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The publisher's final edited version of this article H&b DR-900 available free at Int J Cancer Abstract Alcohol intake has been related to an increased risk of breast cancer BC while dietary fiber intake H&b DR-900 been inversely associated to BC risk. A beneficial effect of fibers on ethanol carcinogenesis through their impact on estrogen levels is still controversial.

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We investigated the role of dietary fiber as a modifying factor of H&b DR-900 association of alcohol and breast cancer using data from the European Prospective Investigation into Cancer and Nutrition EPIC. This study includedwomen aged years at baseline enrolled in the ten countries of the EPIC study and followed up for Information on fiber and alcohol intake at baseline and average lifetime alcohol intake H&b DR-900 calculated from country-specific dietary and H&b DR-900 questionnaires.

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Hazard ratios HR of developing invasive breast cancer according to different levels of alcohol and fiber intake were computed. During 3, person-years, 11, incident breast cancer cases were diagnosed. This modulating effect was stronger for fiber H&b DR-900 vegetables.

Our results suggest that fiber intake H&b DR-900 modulate the positive association of alcohol intake and BC. Introduction A consistent association has been observed between alcohol intake and breast cancer BC among pre- and postmenopausal women 1.

While it is widely accepted that dietary fiber intake inversely correlates to BC risk, 3 a beneficial effect on ethanol carcinogenesis through their impact H&b DR-900 estrogen levels, 4 is still H&b DR-900 5. It is therefore important to evaluate the association of alcohol intake and BC phenotypes and the potential modulating role of fiber intake.

Fiber intake modulates the association of alcohol intake with breast cancer

H&b DR-900 recruited a total ofwomen, aged years who gave informed consent and completed questionnaires on diet, lifestyle, and medical history 6. Only first primary BC cases were retained in the analysis non-primary BCs excluded.

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Dietary assessment and alcohol intake For the present study, intake of alcoholic beverages at baseline was calculated from dietary questionnaires which H&b DR-900 been previously validated for alcohol intake 67. In each country, intake was calculated based on the H&b DR-900 average glass volume and ethanol content for each type H&b DR-900 alcoholic beverage, using information collected in highly standardized hr dietary recalls from a subset of the cohort 89.

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Estimation of dietary fiber intake has been described previously In brief, dietary fiber was defined by the AOAC Association of Official Agricultural Chemists gravimetric method for Total Dietary Fiber, 11 and includes soluble and insoluble forms including lignin of non-starch polysaccharides and resistant starch 10 The dietary fiber variable used in this work was obtained using the EPIC Nutrient Data Base ENDB in which the dietary fiber composition of foods was harmonized across the participating European countries to take into account the different analytical methods used Anthropometric measurements Weight and H&b DR-900 were measured at baseline, while the subjects were not wearing shoes, to the nearest 0.

In France, H&b DR-900, and Oxford, height and weight were self-reported on a questionnaire.

The procedures used to account for procedural differences between centers in the collection of anthropometric measurements, are described elsewhere 14 Outcome assessment Incident BC cases were identified through population cancer registries Denmark, Italy all centers but Naplesthe Netherlands, Norway, H&b DR-900, Sweden and United Kingdom or by a combination of methods including health insurance records, H&b DR-900 and H&b DR-900 registries and active follow-up France, Germany, Naples and Greece.

Subjects were followed up from study entry and until cancer diagnosis except for non-melanoma skin cancer casesdeath, emigration or until the end of the follow-up period varying from and depending on the centerwhichever H&b DR-900 first.

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Menopausal status was determined as previously reported in the EPIC study. Statistical analysis Cox proportional hazards regression H&b DR-900 were used to quantify the association between alcohol intake and the risk of BC.

Age was the primary time variable, and the Breslow method was adopted for handling ties Analyses H&b DR-900 conducted for all women as well as by receptors status. Systematic adjustments H&b DR-900 made for menopausal status, weight, height, smoking status never, former, smoker and unknowneducation, physical activity and energy intake from non-alcohol sources.

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In H&b DR-900, the following variables were included in the models: Analyses were stratified by study center to control for differences in questionnaires, follow-up procedures and other center-specific effects. To further control for the possible confounding effect of age, models were stratified by age at recruitment in 1-year categories Dietary fiber intake was modelled as continuous and categorical low, medium and high intake according to distribution in the controls for total fiber intake as well as H&b DR-900 fiber sources vegetables, fruits and cereals.

The statistical significance of interactions was assessed using likelihood ratio tests based H&b DR-900 the models with and without the interaction terms formed by the product of dietary fiber intake continuous H&b DR-900 the value of alcohol intake at recruitment as well as averaged lifetime intake continuous.

Similar analyses were carried out according to estrogen receptor status. For all models, the proportional hazards assumption was satisfied, and was evaluated via inclusion into H&b DR-900 disease model of interaction terms between exposure and attained age data not shown.

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