Plant-based dietary patterns and breast cancer risk in the European prospective investigation into cancer and nutrition (EPIC) study
While previous literature suggests that plant-based diets may be associated with a lower risk of breast cancer, evidence remains inconsistent. In this study, we investigated the association between adherence to plant-based diets and breast cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Overall plant-based diet index (PDI), healthful (hPDI), and unhealthful PDI (uPDI) were calculated, and multivariable Cox models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) of breast cancer for the three indices. Mediation analysis was performed to assess the role of body mass index (BMI) and waist circumference (WC) in the association between hPDI and postmenopausal breast cancer risk. Over a median follow-up of 14.9 years, 10,805 incident invasive breast cancer cases were identified among 258,343 women. In the multivariable model, not adjusted for BMI, higher adherence to hPDI was inversely associated with breast cancer risk, with HR per 1-SD increase [95% (CI)] of 0.97 (0.94, 0.99). The corresponding HRs (95% CI) per 1-SD increase for overall PDI and uPDI were 0.98 (0.96, 1.00) and 1.01 (0.99, 1.03), respectively. The associations between hPDI and postmenopausal breast cancer were partly explained by BMI and WC, which mediated 30% and 52% of this association, respectively. Higher adherence to hPDI was associated with a slightly lower total breast cancer risk. For postmenopausal breast cancer, this association was partly explained by lower BMI or WC. These findings suggest that promoting healthful plant-based diets could support breast cancer risk reduction.
Authors
- Alex Christensen (ORCID: https://orcid.org/0000-0001-8508-8424)
- Alicia K. Heath (ORCID: https://orcid.org/0000-0001-6517-1300)
- Sanam Shah (ORCID: https://orcid.org/0000-0002-2469-6765)
- Carine Biessy (ORCID: https://orcid.org/0000-0003-3950-0929)
- Nikos Papadimitriou (ORCID: https://orcid.org/0000-0001-8294-7262)
- Fernanda Morales Berstein (ORCID: https://orcid.org/0000-0002-8237-2021)
- Claudia Agnoli (ORCID: https://orcid.org/0000-0003-4472-1179)
- Lene Mellemkjær (ORCID: https://orcid.org/0000-0001-9222-6215)
- Amaia Aizpurúa (ORCID: https://orcid.org/0000-0001-9793-7913)
- Nasser Laouali
- Matthias Bernd Schulze (ORCID: https://orcid.org/0000-0002-0830-5277)
- Rosario Tumino (ORCID: https://orcid.org/0000-0003-2666-414X)
- Yahya Mahamat‐Saleh (ORCID: https://orcid.org/0000-0002-5892-8886)
- Vittorio Simeon (ORCID: https://orcid.org/0000-0003-2387-4125)
- Charlotte Le Cornet (ORCID: https://orcid.org/0000-0002-5291-7545)
- Chloé Marques (ORCID: https://orcid.org/0000-0003-3203-7310)
- Geneviève Nicolas (ORCID: https://orcid.org/0000-0001-7871-7149)
- Marcela Guevara (ORCID: https://orcid.org/0000-0001-9242-6364)
- Francesca Romana Mancini (ORCID: https://orcid.org/0000-0003-2297-3869)
- Dagfinn Aune (ORCID: https://orcid.org/0000-0002-4533-1722)
- Inge Huybrechts (ORCID: https://orcid.org/0000-0003-3838-855X)
- Carlota Castro‐Espín (ORCID: https://orcid.org/0000-0001-9050-7590)
- Sandra M. Colorado‐Yohar (ORCID: https://orcid.org/0000-0002-6700-0780)
- Heinz Freisling (ORCID: https://orcid.org/0000-0001-8648-4998)
- Lorenzo Milani (ORCID: https://orcid.org/0000-0002-2185-2179)
- Christina C. Dahm (ORCID: https://orcid.org/0000-0003-0481-2893)
- A. Nielsen (ORCID: https://orcid.org/0000-0001-8180-6871)
- Sabina Rinaldi
- Christine El-Khoury (ORCID: https://orcid.org/0009-0002-3665-130X)
- Laure Dossus
- Maria-Jose Sánchez
- Verena Katzke
- Xuan Ren (ORCID: https://orcid.org/0009-0006-9589-3412)
Institutions
- Norwegian Institute of Public Health (NO)
- Inserm (FR)
- University of Potsdam (DE)
- German Cancer Research Center (DE)
- OsloMet – Oslo Metropolitan University (NO)
- Université de Versailles Saint-Quentin-en-Yvelines (FR)
- Aarhus University (DK)
- Heidelberg University (DE)
- Université Paris-Saclay (FR)
- Basque Government (ES)
- Universidad de Antioquia (CO)
- University of Bristol (GB)
- Instituto de Salud Pública de Navarra (ES)
- Institut d'Investigació Biomédica de Bellvitge (ES)
- Ministry of Health (ES)
- Centre de recherche en Epidémiologie et Santé des Populations (FR)
- Navarre Institute of Health Research (ES)
- Instituto de Investigación Biosanitaria de Granada (ES)
- University of Campania "Luigi Vanvitelli" (IT)
- Italian Association for Cancer Research (IT)
- Cancer Registry of Norway (NO)
- Université Mohammed VI Polytechnique (MA)
- Onkologikoa (ES)
- Instituto Murciano de Investigación Biosanitaria (ES)
- Danish Cancer Society (DK)
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (ES)
- Fondazione IRCCS Istituto Nazionale dei Tumori (IT)
- MRC Epidemiology Unit (GB)
- German Institute of Human Nutrition (DE)
- Centre international de recherche sur le cancer (FR)
- Imperial College London (GB)
- University of Turin (IT)
- Andalusian School of Public Health (ES)
Publication Details
- Journal
- European Journal of Epidemiology
- Published
- 2025-07-14
- DOI
- https://doi.org/10.1007/s10654-025-01277-y
- Citations
- 3
- Primary Topic
- Nutritional Studies and Diet
- Type
- article
- Field-Weighted Citation Impact
- 5.64
Funders
- Compagnia di San Paolo
- Universitetet i Tromsø
- Kræftens Bekæmpelse
- Cancer Research UK
- Imperial College London
- Agence Nationale de la Recherche
- Institut National de la Santé et de la Recherche Médicale
- ZonMw
- Bundesministerium für Bildung und Forschung
- Ministerie van Volksgezondheid, Welzijn en Sport
- Ministero della Salute
- Ligue Contre le Cancer
- Ministère de l'Enseignement Supérieur et de la Recherche
- Deutsche Krebshilfe
- Institut Gustave-Roussy
- Mutuelle Générale de l'Education Nationale
- Heidelberger Zentrum für Personalisierte Onkologie Deutsches Krebsforschungszentrum In Der Helmholtz-Gemeinschaft
- Medical Research Council
- World Cancer Research Fund