Dietary folate intake and breast cancer risk: European prospective investigation into cancer and nutrition.
de Batlle J., Ferrari P., Chajes V., Park JY., Slimani N., McKenzie F., Overvad K., Roswall N., Tjønneland A., Boutron-Ruault MC., Clavel-Chapelon F., Fagherazzi G., Katzke V., Kaaks R., Bergmann MM., Trichopoulou A., Lagiou P., Trichopoulos D., Palli D., Sieri S., Panico S., Tumino R., Vineis P., Bueno-de-Mesquita HB., Peeters PH., Hjartåker A., Engeset D., Weiderpass E., Sánchez S., Travier N., Sánchez MJ., Amiano P., Chirlaque MD., Barricarte Gurrea A., Khaw KT., Key TJ., Bradbury KE., Ericson U., Sonestedt E., Van Guelpen B., Schneede J., Riboli E., Romieu I.
BACKGROUND: There is limited evidence on the association between dietary folate intake and the risk of breast cancer (BC) by hormone receptor expression in the tumors. We investigated the relationship between dietary folate and BC risk using data from the European Prospective Investigation into Cancer and Nutrition (EPIC). METHODS: A total of 367993 women age 35 to 70 years were recruited in 10 European countries. During a median follow-up of 11.5 years, 11575 women with BC were identified. Dietary folate intake was estimated from country-specific dietary questionnaires. Cox proportional hazards regression models were used to quantify the association between dietary variables and BC risk. BC tumors were classified by receptor status. Subgroup analyses were performed by menopausal status and alcohol intake. Intake of other B vitamins was considered. All statistical tests were two-sided. RESULTS: A borderline inverse association was observed between dietary folate and BC risk (hazard ratio comparing top vs bottom quintile [HRQ5-Q1] = 0.92, 95% CI = 0.83 to 1.01, P trend = .037). In premenopausal women, we observed a statistically significant trend towards lower risk in estrogen receptor-negative BC (HRQ5-Q1 = 0.66, 95% CI = 0.45 to 0.96, P trend = .042) and progesterone receptor-negative BC (HRQ5-Q1 = 0.70, 95% CI = 0.51 to 0.97, P trend = .021). No associations were found in postmenopausal women. A 14% reduction in BC risk was observed when comparing the highest with the lowest dietary folate tertiles in women having a high (>12 alcoholic drinks/week) alcohol intake (HRT3-T1 = 0.86, 95% CI = 0.75 to 0.98, P interaction = .035). CONCLUSIONS: Higher dietary folate intake may be associated with a lower risk of sex hormone receptor-negative BC in premenopausal women.