The study reviewed here (known as the WHEL trial) was designed to see if a stringent low fat, high fruit, high vegetable, high fiber diet made a difference in survival or the cancer coming back in women treated for breast cancer. The results showed that the diet had no effect on survival or the cancer coming back.
The findings surprised many people and contradict the results of many other studies looking at how diet affects breast cancer risk, the cancer coming back, and survival. In the WHEL trial, women who received telephone counseling, newsletters, and cooking lessons promoting a structured, healthy diet had the same results as women who were given dietary guidelines but managed their own diet however they wanted.
The study was well-designed and included many women with a history of breast cancer. There are several possible reasons the results didn't show a benefit from a structured healthy diet:
Many studies have looked at how diet and other lifestyle changes affect the risk of developing breast cancer or having breast cancer come back after treatment. One study showed that eating a traditional Western diet, compared to a traditional Eastern diet, nearly doubled breast cancer risk in Chinese women. Another study showed that women diagnosed with breast cancer who stuck to both a healthy diet and a regular exercise routine improved their chances of survival.
Overall, the available evidence supports the breastcancer.org view that adopting a healthy lifestyle can reduce your risk of developing breast cancer and can improve survival and reduce the risk of recurrence if you've been diagnosed with breast cancer. The cornerstones of a healthy lifestyle include:
Making these changes in your life can be quite difficult. But it's worth it because there's only one of you and you deserve the best life you can possibly have.
NEW YORK (Reuters Health) - Among breast cancer survivors, adopting a low-fat diet high in vegetables, fruit and fiber does not prevent the cancer from returning or prolong survival, according to a paper in the Journal of the American Medical Association.
Dr. John P. Pierce and his associates designed the Women's Healthy Eating and Living (WHEL) trial, based on evidence that plant-derived foods contain anti-cancer chemicals.
Pierce, at the University of California, San Diego, and his team describe the intervention as "a telephone counseling program supplemented with cooking classes and newsletters that promoted daily targets of 5 vegetable servings plus 16 ounces of vegetable juice; 3 fruit servings; 30 grams of fiber; and 15 to 20 percent of" calories from fat.
Subjects in the comparison group received care as usual and were given publications from the National Cancer Institute and the US Department of Health and Human Services, describing the "5-A-Day" dietary guidelines. In addition to five servings of vegetables and fruits, the diet recommends 20 grams of fiber and less than 30 percent of calories from fat.
Between 1995 and 2000, WHEL investigators enrolled more than 3,000 women who were previously treated for breast cancer. Follow-up continued until 2006. They report outcomes for 1,537 subjects randomly assigned to the intervention group and 1,561 assigned to the comparison group.
As noted, the special diet did not prevent breast cancer from returning and it did not improve survival. Roughly 17 percent of patients in each group had their cancer return and about 10 percent in each died during follow-up.
In a related editorial, Dr. Susan M. Gapstur and Dr. Seema Khan, from the Feinberg School of Medicine in Chicago, compared the WHEL study findings with those of the Women's Intervention Nutrition Study (WINS). According to WINS trial results, a low-fat diet imparted significant increases in cancer-free survival, which was associated with a 6-pound weight difference between study groups at year 3.
In the WHEL study, on the other hand, weight loss and amount of daily calories did not differ between the two patient groups, and the actual percentage of calories from fat increased during the trial in both groups.
The editorialists suggest that "these results call into question the validity of some components of the self-reported dietary data," and they attribute the negative findings at least partially to lack of adherence to the diet.
SOURCE: Journal of the American Medical Association, July 18, 2007.
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