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Epidemiology

Fruit and vegetable consumption and incident breast cancer: a systematic review and meta-analysis of prospective studies

British Journal of Cancer volume 125, pages 284–298 (2021)Cite this article

Subjects

Abstract

Background

We conducted a systematic review and meta-analysis of prospective studies to clarify the relation of fruit and vegetable consumption with incident breast cancer.

Methods

We searched systematically PubMed and EMBASE databases up to November 2020 to include prospective studies that reported the association of fruit and vegetable consumption with incident breast cancer. The pooled relative risks (RRs) and 95% confidence intervals (CIs) were calculated for the highest versus the lowest category of total fruit and vegetable, total fruit and total vegetable consumption, as well as fruit juice and subgroups of vegetables in relation to breast cancer incidence, using a random-effect model.

Results

Total fruit and vegetable consumption was associated with lower overall (RR = 0.91, 95% CI = 0.87–0.95) and postmenopausal breast cancer risk (RR = 0.88, 95% CI = 0.79–0.99). Total fruit consumption was associated with lower overall (RR = 0.93, 95% CI = 0.88–0.99) and postmenopausal breast cancer risk (RR = 0.93, 95% CI = 0.87–0.99). Total fruit and vegetable intake were associated with 11% and 26% lower risk of oestrogen- and progesterone-receptor-positive (ER+/PR+) and -negative (ER−/PR−) breast cancer, respectively. Total vegetable consumption was associated with 27% lower risk of ER−/PR− breast cancer. Fruit juice consumption was associated with increased overall breast cancer risk (RR = 1.04, 95% CI = 1.01–1.07). We did not find significant associations for subgroups of vegetable intake and breast cancer risk.

Conclusions

These findings suggest that high total fruit and vegetable consumption are associated with reduced risk of overall, postmenopausal, ER+/PR+ and ER−/PR− breast cancer.

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Fig. 1: Flowchart of study selection.
Fig. 2: Associations of total fruit and vegetable intake and risk of breast cancer.
Fig. 3: Associations of total fruit intake and risk of breast cancer.
Fig. 4: Associations of fruit juice intake and risk of overall breast cancer.
Fig. 5: Associations of total vegetable intake and risk of breast cancer.
Fig. 6: Associations of total fruit and vegetable, total fruit and total vegetable intake and risk of overall breast cancer.
Fig. 7: Associations of total fruit and vegetable, total fruit and total vegetable intake and risk of breast cancer based on hormone-receptor status.

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Acknowledgements

We would like to thank Jacqueline Cellini MLIS, MPH—Research & Instruction Librarian, Harvard T.H. Chan School of Public Health for her valuable contributions in developing the search string.

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Authors and Affiliations

  1. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Maryam S. Farvid

  2. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Junaidah B. Barnett

  3. Department of Sociology and Department of Health and Society, University of Toronto, Toronto, ON, Canada

    Nicholas D. Spence

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Contributions

Study concept and design: M.F.S., data collection and collation: M.S.F., statistical analysis: M.S.F., writing—original draft: M.S.F., writing—review and editing: M.S.F., J.B.B. and N.D.S, study supervision: M.S.F. Interpretation of the data, critical revision of the paper for important intellectual content and approval of the final paper for submission: M.S.F., J.B.B. and N.D.S. The corresponding authors prove that all listed authors meet the authorship criteria, and that no other eligible authors have been omitted.

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Correspondence to Maryam S. Farvid.

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Farvid, M.S., Barnett, J.B. & Spence, N.D. Fruit and vegetable consumption and incident breast cancer: a systematic review and meta-analysis of prospective studies. Br J Cancer 125, 284–298 (2021). https://doi.org/10.1038/s41416-021-01373-2

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