Breast Cancer

NOTICE: This health information was not created by the University of Michigan Health System (UMHS) and may not necessarily reflect specific UMHS practices. For medical advice relating to your personal condition, please consult your doctor. Complete disclaimer

Breast Cancer

Need to Know

Breast Cancer

Related Topics

A healthy lifestyle offers protection now. What changes can you make to reduce your breast cancer risk or ease your treatment? According to research or other evidence, the following self-care steps may be helpful.
  • Get a checkup

    See your healthcare professional once a year for a breast exam and mammogram to detect disease before it becomes advanced

  • Cut back on cocktails, but not on nutrition

    Limit your alcohol consumption and take a multivitamin containing folic acid to reduce alcohol-related breast cancer risk

  • Eat risk-reducing foods

    Add plenty of fiber, tomato products, soy products, and fish to your diet

  • Seek support

    If you have breast cancer, join a weekly patients’ group for social support

About

About This Condition

Breast cancer is a malignancy of the breast that is common in women and rare in men. It is characterized by unregulated replication of cells creating tumors, with the possibility of some of the cells spreading to other sites (metastasis).

This article includes a discussion of studies that have assessed whether certain vitamins, minerals, herbs, or other dietary ingredients offered in dietary or herbal supplements may be beneficial in connection with the reduction of risk of developing breast cancer, or of signs and symptoms in people who have this condition.

This information is provided solely to aid consumers in discussing supplements with their healthcare providers. It is not advised, nor is this information intended to advocate, promote, or encourage self prescription of these supplements for cancer risk reduction or treatment. Furthermore, none of this information should be misconstrued to suggest that dietary or herbal supplements can or should be used in place of conventional anticancer approaches or treatments.  

It should be noted that certain studies referenced below, indicating the potential usefulness of a particular dietary ingredient or dietary or herbal supplement in connection with the reduction of risk of breast cancer, are preliminary evidence only. Some studies suggest an association between high blood or dietary levels of a particular dietary ingredient with a reduced risk of developing breast cancer. Even if such an association were established, this does not mean that dietary supplements containing large amounts of the dietary ingredient will necessarily have a cancer risk reduction effect.

Most breast cancer is not hereditary, although a small percentage of women have a genetic weakness that dramatically increases their risk. Women with a strong family history of breast cancer may choose to explore the possibility of genetic testing with a geneticist, found on the staff of many major hospitals.

The incidence of postmenopausal breast cancer varies dramatically from one part of the world to the other, and those who move from one country to another will, on average, over time, begin to take on the risk of the new society to which they have moved. This evidence strongly suggests that most, though not all, breast cancer is preventable. However, great controversy exists about which factors are most responsible for the large differences in breast cancer incidence that separate high-risk populations from low-risk populations.

A few factors that affect the risk of having breast cancer are widely accepted:

  • The later the age of the first menstrual cycle, the lower the risk.
  • Full-term pregnancy at an early age (teens to early twenties) lowers the risk.
  • Being overweight increases the risk of postmenopausal breast cancer.
  • Use of hormone replacement therapy increases the risk, but this increase in risk has been reported to disappear shortly after hormone use is discontinued.
  • Being older at the time of the last menstrual cycle (early fifties or older) confers a higher risk compared with women who have had their last menstrual cycle at a younger age (late forties or earlier).

Several other factors may affect a woman’s risk of getting breast cancer. Many researchers and some doctors believe that long-term (greater than five years) use of oral contraceptives increases the risk of premenopausal breast cancer, but not the risk of postmenopausal breast cancer. Also, being overweight appears to slightly reduce the risk of premenopausal breast cancer, even though it increases the risk of postmenopausal breast cancer.

Almost all women with noninvasive breast cancer (ductal carcinoma in situ), along with a majority of women diagnosed with node-negative invasive breast cancer, are cured with appropriate conventional treatment. Even when breast cancer is diagnosed after it has spread to lymph nodes, many patients are curable. Once breast cancer has spread to a distant part of the body, conventional treatment sometimes extends life but cannot provide a cure.

Symptoms

The diagnosis of breast cancer is usually begun at the time a painless one-sided lump is discovered by the woman or her physician. In recent years, the diagnosis of breast cancer often begins with suspicious findings from a routine screening mammogram accompanied by no symptoms. In more advanced cases, changes to the contour of the affected breast may occur, and the lump may eventually become immovable.

If breast cancer spreads to a distant part of the body (distal metastasis), symptoms are determined by the location to which the cancer has spread. For example, if breast cancer spreads to bone, it frequently causes bone pain; if it spreads to the brain, it generally causes neurological symptoms, such as headaches that do not respond to aspirin. When it has spread to a distant part of the body, breast cancer also eventually causes severe weight loss, untreatable fatigue-inducing anemia, and finally death.

Eating Right

The right diet is the key to managing many diseases and to improving general quality of life. For this condition, scientific research has found benefit in the following healthy eating tips.

Recommendation Why Get started
Choose your fat wisely Women in countries that eat high amounts of meat and dairy fat have a high breast cancer risk, while women in countries that mostly eat rice, soy, vegetables, and fish have a low risk.

Choose your fat wisely

High-fat diets increase the risk of mammary cancer in animals.1 From country to country, breast cancer risk in women is proportionate to the level of total fat consumed in the diet.2 Estrogen levels, body weight, and breast density have all been reported to decrease when women are put on low-fat diets—all changes that are thought to reduce the risk of breast cancer.3 , 4 , 5 , 6 Moreover, breast cancer patients have been reported to reduce their chances of survival by eating a diet high in saturated fat.7 (Saturated fat is found mostly in meat and dairy fat.) Similarly, breast cancer patients have been reported to be at increased risk of suffering a recurrence if they eat higher levels of fatty foods, such as butter, margarine, red meat, and bacon.8

Analysis of human trials, using a research design dependent on the memories of subjects, also has shown women consuming high-fat diets to be at high risk of breast cancer.9 In some cases, the correlation has been quite strong.10 However, most,11 , 12 , 13 but not all,14“prospective” studies—which avoid problems caused by faulty memories—have not found any association between fat intake and the risk of breast cancer.

Why do some research findings suggest that fat increases the risk of cancer and other studies find no association? Some studies finding dietary fat unrelated to cancer risks have not factored out the effects of olive oil or fish fat; both may protect against cancer.15 , 16 , 17 , 18 Adding them to the total dietary fat intake and then studying whether “more fat causes more cancer” is therefore misleading. Some studies finding no association between fat intake and breast cancer have made one or both of these errors.19 , 20

Scientists know cancers caused by diet most likely occur many years after the causative foods are regularly consumed. When one group of researchers compared dietary intakes to cancer rates occurring ten years after the consumption of food, and also eliminated from consideration the effect of fat from fish consumption, they found a high degree of correlation between consumption of animal fat (other than from fish) and the risk of breast cancer death rates for women at least 50 years of age.21

In the debate over whether dietary fat increases breast cancer risks, only one fact is indisputable: women in countries that consume high amounts of meat and dairy fat have a high risk of breast cancer, while women in countries that mostly consume rice, soy, vegetables, and fish (instead of dairy fat and meat) have a low risk of breast cancer.22

Feast on fiber Many studies have shown that people who eat plenty of whole grains have a lower risk for breast cancer.

Feast on fiber

Insoluble fiber from grains delays the onset of mammary (breast) cancer in animals.23 In an analysis of the data from many studies, people who eat relatively high amounts of whole grains were reported to be at low risk for breast cancer.24

In some studies, the protective effect of fiber against the risk of breast cancer has been stronger in young women than in older women.25 This finding might occur because fiber has been reported to lower estrogen levels in premenopausal women but not in postmenopausal women.26 , 27 Other researchers, however, report that fiber appears to equally reduce the risk of breast cancer in women of all ages.28 One leading researcher has suggested the active components in fiber may be phytate and isoflavones, substances that may provide protection even in the absence of a decrease in estrogen levels.29 If these substances do protect against breast cancer, they might be as helpful in older women as in younger women.

Consuming a diet high in insoluble fiber is best achieved by switching from white rice to brown rice and from bakery goods made with white flour or mixed flours to 100% whole wheat bread, whole rye crackers, and whole grain pancake mixes. Refined white flour is generally listed on food packaging labels as “flour,”“enriched flour,”“unbleached flour,”“durum wheat,”“semolina,” or “white flour.” Breads containing only whole wheat are usually labeled “100% whole wheat.”

Fill up on fruits and veggies Although not proven, a diet high in fruits and vegetables may afford some protection against breast cancer.

Fill up on fruits and veggies

An analysis of 17 studies on breast cancer risk and diet found that high consumption of vegetables was associated with a 25% decreased risk of breast cancer compared with low consumption.30 The same report analyzed 12 studies that found high consumption of fruit was associated with a 6% reduction of breast cancer incidence compared with low consumption. However, when data from only the eight largest and best studies were combined, high intake of fruits and/or vegetables did not correlate with protection from breast cancer.31 Therefore, the protective effect of fruit and vegetable consumption against breast cancer remains unproven.32

Go fish Fish eaters have been reported to have a low risk of breast cancer, possibly due to fish’s high omega-3 fatty acid content.

Go fish

Fish eaters have been reported to have a low risk of breast cancer.33 The omega-3 fatty acids found in fish are thought by some researchers to be the components of fish responsible for protection against cancer.34

Go vegetarian Compared with meat eaters, most studies have found that vegetarians are less likely to be diagnosed with cancer.

Go vegetarian

Compared with meat eaters, most,35 but not all,36 studies have found that vegetarians are less likely to be diagnosed with cancer. Vegetarians have also been shown to have stronger immune functioning, possibly explaining why vegetarians may be partially protected against cancer.37 Female vegetarians have been reported to have lower estrogen levels compared with meat-eating women, possibly explaining a lower incidence of breast cancer that has been reported in vegetarian women.38

Pour on the olive oil Olive oil in the diet has been associated with low breast cancer risk in some preliminary reports.

Pour on the olive oil

Olive oil consumption has been associated with a reduced risk of breast cancer in several preliminary reports.39 , 40 , 41 Oleic acid, the main fatty acid found in olive oil, does not appear to be the cause of this protective effect,42 and scientists now guess that some as-yet undiscovered substance in olive oil might be responsible for the apparent protective effect of olive oil consumption.43

Stay tuned about soy The commonly held belief that eating soy foods will protect against breast cancer is far from proven.

Stay tuned about soy

Asian countries in which soy consumption is high generally have a low incidence of breast cancer. However, the dietary habits in these countries are so different from diets in high-risk countries that attributing protection from breast cancer specifically to soy foods on the basis of this evidence alone is premature.44 Similarly, within a society, women who frequently consume tofu have been reported to be at low risk of breast cancer.45 Consumption of tofu might only be a marker for other dietary or lifestyle factors that are responsible for protection against breast cancer.

Genistein, one of the isoflavones found in many soy foods, inhibits proliferation of breast cancer cells in test tube studies. Most animal studies report that soybeans and soy isoflavones protect against mammary cancer.46 However, the protective effect in animals have occurred primarily when soy has been administered before puberty.47 If the same holds true in humans, consuming soy products in adulthood might provide little, if any, protection against breast cancer.

The findings of several recent studies suggest that consuming soy might, under some circumstances, increase the risk of breast cancer.48 , 49 , 50 , 51 , 52 When ovaries were removed from animals—a situation related to the condition of women who have had a total hysterectomy—dietary genistein was reported to increase the proliferation of breast cancer cells.53 When pregnant rats were given genistein injections, their female offspring were reported to be at greater risk of breast cancer.54 Although premenopausal women have shown decreases in estrogen levels in response to soy consumption,55 , 56 proestrogenic effects have also been reported.57 When premenopausal women were given soy isoflavones, an increase in breast secretions resulted—an effect thought to elevate the risk of breast cancer.58 In yet another trial, healthy breast cells from women previously given soy supplements containing isoflavones showed an increase in proliferation rates—an effect that might also increase the risk of breast cancer.59

The commonly held belief that consuming soybeans or isoflavones such as genistein will protect against breast cancer is, therefore, far from proven.60 , 61 , 62 , 63 , 64 Possibly, consuming soybeans in childhood may ultimately be proven to have a protective effect.65 Doing the same in adulthood, however, may have very different effects.66 , 67 , 68 , 69 , 70

Some scientists, at least under some circumstances, remain hopeful about the potential for soy to protect against breast cancer. These scientists recommend consumption of foods made from soy (such as tofu), as opposed to taking isoflavone supplements. Several substances in soybeans other than isoflavones have shown anticancer activity in preliminary research.71

Team up with tomatoes High in the antioxidant lycopene, tomatoes have been shown to protect against a variety of cancers including breast cancer.

Team up with tomatoes

Tomatoes contain lycopene—an antioxidant similar in structure to beta-carotene. Most lycopene in our diet comes from tomatoes, though traces of lycopene exist in other foods. Lycopene has been reported to inhibit the proliferation of cancer cells in test tube research.72

A review of published research found that higher intake of tomatoes or higher blood levels of lycopene correlated with a reduced risk of a variety of cancers in 57 of 72 studies. Findings in 35 of these studies were statistically significant.73 Evidence of a protective effect for tomato consumption was strongest for cancers other than breast cancer (prostate, lung, and stomach cancer), but some evidence of a protective effect also appeared for breast cancer.

Cut down on alcohol Limit your intake to lower your risk: Studies show that women who drink alcohol have a higher breast cancer risk than those who abstain.

Cut down on alcohol

An analysis of studies using the best available methodology found that women who drink alcohol have a higher risk of breast cancer compared with teetotalers.74 Alcohol consumption during early adulthood may be more of a risk factor than alcohol consumption at a later age.75

Some,76 , 77 though not all,78 studies have reported that alcohol increases estrogen levels. Increased estrogen levels might explain the increase in risk.

In a preliminary report, drinkers with low intake of folic acid had a 32% increased risk of breast cancer compared with nondrinkers; however, the excess risk was only 5% in those drinkers who consumed adequate levels of folic acid.79 In the same report, women taking multivitamins containing folic acid and having at least 1.5 drinks per day had a 26% lower risk of being diagnosed with breast cancer compared with women drinking the same amount of alcohol but not taking folic acid-containing vitamins.80

Reduce your sugar Studies have shown that women who eat high amounts of sugar-containing foods have had an increased breast cancer risk, whether the association may be due to other dietary or lifestyle factors is unknown.

Reduce your sugar

Preliminary studies have reported associations between an increased intake of sugar or sugar-containing foods and an increased risk of breast cancer,81 though this link does not appear consistently in published research.82 Whether these associations exist because sugar directly promotes cancer or because sugar consumption is only a marker for some other dietary or lifestyle factor remains unknown.

Watch the meat Some studies have shown that eating meat is linked to increased breast cancer risk, although the association may depend on whether the meat is well-done, which introduces more carcinogens.

Watch the meat

Most,83 , 84 but not all,85 studies show that consumption of meat is associated with an increased risk of breast cancer. This association probably depends in part on how well the meat is cooked. Well-done meat contains more carcinogenic material than does lightly cooked meat.86 Evidence from preliminary studies shows that women who eat well-done meat have a high risk of breast cancer.87 Genetic factors may determine which women increase their risk of breast cancer by eating well-done meat.88

Supplements

What Are "Star" Ratings?

a7_3star   Reliable and relatively consistent scientific data showing a substantial health benefit.

a7_2star   Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.

a7_1star   For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support.

Our proprietary “Star-Rating” system was developed to help you easily understand the amount of scientific support behind each supplement in relation to a specific health condition. While there is no way to predict whether a vitamin, mineral, or herb will successfully treat or prevent associated health conditions, our unique ratings tell you how well these supplements are understood by the medical community, and whether studies have found them to be effective for other people.

For over a decade, our team has combed through thousands of research articles published in reputable journals. To help you make educated decisions, and to better understand controversial or confusing supplements, our medical experts have digested the science into these three easy-to-follow ratings. We hope this provides you with a helpful resource to make informed decisions towards your health and well-being.


Supplement Amount Why
Folic Acid
400 mcg daily 2 stars   For women who drink alcohol, folic acid may reduce breast cancer risk by reversing the damaging effect alcohol has on DNA.


2 stars  Folic Acid

400 mcg daily

Among women who drink alcohol, those who consume relatively high amounts of folate from their diet have been reported to be at reduced risk of breast cancer, compared with women who drink alcohol but consumed less folate, according to a preliminary study.89 In a similar report, consumption of folic acid-containing supplements was associated with a lower risk of breast cancer in women who drank alcohol, compared with women who drank alcohol but did not take such supplements.90

The damaging effect alcohol has on DNA—the material responsible for normal replication of cells—is partially reversed by folic acid. Therefore, a potential association between both dietary folate and folic acid supplements and protection against breast cancer in women who drink alcohol is consistent with our understanding of the biochemical effects of these substances. A combined intake from food and supplements of at least 600 mcg per day was associated with a 43% reduced risk of breast cancer in women who consumed 1.5 drinks per day or more, compared with women who drank the same amount but did not take folic acid-containing supplements.91

No research has yet explored the effect of folic acid supplementation in people who have already been diagnosed with cancer. Cancer patients taking the chemotherapy drug methotrexate must not take folic acid supplements without the direction of their oncologist.


Supplement Amount Why
Coenzyme Q10
Refer to label instructions 1 star   Some studies have found that women who take CoQ10 have a greater chance of remaining cancer-free after breast-cancer treatment.


1 star  Coenzyme Q10

French researchers have reported that the lower the blood level of CoQ10 in breast cancer patients, the worse the chance of remaining free of disease.92 For several years, researchers from Denmark and the United States have been studying the effects CoQ10 in a group of 32 breast cancer patients who were either at high risk of suffering a recurrence or had already been diagnosed with advanced disease.93 After 18 months, only one patient had suffered a recurrence, all were still alive, those who did not have advanced disease at the beginning of the trial had not progressed to advanced disease, one patient with advanced disease had stabilized, and two patients with advanced disease had significantly improved.94 Patients continued to do well after two years of supplementation,95 and after three to five years, surprising improvements were reported in two patients who had had advanced disease at the beginning of the trial.96

At first, 90 mg of CoQ10 per day was used. In subsequent reports, the amount of CoQ10 was increased until some women were receiving 390 mg per day.97 Initially, the CoQ10 was accompanied by the use of many other supplements.98 The researchers of this trial have attributed the therapeutic effects observed primarily to CoQ10 and, in later reports, no further mention of other supplements was made.99 , 100 , 101

This preliminary investigation has been conducted with no control group, and published reports have provided only sketchy details about the conditions of most of the women being studied. Some of the patients were given conventional treatments along with CoQ10. Therefore, CoQ10 remains unproven as a cancer treatment.


Supplement Amount Why
Conjugated Linoleic Acid
Refer to label instructions 1 star   Preliminary research suggests that CLA might reduce breast cancer risk.


1 star  Conjugated Linoleic Acid

Preliminary animal and test tube research suggests that CLA might reduce the risk of cancers at several sites, including breast, prostate, colorectal, lung, skin, and stomach.102 , 103 , 104 , 105 Whether CLA will have a similar protective effect for people has yet to be demonstrated in human research.


Supplement Amount Why
Coriolus versicolor
3 grams daily 1 star   A Japanese extract from this mushroom, called PKU, has been shown to benefit breast cancer patients when combined with chemotherapy.


1 star  Coriolus versicolor

3 grams daily

Coriolus is a Chinese mushroom that has been reported to improve parameters of immune function.106 A Japanese extract from this mushroom called Polysaccharide Krestin (PSK) has been studied in many trials with cancer patients, often in conjunction with conventional treatment.107 , 108 , 109 , 110 , 111 , 112 , 113 , 114 , 115 PSK’s effects in women with breast cancer have been somewhat inconsistent. One double-blind trial reported that some groups of women with breast cancer, given PSK along with chemotherapy, had better outcomes than those who took chemotherapy alone.116 Another double-blind trial reported 81% survival in breast cancer patients given PSK plus chemotherapy, compared with 65% in those given chemotherapy alone, though this difference did not quite reach statistical significance.117 A third double-blind trial did not find PSK to be beneficial for women with breast cancer.118

PSK is not readily available in the United States and is available in Japan only by prescription. Although hot water-extracted products made from Coriolus versicolor are available in the United States without prescription, the extent to which these herbal products produce the effects of Japanese PSK remains unknown.


Supplement Amount Why
Eleuthero
Refer to label instructions 1 star   Eleuthero has been shown to enhance immune function in trials studying people with cancer, particularly breast cancer.


1 star  Eleuthero

Also known as Siberian ginseng, eleuthero (Eleutherococcus senticosus, Acanthopanax s.) has been shown to enhance immune function in preliminary Russian trials studying people with cancer, particularly breast cancer.119 , 120 These trials typically used 1to 2 ml of a fluid extract taken three times per day for at least one month. Most of the people in these trials were also treated with chemotherapy, radiation therapy, and/or surgery.121 , 122 Several of the Russian trials showed fewer side effects from conventional therapies among those who also took eleuthero extracts. No information is available on the ability of eleuthero to prevent cancer, nor have clinical trials yet explored whether eleuthero extracts affect either recurrence of breast cancer or survival in women with breast cancer.

Supplement Amount Why
Green Tea
Refer to label instructions 1 star   In one Japanese study, drinking green tea was associated with improvements in women just diagnosed with breast cancer.


1 star  Green Tea

In one Japanese study, green tea consumption was associated with improvements in women with early stages of breast cancer, but not in women with more advanced disease.123 Recurrence rates were found to be lowest in those who drank at least 5 cups per day.124 Despite these associations, however, no proof yet exists that green tea consumption helps breast cancer patients or helps healthy women prevent breast cancer.


Supplement Amount Why
Mistletoe
Refer to label instructions 1 star   In one trial, women with breast cancer (all treated with chemotherapy) who received mistletoe injections experienced improved immunity and quality of life.


1 star  Mistletoe

Special extracts of European mistletoe(Viscum album) injected under the skin has been studied in several positive and negative double-blind trials with cancer patients.125 , 126 , 127 , 128 , 129 A double-blind trial of women with breast cancer (all treated with chemotherapy) found that those who received mistletoe injections had improved immunity and quality of life compared with those who took placebo.130 The use of oral mistletoe preparations has not been studied in breast cancer patients. Mistletoe injections (usually of a product called Iscador) are available only through physicians and are not readily available in the United States. It is unknown if American mistletoe (Phoradendron leucarpum) would provide the same effect as European mistletoe.

Supplement Amount Why
Vitamin D
Refer to label instructions 1 star   Vitamin D from supplements and from exposure to the sun both appear to protect against breast cancer.


1 star  Vitamin D

Breast cancer rates have been reported to be relatively high in areas of low exposure to sunlight.131 Sunlight triggers the formation of vitamin D in the skin, which can be activated in the liver and kidneys into a hormone with great activity. This activated form of vitamin D causes “cellular differentiation”—essentially the opposite of cancer.

The following evidence indicates that vitamin D might have a protective role against breast cancer:

  • Synthetic vitamin D-like molecules have prevented the equivalent of breast cancer in animals.132
  • Activated vitamin D appears to have antiestrogenic activity.133
  • Both sunlight and dietary exposure to vitamin D have correlated with a reduced risk of breast cancer.134 , 135

Activated vitamin D comes in several forms. One of them—1,25 dihydroxycholecalciferol—is an exact duplicate of the hormone made in the human body.

The following preliminary, non-clinical evidence supports the idea that activated vitamin D may be of help to some breast cancer patients:

  • In combination with tamoxifen, a synthetic, activated-vitamin D-like molecule has inhibited the growth of breast cancer cells in test tube research.136
  • Synthetic vitamin D-like molecules induce tumor cell death in breast cancer cells.137
  • Activated vitamin D suppresses the growth of human cancer cells transplanted into animals.138
  • In test tube research, activated vitamin D has increased the anticancer action of chemotherapy.139

In a preliminary trial, activated vitamin D was applied topically to the breast, once per day for six weeks, in 19 patients with breast cancer.140 Of the 14 patients who completed the trial, three showed a large reduction in tumor size, and one showed a minor improvement. Those who responded had tumors that contained receptors for activated vitamin D. However, other preliminary reports have not found that high levels of these receptors consistently correlate with a better outcome.141 , 142 , 143

With a doctor’s prescription, compounding pharmacists can put activated vitamin D, a hormone, into a topical ointment. Due to potential toxicity, use of this hormone, even topically, requires careful monitoring by a physician. Standard vitamin D supplements are unlikely to duplicate the effects of activated vitamin D in women with breast cancer. The patients in the breast cancer trial all had locally advanced disease.

References

1. Fay MP, Freedman LS, Clifford CK, Midthune DN. Effect of different types and amounts of fat on the development of mammary tumors in rodents: a review. Cancer Res 1997;57:3979–88.

2. Armstrong B, Doll R. Environmental factors and cancer incidence and mortality in different countries, with special reference to dietary practices. Int J Cancer 1975;15:617–31.

3. Boyar AP, Rose DP, Loughridge JR, et al. Response to a diet low in total fat in women with postmenopausal breast cancer: a pilot study. Nutr Cancer 1988;11:93–9.

4. Bagga D, Ashley JM, Geffrey SP, et al. Effects of a very low fat, high fiber diet on serum hormones and menstrual function. Cancer 1995;76:2491–6.

5. Chlebowski RT, Blackburn GL, Buzzard IM, et al. Adherence to a dietary fat intake reduction program in postmenopausal women receiving therapy for early breast cancer. J Clin Oncol 1993;11:2072–80.

6. Boyd NF, Greenberg C, Lockwood G, et al. Effects at two years of a low-fat, high-carbohydrate diet on radiologic features of the breast: results from a randomized trial. J Natl Cancer Inst1997;89:488–96.

7. Jain M, Miller AB, To T. Premorbid diet and the prognosis of women with breast cancer. J Natl Cancer Inst 1994;86:1390–7.

8. Herbert JR, Hurley TG, Ma Yunsheng. The effect of dietary exposures on recurrence and mortality in early stage breast cancer. Breast Cancer Res Treat 1998;51:17–28.

9. Howe GR, Hirohata T, Hislop G, et al. Dietary factors and risk of breast cancer : combined analysis of 12 case-control studies. J Natl Cancer Inst 19990;82:561–9.

10. Toniolo P, Riboli E, Protta F, et al. Calorie-providing nutrients and risk of breast cancer. J Natl Cancer Inst 1989;81:278–6.

11. Holmes MD, Hunter DH, Colditz GA, et al. Association of dietary intake of fat and fatty acids with risk of breast cancer. JAMA 1999;281:914–20.

12. Jones DY, Schatzkin A, Green SB, et al. Dietary fat and breast cancer in the National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study. J Natl Cancer Inst 1987;79:465–71.

13. Newman SC, Miller AB, Howe GR. A study of the effect of weight and dietary fat on breast cancer survival time. Am J Epidemiol 1986;123:767–74.

14. Howe GR, Friedenreich CM, Jain M, Miller AB. A cohort study of fat intake and risk of breast cancer. J Natl Cancer Inst 1991;83:336–40.

15. Trichopoulou A, Katsouyanni K, Stuver S, et al. Consumption of olive and specific food groups in relation to breast cancer risk in Greece. J Natl Cancer Inst 1995;87:110–6.

16. La Vecchia C, Negri E, Franceschi S, et al. Olive oil, other dietary fats, and the risk of breast cancer (Italy). Cancer Causes Control 1995;6:545–50.

17. Martin-Moreno JM, Willett WC, Gorgojo L, et al. Dietary fat, olive oil intake and breast cancer risk. Int J Cancer 1994;58:774–80.

18. Kaizer L, Boyd NF, Kriukov V, Tritchler D. Fish consumption and breast cancer risk: an ecological study. Nutr Cancer 1989;12:61–8.

19. Jones DY, Schatzkin A, Green SB, et al. Dietary fat and breast cancer in the National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study. J Natl Cancer Inst 1987;79:465–71.

20. Newman SC, Miller AB, Howe GR. A study of the effect of weight and dietary fat on breast cancer survival time. Am J Epidemiol 1986;123:767–74.

21. Saskai S, Moracsek M, Kesteloot H. An ecological study of the relationship between dietary fat intake and breast cancer mortality. Prev Med 1993;22:187–202.

22. Armstrong B, Doll R. Environmental factors and cancer incidence and mortality in different countries, with special reference to dietary practices. Int J Cancer 1975;15:617–31.

23. Rao GN, Ney E, Herbert RA. Influence of diet on mammary cancer in transgenic mice bearing an oncogene expressed in mammary tissue. Breast Cancer Res Treat 1997;45:149–58.

24. Jacobs DR Jr, Marquart L, Salvin J, Kushi LH. Whole-grain intake and cancer: an expanded review and meta-analysis. Nutr Cancer 1998;30:85–96.

25. La Vecchia C, Ferraroni M, Franceschi S, et al. Fibers and breast cancer risk. Nutr Cancer 1997;28:264–9.

26. Golden BR, Woods MN, Spiegelman DL, et al. The effect of dietary fat and fiber on serum estrogen concentrations in premenopausal women under controlled dietary conditions. Cancer 1994;74(3 Suppl):1125–31.

27. Stark AH, Switzer BR, Atwood JR, et al. Estrogen profiles in postmenopausal African-American women in a wheat bran fiber intervention study. Nutr Cancer 1998;31:138–42.

28. Baghurst PA, Rohan TE. High-fiber diets and reduced risk of breast cancer. Int J Cancer 1994;56:173–6.

29. Cohen LA. Dietary fiber and breast cancer. Anticancer Res 1999;19:3685–8.

30. Gandini S, Merzenich H, Robertson C, Boyle P. Meta-analysis of studies on breast cancer risk and diet: the role of fruit and vegetable consumption and the intake of associated micronutrients. Eur J Cancer 2000;36:636–46.

31. Smith-Warner SA, Spiegelman D, Yaun SS, et al. Intake of fruits and vegetables and risk of breast cancer. A polled analysis of cohort studies. JAMA 2001;285:769–76.

32. Smith-Warner SA, Spiegelman D, Yaun SS, et al. Intake of fruits and vegetables and risk of breast cancer. A polled analysis of cohort studies. JAMA 2001;285:769–76.

33. Kaizer L, Boyd NF, Kriukov V, Tritchler D. Fish consumption and breast cancer risk: an ecological study. Nutr Cancer 1989;12:61–8.

34. Rose DP, Connolley JM. Omega-3 fatty acids as cancer chemopreventive agents. Pharmacol Ther 1999;83:217–44.

35. Frentzel-Beyme R, Chang-Claude J. Vegetarian diets and colon cancer: the German experience. Am J Clin Nutr 1994;59(suppl):1143–52S.

36. Kinlen LJ, Hermon C, Smith PG. A proportionate study of cancer mortality among members of a vegetarian society. Br J Cancer 1983;48:355–61.

37. Malter M, Schriever G, Eilber U. Natural killer cells, vitamins, and other blood components of vegetarian and omnivorous men. Nutr Cancer 1989;32:271–8.

38. Armstrong BK, Brown JB, Clarke HT, et al. Diet and reproductive hormones: a study of vegetarian and nonvegetarian postmenopausal women. J Natl Cancer Inst 1981:67:761–7.

39. Trichopoulou A, Katsouyanni K, Stuver S, et al. Consumption of olive and specific food groups in relation to breast cancer risk in Greece. J Natl Cancer Inst 1995;87:110–6.

40. La Vecchia C, Negri E, Franceschi S, et al. Olive oil, other dietary fats, and the risk of breast cancer (Italy). Cancer Causes Control 1995;6:545–50.

41. Martin-Moreno JM, Willett WC, Gorgojo L, et al. Dietary fat, olive oil intake and breast cancer risk. Int J Cancer 1994;58:774–80.

42. Shun-Zhang Y, Rui-Fang L, Da-Dao X, Howe GR. A case-control study of dietary and nondietary risk factors for breast cancer in Shanghai. Cancer Res 1990;50:5017–21.

43. Simonsen NR, Navajas JF-C, Martin-Moreno JM, et al. Tissue stores of individual monounsaturated fatty acids and breast cancer: the EURAMIC study. Am J Clin Nutr 1998;68:134–41.

44. Wu AH, Ziegler RG, Nomura AMY, et al. Soy intake and risk of breast cancer in Asians and Asian Americans. Am J Clin Nutr 1998;68(suppl):1437–43S [review].

45. Wu AH, Ziegler RG, Horn-Ross PL, et al. Tofu and risk of breast cancer in Asian-Americans. Cancer Epidemiol Biomarkers Prev 1996;5:901–6.

46. Messina MJ, Persky V, Setchell KDR, Barnes S. Soy intake and cancer risk: a review of the in vitro and in vivo data. Nutr Cancer 1994;21:113–31 [review].

47. Messina MJ. Legumes and soybeans: overview of their nutritional profiles and health effects. Am J Clin Nutr 1999;70(suppl):439–50S [review].

48. Barnes S. The chemopreventive properties of soy isoflavonoids in animal models of breast cancer. Breast Cancer Res Treat 1997;46:169–79 [review].

49. Hilakivi-Clarke L, Cho E, Onojafe I, et al. Maternal exposure to genistein during pregnancy increases carcinogen-induced mammary tumorigenesis in female rat offspring. Oncol Rep 1999;6:1089–95.

50. Hargreaves DNF, Potten CS, Harding C, et al. Two-week dietary soy supplementation has an estrogenic effect on normal premenopausal breast. J Clin Endocrinol Metab 1999;84:4017–24.

51. Petrakis NL, Barnes S, King EB, et al. Stimulatory influence of soy protein isolate on breast secretion in pre- and postmenopausal women. Cancer Epidemiol Biomarkers Prev 1996;5:785–94.

52. McMichael-Phillips DF, Harding C, Morton M, et al. Effects of soy-protein supplementation on epithelial proliferation in the histologically normal human breast. Am J Clin Nutr 1998;68(suppl):1431–6S.

53. Barnes S. The chemopreventive properties of soy isoflavonoids in animal models of breast cancer. Breast Cancer Res Treat 1997;46:169–79 [review].

54. Hilakivi-Clarke L, Cho E, Onojafe I, et al. Maternal exposure to genistein during pregnancy increases carcinogen-induced mammary tumorigenesis in female rat offspring. Oncol Rep 1999;6:1089–95.

55. Lu LJ, Anderson KE, Grady JJ, Nagamani M. Effects of soya consumption for one month on steroid hormones in premenopausal women: implications for breast cancer risk reduction. Cancer Epidemiol Biomarkers Prev 1996;5:63–70.

56. Nagato C, Takatsuka N, Inaba S, et al. Effect of soymilk consumption on serum estrogen concentrations in premenopausal Japanese women. J Natl Cancer Inst 1998;90:1830–5.

57. Hargreaves DNF, Potten CS, Harding C, et al. Two-week dietary soy supplementation has an estrogenic effect on normal premenopausal breast. J Clin Endocrinol Metab 1999;84:4017–24.

58. Petrakis NL, Barnes S, King EB, et al. Stimulatory influence of soy protein isolate on breast secretion in pre- and postmenopausal women. Cancer Epidemiol Biomarkers Prev 1996;5:785–94.

59. McMichael-Phillips DF, Harding C, Morton M, et al. Effects of soy-protein supplementation on epithelial proliferation in the histologically normal human breast. Am J Clin Nutr 1998;68(suppl):1431–6S.

60. Barnes S. The chemopreventive properties of soy isoflavonoids in animal models of breast cancer. Breast Cancer Res Treat 1997;46:169–79 [review].

61. Hilakivi-Clarke L, Cho E, Onojafe I, et al. Maternal exposure to genistein during pregnancy increases carcinogen-induced mammary tumorigenesis in female rat offspring. Oncol Rep 1999;6:1089–95.

62. Hargreaves DNF, Potten CS, Harding C, et al. Two-week dietary soy supplementation has an estrogenic effect on normal premenopausal breast. J Clin Endocrinol Metab 1999;84:4017–24.

63. Petrakis NL, Barnes S, King EB, et al. Stimulatory influence of soy protein isolate on breast secretion in pre- and postmenopausal women. Cancer Epidemiol Biomarkers Prev 1996;5:785–94.

64. McMichael-Phillips DF, Harding C, Morton M, et al. Effects of soy-protein supplementation on epithelial proliferation in the histologically normal human breast. Am J Clin Nutr 1998;68(suppl):1431–6S.

65. Messina MJ. Legumes and soybeans: overview of their nutritional profiles and health effects. Am J Clin Nutr 1999;70(suppl):439–50S [review].

66. Barnes S. The chemopreventive properties of soy isoflavonoids in animal models of breast cancer. Breast Cancer Res Treat 1997;46:169–79 [review].

67. Hilakivi-Clarke L, Cho E, Onojafe I, et al. Maternal exposure to genistein during pregnancy increases carcinogen-induced mammary tumorigenesis in female rat offspring. Oncol Rep 1999;6:1089–95.

68. Hargreaves DNF, Potten CS, Harding C, et al. Two-week dietary soy supplementation has an estrogenic effect on normal premenopausal breast. J Clin Endocrinol Metab 1999;84:4017–24.

69. Petrakis NL, Barnes S, King EB, et al. Stimulatory influence of soy protein isolate on breast secretion in pre- and postmenopausal women. Cancer Epidemiol Biomarkers Prev 1996;5:785–94.

70. McMichael-Phillips DF, Harding C, Morton M, et al. Effects of soy-protein supplementation on epithelial proliferation in the histologically normal human breast. Am J Clin Nutr 1998;68(suppl):1431–6S.

71. Messina M, Barnes S. The role of soy products in reducing risk of cancer. J Natl Cancer Inst 1991;83:541–6 [review].

72. Levy J, Bosin E, Feldman B, et al. Lycopene is a more potent inhibitor of human cancer cell proliferation than either a-carotene or ß-carotene. Nutr Cancer 1995;24:257–66.

73. Giovannucci E. Tomatoes, tomato-based products, lycopene, and cancer: review of the epidemiologic literature. J Natl Cancer Inst 1999;91:317–31.

74. Smith-Warner SA, Spiegelman D, Yaun SS, et al. Alcohol and breast cancer in women. A pooled analysis of cohort studies. JAMA 1998;279:535–40.

75. Garland M, Hunter DJ, Colditz GA, et al. Alcohol consumption in relation to breast cancer risk in a cohort of United States women 25–42 years of age. Cancer Epidemiol Biomarkers Prev 1999;8:1017–21.

76. Purohit V. Moderate alcohol consumption and estrogen levels in postmenopausal women: a review. Alcohol Clin Exp Res 1998;22:994–7.

77. Ginsburg ES, Mello NK, Mendelson JH, et al. Effects of alcohol ingestion on estrogens in postmenopausal women. JAMA 1996;276:1747–51.

78. Becker U, Gluud C, Bennet P, et al. Effect of alcohol and glucose infusion on pituitary-gonadal hormones in normal females. Drug Alcohol Depend 1988;22:141–9.

79. Zhang S, Hunter DJ, Hankinson SE, et al. A prospective study of folate intake and the risk of breast cancer. JAMA 1999;281:1632–7.

80. Zhang S, Hunter DJ, Hankinson SE, et al. A prospective study of folate intake and the risk of breast cancer. JAMA 1999;281:1632–7.

81. Burley VJ. Sugar consumption and human cancer in sites other than the digestive tract. Eur J Cancer Prev 1998;7:253–77 [review].

82. Decarli A, Favero A, La Vecchia C, et al. Macronutrients, energy intake, and breast cancer risk: implications from different models. Epidemiology 1997;8:425–8.

83. Zheng W, Gustafson DR, Sinha R, et al. Well-done meat intake and the risk of breast cancer. J Natl Cancer Inst 1998;90:1724–9.

84. De Stefani E, Ronco A, Mendilaharsu M, et al. Meat intake, heterocyclic amines, and risk of breast cancer : a case-control study in Uruguay. Cancer Epidemiol Biomarkers Prev 1997;6:573–81.

85. Ambrosone CB, Freudenheim JL, Sinha R, et al. Breast cancer risk, meat consumption and N-acetyltransferase (NAT2) genetic polymorphisms. Int J Cancer 1998;75:825–30.

86. Bjeldanes LF, Morris MM, Felton JS, et al. Effect of meat composition and cooking conditions on mutagen formation in fried ground beef. J Agriculture Food Chem 1983;31:18–21.

87. Zheng W, Gustafson DR, Sinha R, et al. Well-done meat intake and the risk of breast cancer. J Natl Cancer Inst 1998;90:1724–9.

88. Zheng W, Deitz AC, Campbell DR, et al. N-acetyltransferase 1 genetic polymorphism, cigarette smoking, well-done meat intake, and breast cancer risk. Cancer Epidemiol Biomarkers Prev 1999;8:233–9.

89. Rohan TE, Jain MG, Howe GR, Miller AB. Dietary folate consumption and breast cancer risk. J Natl Cancer Inst 2000;92:266–9.

90. Zhang S, Hunter DJ, Hankinson SE, et al. A prospective study of folate intake and the risk of breast cancer. JAMA 1999;281:1632–7.

91. Zhang S, Hunter DJ, Hankinson SE, et al. A prospective study of folate intake and the risk of breast cancer. JAMA 1999;281:1632–7.

92. Jolliet P, Simon N, Barr J, et al. Plasma coenzyme Q10 concentrations in breast cancer: prognosis and therapeutic consequences. Int J Clin Pharmacol Ther 1998;36:506–9.

93. Lockwood K, Moesgaard S, Hanioka T, Folkers K. Apparent partial remission of breast cancer in “high risk” patients supplemented with nutritional antioxidants, essential fatty acids and CoQ10. Eighth International Symposium on the Biomedical and Clinical Aspects of Coenzyme Q10, Stockholm, Sweden, November, 1993.

94. Lockwood K, Moesgaard S, Hanioka T, Folkers K. Apparent partial remission of breast cancer in ‘high risk’ patients supplemented with nutritional antioxidants, essential fatty acids and coenzyme Q10. Molec Aspects Med 1994;5(Suppl):S231–40.

95. Lockwood K., Moesgaard S., Folkers K. Partial and complete regression of breast cancer in patients in relation to dosage of coenzyme Q10. Biochem Biophys Res Comm 1994;199:1504–8.

96. Lockwood K., Moesgaard S., Yamamoto T., Folkers K. Progress on therapy of breast cancer with vitamin Q10 and the regression of metastases. Biochem Biophys Res Comm 1995;212:172–7.

97. Lockwood K, Moesgaard S, Hanioka T, Folkers K. Apparent partial remission of breast cancer in ‘high risk’ patients supplemented with nutritional antioxidants, essential fatty acids and coenzyme Q10. Molec Aspects Med 1994;5(Suppl):S231–40.

98. Lockwood K, Moesgaard S, Hanioka T, Folkers K. Apparent partial remission of breast cancer in “high risk” patients supplemented with nutritional antioxidants, essential fatty acids and CoQ10. Eighth International Symposium on the Biomedical and Clinical Aspects of Coenzyme Q10, Stockholm, Sweden, November, 1993.

99. Lockwood K, Moesgaard S, Hanioka T, Folkers K. Apparent partial remission of breast cancer in ‘high risk’ patients supplemented with nutritional antioxidants, essential fatty acids and coenzyme Q10. Molec Aspects Med 1994;5(Suppl):S231–40.

100. Lockwood K., Moesgaard S., Folkers K. Partial and complete regression of breast cancer in patients in relation to dosage of coenzyme Q10. Biochem Biophys Res Comm 1994;199:1504–8.

101. Lockwood K., Moesgaard S., Yamamoto T., Folkers K. Progress on therapy of breast cancer with vitamin Q10 and the regression of metastases. Biochem Biophys Res Comm 1995;212:172–7.

102. Cesano A, Visonneau S, Scimeca JA, et al. Opposite effects of linoleic acid and conjugated linoleic acid on human prostatic cancer in SCID mice. Anticancer Res 1998;18:1429-34.

103. Thompson H, Zhu Z, Banni S, et al. Morphological and biochemical status of the mammary gland as influenced by conjugated linoleic acid: implication for a reduction in mammary cancer risk. Cancer Res 1997;57:5067-72.

104. Ip C. Review of the effects of trans fatty acids, oleic acid, n-3 polyunsaturated fatty acids, and conjugated linoleic acid on mammary carcinogenesis in animals. Am J Clin Nutr 1997;66(suppl):1523S-29S [review].

105. Parodi PW. Cows’ milk fat components as potential anticarcinogenic agents. J Nutr 1997;127:1055-60 [review].

106. Pedrinaci S, Algarra I, Garrido F. Protein-bound polysaccharide (PSK) induces cytotoxic activity in the NKL human natural killer cell line. Int J Clin Lab Res 1999;29:135–40.

107. Kidd PM. The use of mushroom glucans and proteoglycans in cancer treatment. Altern Med Rev 2000;5:4–27 [review].

108. Maehara Y, Moriguchi S, Sakaguchi Y, et al. Adjuvant chemotherapy enhances long-term survival of patients with advanced gastric cancer following curative resection. J Surg Oncol 1990;45:169–72.

109. Kidd PM. The use of mushroom glucans and proteoglycans in cancer treatment. Altern Med Rev 2000;5:4–27 [review].

110. Kaibara N, Soejima K, Nakamura T, et al. Postoperative long-term chemotherapy for advanced gastric cancer. Jpn J Surg 1976;6:54–9.

111. Niimoto M, Hattori T, Tamada R, et al. Postoperative adjuvant immunochemotherapy with mitomycin C, futraful and PSK for gastric cancer. An analysis of data on 579 patients followed for five years. Jpn J Surg 1988;18:681–6.

112. Nakazato H, Koike A, Saji S, et al. Efficacy of immunochemotherapy as adjuvant treatment after curative resection of gastric cancer. Lancet 1994;343:1122–6.

113. Ogoshi K, Satou H, Isono K, et al. Possible predictive markers of immunotherapy in esophageal cancer: retrospective analysis of a randomized study. Cancer Invest 1995;13:363–9.

114. Hayakawa K, Mitsuhashi N, Saito Y, et al. Effect of Krestin (PSK) as adjuvant treatment on the prognosis after radical radiotherapy in patients with non-small cell lung cancer. Anticancer Res 1993;13:1815–20.

115. Kondo M, Torisu M. Evaluation of an anticancer activity of a protein-bound polysaccharide PS-K (Krestin). In: Torisu M, Yoshida T (eds). Basic Mechanisms and Clinical Treatment of Tumor Metastasis. New York: Academic Press, 1985, 623–36.

116. Toi M, Hattori T, Akagi M, et al. Randomized adjuvant trial to evaluate the addition of tamoxifen and PSK to chemotherapy in patients with primary breast cancer. 5-year results from the Nishi-Nippon Group of the Adjuvant Chemoendorine Therapy for Breast Cancer Organization. Cancer 1992;70:2475–83.

117. Iino Y, Yokoe T, Maemura M, et al. Immunochemotherapies versus chemotherapy as adjuvant treatment after curative resection of operable breast cancer. Anticancer Res 1995;15:2907–12.

118. Morimoto T, Ogawa M, Orita K, et al. Postoperative adjuvant randomised trial comparing chemo-endocrine therapy, chemotherapy and immunotherapy for patients with stage II breast cancer: 5-year results from the Nishinihon Cooperative Study Group of Adjuvant Chemo-endocrine Therapy for Breast Cancer (ACETBC) of Japan. Eur J Cancer 1996;32A:235–42.

119. Gvamichava AR, Khatiashvili TM, Khudzhadze RG, et al. First results of the use of Eleutherococcus in the combined treatment of breast carcinoma. Lek Sredestva Dal’nego Vostoka 1966;7:231–5 [in Russian].

120. Kupin VI, Polevaia YeB, Sorokin AM. Stimulation of the immunological reactivity of cancer patients by Eleutherococcus extract. Vopr Onkol 1986;32:21–6 [in Russian].

121. Gvamichava AR, Khatiashvili TM, Khudzhadze RG, et al. First results of the use of Eleutherococcus in the combined treatment of breast carcinoma. Lek Sredestva Dal’nego Vostoka 1966;7:231–5 [in Russian].

122. Kupin VI, Polevaia YeB, Sorokin AM. Stimulation of the immunological reactivity of cancer patients by Eleutherococcus extract. Vopr Onkol 1986;32:21–6 [in Russian].

123. Nakachi K, Suemasu K, Suga K, et al. Influence of drinking green tea on breast cancer malignancy among Japanese patients. Jpn J Cancer Res 1998;89:254–61.

124. Nakachi K, Suemasu K, Suga K, et al. Influence of drinking green tea on breast cancer malignancy among Japanese patients. Jpn J Cancer Res 1998;89:254–61.

125. Kleijnen J, Knipschild P. Mistletoe treatment for cancer. Review of controlled trials in humans. Phytomedicine 1994;1:255–60 [review].

126. Dold U, Edler L, Mäurer HC, et al. Supplemental Cancer Therapy for Advanced Non-Small Cell Bronchial Carcinoma. Stuttgart: Georg Thieme Verlag, 1991.

127. Douwes FR, Kalden M, Frank G, Holzhauer P. Treatment of advanced colorectal carcinomas. Deutsch Z Onkol 1988;21:63–7 [in German].

128. Kjaer M. Mistletoe (Iscador) therapy in stage IV renal adenocarcinoma. Acta Oncol 1988;28:489–94.

129. Steuer-Vogt MK, Bonkowsky V, Ambrosch P, et al. The effect of an adjuvant mistletoe treatment programme in resected head and neck cancer patients: a randomised controlled clinical trial. Eur J Cancer 2001;37:23–31.

130. Heiny BM. Adjuvant treatment with standardized mistletoe extract reduces leukopenia and improves the quality of life of patients with advanced carcinoma of the breast receiving palliative chemotherapy (VEC regimen). Krebsmedizin 1991:12:3–14 [in German].

131. Gorham ED, Garland FC, Garland CF. Sunlight and breast cancer incidence in the USSR. Int J Epidemiol 1990;19:820–4.

132. Anzano MA, Smith JM, Uskokovic, et al. 1a,25-dihydroxy-16-ene-23-yne-26,27-hexafluorocholecalciferol (Ro24–5531), a new deltanoid (vitamin D analogue) for prevention of breast cancer in the rat. Cancer Res 1994;54:1653–6.

133. Demdirpence E, Balaguer P, Trousse F, et al. Antiestrogenic effects of all-trans-retinoic acid and 1,25-dihydroxyvitamin D3 in breast cancer cells occur at the estrogen response element level but through different molecular mechanisms. Cancer Res 1994;54:1458–64.

134. John EM, Schwartz GG, Dreon DM, Koo J. Vitamin D and breast cancer risk: the NHANES I Epidemiologic follow-up study, 1971–1975 to 1992. Cancer Epidemiol Biomarkers Prev 1999;8:399–406.

135. Robien K, Cutler GJ, Lazovich D. Vitamin D intake and breast cancer risk in postmenopausal women: the Iowa Women's Health Study. Cancer Causes Control 2007;18:775–82.

136. Vink-van Wijngaarden T, Pols HA, Buurman CJ, et al. Inhibition of breast cancer cell growth by combined treatment with vitamin D3 analogues and tamoxifen. Cancer Res 1994;54:5711–7.

137. James SY, Merceer E, Brady M, et al. ERB1089, a synthetic analogue of vitamin D, induces apoptosis in breast cancer cells in vivo and in vitro. Br J Pharmacol 1998;125:953–62.

138. Eisman JA, Barkla DH, Tutton PJM. Suppression of in vitro growth of human cancer solid tumor xenografts by 1,25-dihydroxyvitamin D3. Cancer Res 1987;47:21–5.

139. Ravid A, Rocker D, Machlenkin A, et al. 1,25-dihydroxyvitamin D3 enhances the susceptibility of breast cancer cells to doxorubicin-induced oxidative damage. Cancer Res 1999;59:862–7.

140. Bower M, Colston KW, Stein RC, et al. Topical calcipotriol treatment in advanced breast cancer. Lancet 1991;337:701–2.

141. Colston KW, Berger U, Coombes RC. Possible role for vitamin D in controlling breast cancer cell proliferation. Lancet 1989;I:188–91.

142. Eisman JA, Suva LJ, Martin TJ. Significance of 1,25-dihydroxyvitamin D3 receptor in primary breast cancer. Cancer Res 1986;46:5406–8.

143. Freake HC, Abeyasekera G, Iwasaki J, et al. Measurement of 1,25-dihydroxyvitamin D3 receptors in breast cancer and their relationship to biochemical and clinical indices. Cancer Res 1984;44:1677–81.

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.

Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.