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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EConsumption of fruits, vegetables, and carotenoids has been shown to reduce the risk of breast cancer, as they are rich in flavonoids. The objective of the Cancer Prevention Study II [CPS-II] Nutrition Cohort was to evaluate the association of several flavonoids on the risk of invasive breast cancer in women stratified by estrogen-negative status, as discussed in this article.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Ebreast cancer\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Enutrition physiology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Enutrition clinical trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003EConsumption of fruits, vegetables, and carotenoids has been shown to reduce the risk of breast cancer, in particular estrogen-negative (ER\u2013) breast cancer [Jung S et al. \u003Cem\u003EJ Natl Cancer Inst\u003C\/em\u003E 2013; Aune D et al. \u003Cem\u003EBreast Cancer Res Treat\u003C\/em\u003E 2012; Eliassen AH et al. \u003Cem\u003EJ Natl Cancer Inst\u003C\/em\u003E 2012; Zhang X et al. \u003Cem\u003EAm J Clin Nutr\u003C\/em\u003E 2012]. Fruits and vegetables are rich in flavonoids, which are potential anticancer agents. Flavonoids have antioxidant, anti-inflammatory anti-proliferative, and pro-apoptotic effects. A recent meta-analysis reported that flavonols and flavones, but not other flavonoid subclasses, were associated with a decreased risk of breast cancer, especially in postmenopausal women [Chang H et al. \u003Cem\u003EPloS ONE\u003C\/em\u003E 2013].\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EMost previous studies have focused on the association between 1 or 2 subclasses of flavonoids, and no studies have investigated proanthocyanidins. Furthermore, only 3 studies have stratified subjects by the ER status of the breast cancer. The objective of the Cancer Prevention Study II [CPS-II] Nutrition Cohort, presented by Ying Wang, PhD, Epidemiology Research Program, American Cancer Society, Atlanta, Georgia, USA, was to evaluate the association of several flavonoids on the risk of invasive breast cancer in women stratified by ER status.\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EThe study population included 73,640 women who returned a modified Willett food frequency questionnaire. A total of 56,630 postmenopausal women were included in the analysis after 1752 were lost to follow-up. Women previously diagnosed with cancer and those women who reported energy intake that was outside the acceptable range were excluded from the analysis. The women were followed until they developed breast cancer, they died, the last survey was returned, or June 30, 2009.\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EAt a mean follow-up of 8.5 years, 2116 cases of invasive breast cancer, including 1498 ER+ and 218 ER\u2013 cancers, were diagnosed. Flavonoid exposure was assessed with the food frequency questionnaire; information from the USDA flavonoid, proanthocynanidin, and isoflavone databases; and scientific publications. The flavonoids assessed included flavones, flavonols, flavanones, anthocyanidins, flavan3ols, isoflavones, and proanthocyanidins. The women were categorized into quintiles of flavonoid intake. The median intake and range (mg\/day) of total flavonoids for each quintile (Q) were Q1 = 9.5 (\u2264 118.7); Q2 = 143.7 (\u0026gt; 118.7 to 171.0); Q3 = 201.4 (\u0026gt; 171.0 to 239.2); Q4 = 288.6 (\u0026gt; 239.2 to 363.8); and Q5 = 522.9 (\u0026gt; 363.8 to 2062.8). The mean age ranged from 68.4 to 68.9 years in each quintile, and \u223c 98% of the women in each quintile were white.\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EThe intake of flavones, but not other flavonoids, was inversely associated with total invasive breast cancer risk when evaluated by quintiles (p value for trend = .04) and continuous exposure (RR, 0.96; 95% CI, 0.92 to 1.00). When evaluated by quintiles, intake of no flavonoids was associated with ER+ or ER\u2013 breast cancer risk. When evaluated by continuous exposure, flavones intake was inversely associated with ER+ breast cancer risk (RR, 0.96; 95% CI, 0.91 to 1.00), and flavan-3\u2013ol intake was inversely associated with ER\u2013 breast cancer risk (RR, 0.81; 95% CI, 0.67 to 0.97; \u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E).\u003C\/p\u003E\n         \u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/5\/13\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Flavonoid Association With Breast Cancer Risk by ER Status\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1228627126\u0022 data-figure-caption=\u0022Flavonoid Association With Breast Cancer Risk by ER Status\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/5\/13\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/5\/13\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/5\/13\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16458\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-7\u0022 class=\u0022first-child\u0022\u003EFlavonoid Association With Breast Cancer Risk by ER Status\u003C\/p\u003E\n            \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EER=estrogen receptor; SD=standard deviation.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EThe increments are 220 mg\/d for total flavonoids, 10 mg\/d for anthocyanidins, 40 mg\/d for flavan-3\u2013ols, 20 mg\/d for flavanones, 1 mg\/d for flavones, 10 mg\/d for flavonols, 3 mg\/d for isoflavones, and 170 mg\/d for proanthocyanidins.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-3\u0022\u003EReproduced with permission from Y Wang, PhD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-8\u0022\u003EDr. Wang concluded that these findings are consistent with the results of other research. The results suggest that plant-based diets have a protective role against breast cancer. Future pooled analyses of large cohort studies are warranted to confirm these findings.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/5\/13.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzlxs2\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzlxs2\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}