 comparing ≥25 g/d with <1 g/d of cottage/ricotta cheese). Dietary calcium intake was only weakly associated with breast cancer risk (pooled HR = 0.98, 95% CI: 0.97, 0.99 per 350 mg/d).
Our study shows that adult dairy or calcium consumption is unlikely to associate with a higher risk of breast cancer and that higher yogurt and cottage/ricotta cheese intakes were inversely associated with the risk of ER-negative breast cancer, a less hormonally dependent subtype with poor prognosis. Future studies on fermented dairy products, earlier life exposures, ER-negative breast cancer, and different racial/ethnic populations may further elucidate the relation.

© The Author(s) 2021. Published by Oxford University Press on behalf of the American Society for Nutrition.

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About The Expert

You Wu

Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.

Ruyi Huang

Department of Medical Education, E-DA Hospital and School of Medicine for International Students, School of Medicine, I-SHOU University, Kaohsiung City, Taiwan.

Department of Family Medicine, National Taiwan University Hospital, Taipei, Taiwan.

Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.

Molin Wang

Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.

Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.

Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA.

Leslie Bernstein

Department of Population Sciences, Beckman Research Institute, City of Hope, Duarte, CA, USA.

Traci N Bethea

Slone Epidemiology Center at Boston University, Boston, MA, USA.

Department of Medicine, Boston University School of Medicine, Boston, MA, USA.

Chu Chen

Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.

Yu Chen

Division of Epidemiology, Department of Population Health and Department of Environmental Medicine, New York University School of Medicine, New York, NY, USA.

A Heather Eliassen

Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.

Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA.

Neal D Freedman

Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD, USA.

Mia M Gaudet

Department of Population Science, American Cancer Society, Atlanta, GA, USA.

Gretchen L Gierach

Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD, USA.

Graham G Giles

Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia.

Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.

Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.

Vittorio Krogh

Epidemiology and Prevention Unit Department of Research, IRCCS National Cancer Institute Foundation, Milan, Italy.

Susanna C Larsson

Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.

Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden.

Linda M Liao

Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD, USA.

Marjorie L McCullough

Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.

Department of Population Science, American Cancer Society, Atlanta, GA, USA.

Anthony B Miller

Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.

Roger L Milne

Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia.

Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.

Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.

Kristine R Monroe

Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.

Marian L Neuhouser

Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.

Julie R Palmer

Slone Epidemiology Center at Boston University, Boston, MA, USA.

Department of Medicine, Boston University School of Medicine, Boston, MA, USA.

Anna Prizment

Division of Hematology, Oncology and Transplantation, University of Minnesota Medical School, Minneapolis, MN, USA.

Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA.

Peggy Reynolds

Department of Epidemiology and Biostatistics, University of California San Francisco, Berkeley, CA, USA.

Kim Robien

Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, WA, USA.

Thomas E Rohan

Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA.

Sven Sandin

Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.

Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Seaver Autism Center for Research and Treatment at Mount Sinai, New York, NY, USA.

Norie Sawada

Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan.

Sabina Sieri

Epidemiology and Prevention Unit Department of Research, IRCCS National Cancer Institute Foundation, Milan, Italy.

Rashmi Sinha

Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD, USA.

Rachael Z Stolzenberg-Solomon

Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD, USA.

Shoichiro Tsugane

Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan.

Piet A van den Brandt

Department of Epidemiology, GROW-School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands.

Department of Epidemiology, Care and Public Health Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.

Kala Visvanathan

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

Elisabete Weiderpass

International Agency for Research on Cancer, WHO, Lyon, France.

Lynne R Wilkens

University of Hawaii Cancer Center, Honolulu, HI, USA.

Walter C Willett

Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.

Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.

Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA.

Alicja Wolk

Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.

Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden.

Anne Zeleniuch-Jacquotte

Division of Epidemiology, Department of Population Health and Department of Environmental Medicine, New York University School of Medicine, New York, NY, USA.

Regina G Ziegler

Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD, USA.

Stephanie A Smith-Warner

Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.

Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.

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Dairy foods, calcium, and risk of breast cancer overall and for subtypes defined by estrogen receptor status: a pooled analysis of 21 cohort studies.

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