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Increasing dietary fiber intake may reduce the
risk of breast cancer Winter 2009, Vol 5, Issue 14 
Given the prevalence of breast cancer in Western countries, the authors of this
featured study suggest their findings may be of public health significance. The
researchers focused specifically on the potential role of dietary fiber and estrogen
receptor (ER)/progesterone receptor (PR) defined breast cancer risk in postmenopausal
women. Reiko et al referenced several previously proposed mechanisms
and studies evaluating dietary fiber intake and related phytochemicals on the
bioactivity, circulating blood levels and metabolism of steroid hormones such as
estrogen. They also site research noting fiber's potential to indirectly diminish postmenopausal
ER+ PR+ breast cancer risk by preventing obesity and type 2 diabetes
through modulating insulin resistance. While several epidemiological studies have
assessed the relationship of dietary fiber intake and breast cancer prior to this
research, the authors note that only two prospective studies reported data on ER/PR
defined breast cancer risk in postmenopausal women and their intake of fiber.
These two former studies had limited cases, while a strength of this investigation is
the large sample size and prospective population-based cohort design. Associations
of ER/PR defined breast cancer risk and dietary fiber intake was evaluated in the
Swedish Mammography Cohort (SMC), which included 51,283 women. Food frequency
questionnaires were conducted in 1987 and 1997, from which dietary fiber
intake was measured. Subjects were divided into five categories based on the quintile
levels of their fiber intake. The researchers investigated other possible modifiers, such
as family history, body mass index (BMI), postmenopausal hormones (PMH), and
alcohol intake. During the follow-up period of the 51,283 women, 1,284 invasive cases
of breast cancer were diagnosed, 1,188 of which included data available on ER/PR
status. The two largest groupings among these cases were 60.3% ER+PR+, and
23.5% ER+PR-. The statistical significance of the study was p < 0.05.
Comparing the highest and lowest quintiles of fiber intake, Reiko et al observed statistically
significant risk reductions for overall (34%) and ER+PR+ (38%) tumors
with fruit fiber. Among PMH users, total fiber intake – and especially cereal fiber
intake – also showed statistically significant risk reduction of ~50% for ER+PR+
tumors. Non-significant inverse associations of total dietary fiber intake and of
overall invasive breast cancer were also observed. Among the proposed biological
mechanisms presented to explain their findings, the presence of phytochemicals in
fiber, such as plant lignans, may play a role in decreasing cancer risk. However,
after adjusting for lignans, the association of cereal fiber and risk reduction among
PMH users remained significant. This led investigators to support the hypothesis
that a mechanism accounting for their observations is fiber's estrogen-binding
capacity in the colon and reduction of bacterial b-glucuronidase activity (which
inhibits intestinal reabsorption of estrogens through increased fecal bulk). Reiko et
al conclude that their findings, if confirmed by further research, are "of public
health significance, because they imply that postmenopausal women may decrease
their risk of breast cancer by increasing dietary fiber intake."
Study: Reiko, S., et al, Int. J. Cancer, 122: 403-412 (2008) RETURN from dietary fiber and breast cancer |
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