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护士健康研究（NHS）是目前规模最大和持续时间最长的女性健康影响因素研究，始于1976年，共有12.17万位30～55岁美国已婚注册护士参与；1989年开始Ⅱ期研究（NHSII），共有12.3万位25～42岁参与者，其中很多是NHS参与者的女儿或侄女；2010年开始3期研究（NHS3）同时对加拿大护士和男性护士开放，目前仍在进行。该研究经费来自美国国家卫生研究院，由哈佛大学医学院、哈佛大学陈曾熙公共卫生学院、布列根医院和波士顿妇女医院等机构共同开展。 2018年7月6日，国际抗癌联盟官方期刊《国际癌症杂志》在线发表哈佛大学陈曾熙公共卫生学院、布列根医院和波士顿妇女医院、哈佛大学医学院、达纳法伯癌症研究所的研究报告，分析了水果和蔬菜摄入量（包括特定的水果和蔬菜）与不同特征（绝经状态、激素受体状态、分子亚型）乳腺癌发生情况的相关性。 该研究根据1980～2012年NHS和1991～2013年NHSII共18万2145位年龄27～59岁女性经过多次验证的调查问卷，对水果和蔬菜累积平均摄入量与浸润性乳腺癌风险的相关性进行分析。通过多因素比例风险回归模型，对已知风险因素进行校正，推算乳腺癌风险比及其95%置信区间，并且根据不同的激素受体状态和分子亚型对肿瘤进行评定。 结果，该前瞻研究共记录到浸润性乳腺癌病例1万0911例。 水果和蔬菜（尤其十字花科和黄色或橙色蔬菜）总摄入量较多（>5.5份/天）与较少（≤2.5份/天）相比，乳腺癌风险显著减少11%（风险比：0.89，95%置信区间：0.83～0.96，趋势分析P=0.005）。 蔬菜总摄入量每增加2份/天，雌激素受体阴性乳腺癌风险显著减少15%（风险比：0.85，95%置信区间：0.77～0.93，异质分析P=0.02）。 根据分子亚型分析，水果和蔬菜总摄入量每增加2份/天：
因此，该研究结果表明，水果和蔬菜（尤其十字花科和黄色或橙色蔬菜）摄入量较多，可能减少乳腺癌风险，尤其恶化可能较高的HER2阳性激素受体阴性或三阴性乳腺癌。 相关阅读 Int J Cancer. 2018 Jul 6. [Epub ahead of print] Fruit and vegetable consumption and breast cancer incidence: Repeated measures over 30 years of follow-up. Farvid MS, Chen WY, Rosner BA, Tamimi RM, Willett WC, Eliassen AH. Harvard T.H. Chan School of Public Health, Boston, MA, USA; Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Dana-Farber Cancer Institute, Boston, MA, USA. We evaluated the relation of fruit and vegetable consumption, including specific fruits and vegetables, with incident breast cancer characterized by menopausal status, hormone receptor status, and molecular subtypes. Fruit and vegetable consumption, cumulatively averaged across repeated, validated questionnaires, was examined in relation to risk of invasive breast cancer among 182,145 women initially aged 27-59y in the Nurses' Health Study (NHS, 1980-2012) and NHSII (1991-2013). Cox proportional hazards regression, adjusted for known risk factors, was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), and assessed tumors by hormone receptor status and molecular subtypes. We prospectively documented 10,911 invasive breast cancer cases. Greater intake of total fruits and vegetables, especially cruciferous and yellow/orange vegetables, was associated with significantly lower breast cancer risk (>5.5 versus ≤2.5 servings/day HR=0.89, 95%CI=0.83-0.96; Ptrend =0.005). Intake of total vegetables was especially associated with lower risk of estrogen receptor negative tumors (HR per 2 additional servings/day as a continuous variable=0.85, 95%CI=0.77-0.93; Pheterogeneity =0.02). Among molecular subtypes, higher intake of total fruits and vegetables (HR per 2 additional servings/day as a continuous variable) was most strongly associated with lower risk of human epidermal growth factor receptor 2 (HER2)-enriched (HR=0.78, 95%CI=0.66-0.92), basal-like (HR=0.85, 95%CI=0.73-0.99), and luminal A (HR=0.94, 95%CI=0.89-0.99), but not with luminal B tumors (Pheterogeneity =0.03). In conclusion, our findings support that higher intake of fruits and vegetables, and specifically cruciferous and yellow/orange vegetables, may reduce the risk of breast cancer, especially those that are more likely to be aggressive tumors. PMID: 29978479 DOI: 10.1002/ijc.31653 |
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