Degree of food processing and breast cancer risk: a prospective study in 9 European countries

Manon Cairat^#^{1

2

3}, Sahar Yammine^#⁴, Thibault Fiolet², Agnès Fournier², Marie-Christine Boutron-Ruault², Nasser Laouali², Francesca Romana Mancini², Gianluca Severi², Fernanda Morales Berstein^{5

6}, Fernanda Rauber⁷, Renata Bertazzi Levy⁷, Guri Skeie⁸, Kristin Benjaminsen Borch⁸, Anne Tjønneland^{9

10}, Lene Mellemkjær⁹, Yan Borné¹¹, Ann H Rosendahl¹², Giovanna Masala¹³, Maria Teresa Giraudo¹⁴, Maria Santucci de Magistris¹⁵, Verena Katzke¹⁶, Rashmita Bajracharya¹⁶, Carmen Santiuste^{17

18}, Pilar Amiano^{18

19

20}, Stina Bodén²¹, Carlota Castro-Espin^{22

23}, Maria-Jose Sánchez^{18

24

25

26}, Mathilde Touvier^{4

27}, Mélanie Deschasaux-Tanguy^{4

27}, Bernard Srour^{4

27}, Matthias B Schulze^{28

29}, Marcela Guevara^{18

30

31}, Nathalie Kliemann³², Jessica Blanco Lopez¹, Aline Al Nahas¹, Kiara Chang³³, Eszter P Vamos³³, Christopher Millett³³, Elio Riboli³⁴, Alicia K Heath³⁴, Carine Biessy¹, Vivian Viallon¹, Corinne Casagrande¹, Genevieve Nicolas¹, Marc J Gunter^{1

34}, Inge Huybrechts¹

Affiliations

¹ Nutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, France.
² Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, CESP, 94805 Villejuif, France.
³ Inserm U1018, "Exposome, Heredity, Cancer, and Health" Team, Hôpital Paul Brousse, Bâtiment 15/16, 16 avenue Paul Vaillant Couturier, 94807 VILLEJUIF CEDEX, France.
⁴ Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), F-93017 Bobigny, France.
⁵ Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.
⁶ MRC Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom.
⁷ Department of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil.
⁸ Department of Community Medicine, Faculty of Health Sciences, UiT - the Arctic University of Norway, Tromsø, Norway.
⁹ Danish Cancer Society Research Center, Copenhagen, Denmark.
¹⁰ Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
¹¹ Nutrition Epidemiology, Department of Clinical Sciences Malmö, Faculty of Medicine, Lund University, Lund, Sweden.
¹² Department of Clinical Sciences Lund, Oncology, Lund University and Skåne University Hospital, Lund, Sweden.
¹³ Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy.
¹⁴ Department of Clinical and Biological Sciences and Centre for Biostatistics, Epidemiology, and Public Health (C-BEPH), Turin, Italy.
¹⁵ Dipartimento di medicina clinica e chirurgia Federico ii university, Naples, Italy.
¹⁶ Department of Cancer Epidemiology, German Cancer research Center (DKFZ), Heidelberg, Germany.
¹⁷ Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain.
¹⁸ Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.
¹⁹ Epidemiology of Chronic and Communicable Diseases Group, Biodonostia Health Research Institute, San Sebastián, Spain.
²⁰ Sub Directorate for Public Health and Addictions of Gipuzkoa, Ministry of Health of the Basque Government, San Sebastian, Spain.
²¹ Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden.
²² Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO), Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, Barcelona, Spain.
²³ Unit of Nutrition and Cancer, Epidemiology, Public Health, Cancer Prevention and Palliative Program, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Av. Granvia de L'Hospitalet, 199-203 Barcelona, Spain.
²⁴ Escuela Andaluza de Salud Pública (EASP), 18011 Granada, Spain.
²⁵ Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain.
²⁶ Department of Preventive Medicine and Public Health, University of Granada, 18071 Granada, Spain.
²⁷ Nutrition And Cancer Research Network (NACRe Network), Paris, France.
²⁸ Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany.
²⁹ Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany.
³⁰ Instituto de Salud Pública y Laboral de Navarra, 31003 Pamplona, Spain.
³¹ Navarra Institute for Health Research (IdiSNA), 31008 Pamplona, Spain.
³² Cancer Hospital and Research Centre of Santa Catarina (CEPON), Florianópolis, Brazil.
³³ Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom.
³⁴ Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom.

^# Contributed equally.

PMID: 39399144
PMCID: PMC11468235
DOI: 10.1186/s43014-024-00264-2

Degree of food processing and breast cancer risk: a prospective study in 9 European countries

Manon Cairat et al. Food Prod Process Nutr. 2024.

. 2024;6(1):89.

doi: 10.1186/s43014-024-00264-2. Epub 2024 Oct 9.

Authors

Affiliations

¹ Nutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, France.
² Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, CESP, 94805 Villejuif, France.
³ Inserm U1018, "Exposome, Heredity, Cancer, and Health" Team, Hôpital Paul Brousse, Bâtiment 15/16, 16 avenue Paul Vaillant Couturier, 94807 VILLEJUIF CEDEX, France.
⁴ Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), F-93017 Bobigny, France.
⁵ Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.
⁶ MRC Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom.
⁷ Department of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil.
⁸ Department of Community Medicine, Faculty of Health Sciences, UiT - the Arctic University of Norway, Tromsø, Norway.
⁹ Danish Cancer Society Research Center, Copenhagen, Denmark.
¹⁰ Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
¹¹ Nutrition Epidemiology, Department of Clinical Sciences Malmö, Faculty of Medicine, Lund University, Lund, Sweden.
¹² Department of Clinical Sciences Lund, Oncology, Lund University and Skåne University Hospital, Lund, Sweden.
¹³ Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy.
¹⁴ Department of Clinical and Biological Sciences and Centre for Biostatistics, Epidemiology, and Public Health (C-BEPH), Turin, Italy.
¹⁵ Dipartimento di medicina clinica e chirurgia Federico ii university, Naples, Italy.
¹⁶ Department of Cancer Epidemiology, German Cancer research Center (DKFZ), Heidelberg, Germany.
¹⁷ Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain.
¹⁸ Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.
¹⁹ Epidemiology of Chronic and Communicable Diseases Group, Biodonostia Health Research Institute, San Sebastián, Spain.
²⁰ Sub Directorate for Public Health and Addictions of Gipuzkoa, Ministry of Health of the Basque Government, San Sebastian, Spain.
²¹ Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden.
²² Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO), Av. Granvia de L'Hospitalet 199-203, L'Hospitalet de Llobregat, Barcelona, Spain.
²³ Unit of Nutrition and Cancer, Epidemiology, Public Health, Cancer Prevention and Palliative Program, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Av. Granvia de L'Hospitalet, 199-203 Barcelona, Spain.
²⁴ Escuela Andaluza de Salud Pública (EASP), 18011 Granada, Spain.
²⁵ Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain.
²⁶ Department of Preventive Medicine and Public Health, University of Granada, 18071 Granada, Spain.
²⁷ Nutrition And Cancer Research Network (NACRe Network), Paris, France.
²⁸ Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany.
²⁹ Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany.
³⁰ Instituto de Salud Pública y Laboral de Navarra, 31003 Pamplona, Spain.
³¹ Navarra Institute for Health Research (IdiSNA), 31008 Pamplona, Spain.
³² Cancer Hospital and Research Centre of Santa Catarina (CEPON), Florianópolis, Brazil.
³³ Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom.
³⁴ Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom.

^# Contributed equally.

PMID: 39399144
PMCID: PMC11468235
DOI: 10.1186/s43014-024-00264-2

Abstract

Recent epidemiological studies have suggested a positive association between ultra-processed food consumption and breast cancer risk, although some studies also reported no association. Furthermore, the evidence regarding the associations between intake of food with lower degrees of processing and breast cancer risk is limited. Thus, we investigated the associations between dietary intake by degree of food processing and breast cancer risk, overall and by breast cancer subtypes in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Dietary intake of EPIC participants was assessed via questionnaires at baseline. More than 11,000 food ingredients were classified into four groups of food processing levels using the NOVA classification system: unprocessed/minimally processed (NOVA 1), culinary ingredients (NOVA 2), processed (NOVA 3) and ultra-processed (NOVA 4). Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of breast cancer per standard deviation increase in daily consumption (grams) of foods from each NOVA group. The current analysis included 14,933 breast cancer cases, diagnosed among the 318,686 EPIC female participants, (median follow-up of 14.9 years). No associations were found between breast cancer risk and the level of dietary intake from NOVA 1 [HR _{per 1 SD}=0.99 (95% CI 0.97 - 1.01)], NOVA 2 [HR _{per 1 SD} =1.01 (95% CI 0.98 - 1.03)] and NOVA 4 [HR _{per 1 SD} =1.01 (95% CI 0.99 - 1.03)] foods. However, a positive association was found between NOVA 3 and breast cancer risk [HR _{per 1 SD} =1.05 (95% CI 1.03 - 1.07)] which became non-significant after adjustment for alcohol intake [HR _{per 1 SD} =1.01 (95% CI 0.98 - 1.05)] or when beer and wine were excluded from this group [HR _{per 1 SD} =0.99 (95% CI 0.97 - 1.01)]. The associations did not differ by breast cancer subtype, menopausal status or body mass index. Findings from this large-scale prospective study suggest that the positive association between processed food intake and breast cancer risk was likely driven by alcoholic beverage consumption.

Supplementary information: The online version contains supplementary material available at 10.1186/s43014-024-00264-2.

Keywords: Breast cancer; Epidemiology; Food processing; NOVA classification; Prospective study.

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Conflict of interest statement

Competing interestsThe authors declare no potential conflicts of interest.

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Degree of food processing and breast cancer risk: a prospective study in 9 European countries

Affiliations

Degree of food processing and breast cancer risk: a prospective study in 9 European countries

Authors

Affiliations

Abstract

Conflict of interest statement

References

Grants and funding

LinkOut - more resources

Full Text Sources