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. 2025 Aug;40(8):947-958.
doi: 10.1007/s10654-025-01277-y. Epub 2025 Jul 14.

Plant-based dietary patterns and breast cancer risk in the European prospective investigation into cancer and nutrition (EPIC) study

Sanam Shah  1 , Nasser Laouali  2 , Yahya Mahamat-Saleh  3 , Carine Biessy  3 , Geneviève Nicolas  3 , Sabina Rinaldi  3 , Raul Zamora-Ros  4 , Nikos Papadimitriou  3 , Fernanda Morales-Berstein  5   6 , Christina C Dahm  7 , Anne Kristine Lundgård Christensen  7 , Lene Mellemkjaer  8 , Anne Marie Overgaard Nielsen  8 , Francesca Romana Mancini  9 , Xuan Ren  9 , Chloé Marques  9 , Verena Katzke  10 , Charlotte Le Cornet  10 , Christine El-Khoury  11 , Matthias B Schulze  11   12 , Claudia Agnoli  13 , Vittorio Simeon  14 , Rosario Tumino  15 , Lorenzo Milani  16 , Carlota Castro-Espin  3   4 , Maria-Jose Sánchez  17   18   19 , Amaia Aizpurua  20   21 , Sandra M Colorado-Yohar  19   22   23 , Marcela Guevara  19   24   25 , Alicia Heath  26 , Dagfinn Aune  26   27   28 , Heinz Freisling  3 , Inge Huybrechts  3 , Laure Dossus  3
Affiliations

Plant-based dietary patterns and breast cancer risk in the European prospective investigation into cancer and nutrition (EPIC) study

Sanam Shah et al. Eur J Epidemiol. 2025 Aug.

Abstract

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.

Keywords: Body mass index; Breast cancer; Dietary pattern; Mediation; Plant-based diet; Prospective study.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare no duality of interest associated with this manuscript. Ethical approval: This study complies with the Declaration of Helsinki. EPIC was approved by the Ethics Committee of the International Agency for Research on Cancer (IARC) (ref IEC 14–02), Lyon, France, as well as the local ethics committees of the study centres. All participants provided written informed consent for data collection and storage as well as individual follow-up. Disclaimer: Where authors are identified as personnel of the International Agency for Research on Cancer / World Health Organization, the authors alone are responsible for the views expressed in this article and they do not necessarily represent the decisions, policy or views of the International Agency for Research on Cancer / World Health Organization.

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