Fruit and ovarian cancer.
Ovarian cancer risk: Data about total fruits in relation to ovarian cancer risk was provided by a pooled analysis of 12 cohorts (9), and 2 additional
cohorts (8, 12), including a total of 3,225 cases.
A nonsignificantly increased risk was found in one cohort (8). No other associations were found. The average RR = 1.03.
Inclusion of intermediate levels of consumption:
Data from one cohort was not presented as a categorized variable, and therefore, could not be included (8). But the related article stated that "there was evidence
for an increased risk for both low (< 150 g/d) and high intake (> 250 g/d)".
A significantly increased risk was found in one cohort of very large size at the level of consumption of 192-310 g/day (12; George SM). No other
(non)significant effects were found.
Effect modification: The association tended to differ by age of diagnosis, but not significant (9). No effect modification was found by parity, oral
contraceptive use, postmenopausal hormone use, smoking status, alcohol consumption, and multivitamin supplement use.
Disease progression No data was found.
Ovarian cancer mortality Data about the relation with ovarian cancer mortality was provided by 2 cohorts (5, 10). No associations were found. The average RR = 0.94.
Conclusion: A nonsignificantly increased ovarian cancer risk was found in one cohort, but no other associations were found. No evidence was found for an
association between total fruit and ovarian cancer risk. No data was found about disease progression, and no associations were found with ovarian cancer mortality.
No evidence was found for an association between total fruit consumption and disease progression or ovarian cancer mortality.
| Author | Cohort name | Cases | Relative Risk (RR) |
|---|---|---|---|
| 12) George SM (2008) | The NIH-AARP Diet and Health Study | 514 | RR = 1.02 (0.74-1.40; P = 0.51) |
| 9) Koushik A (2005) | Pooled analysis of 12 cohort studies | 2,130 | RR = 1.02 (0.88-1.19; P = 0.43) |
| 8) Schulz M (2005) | The EPIC Study | 581 | HR = 1.08 (0.99-1.18) |
| Total number of cases: 3,225 | Average RR = 1.03 |
| Author | Cohort name | Cases | Relative Risk (RR) |
|---|---|---|---|
| 10) Sakauchi F (2007) | The JACC Study | 50 | HR = 1.32 (0.61-2.90; P = 0.39) |
| 5) Nagle CM (2003) | No cohort name defined | 372 | HR = 0.89 (0.67-1.18; P = 0.59) |
| Total number of cases: 422 | Average RR = 0.94 |
| Author | Cohort name | Subjects | Years of follow-up | Cases | End point | Consumption of | Relative Risk (RR) | Adjustments | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 12) George SM (2008) | The National Institutes of Health-AARP Diet and Health Study. | 142,730 women aged 50-71 who did not have self-reported bilateral oophorectomy. (USA) | 1995-2003 | 514 | Ovarian cancer incidence | Fruit |
RR = 1.02 (0.74-1.40; P = 0.509) for the highest vs lowest quintile of consumption. Amount specific data (range of intake [cup equivalents/1000 kcal]): 0-0.60: RR = 1. 0.60-0.97: RR = 1.42 (1.07-1.89). 0.97-1.35: RR = 1.19 (0.88-1.60). 1.35-1.90: RR = 1.3 (0.96-1.74). 1.90-5.58: RR = 1.02 (0.74-1.40). 1 cup = 237 mL. One cup is 1 cup of raw/cooked fruit, 1 cup of 100% juice, or 0.5 cup of dried fruit. | Age, smoking, energy intake, BMI, alcohol, physical activity, education , race, marital status, family history, menopausal hormone therapy, and vegetable intake. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 9) Koushik A (2005) | Pooled analysis of 12 cohort studies. | 560,441 women. | 7-22 | 2,130 | Invasive epithelial ovarian cancer risk | Total fruits (fruits and fruit juices) |
INCLUSION CRITERIA:
RELATIVE RISK:
Effect modification: This association was not modified by parity, oral contraceptive use, postmenopausal hormone use among postmenopausal women, smoking status, or alcohol consumption (results not shown). Results from analyses restricted to nonusers of multivitamin supplements (n = 1,018 cases) were similar to that seen among the whole study population (results not shown). Simultaneous inclusion of total fruits and total vegetables in the same model did not appreciably change the RRs compared with analysis of each group separately (results not shown). Excluding fruit juices: RRs for total fruits not including fruit juices were similar with RRs for total fruits (results not shown). Very high vs very low consumpton: When highest vs lowest deciles (study-specific) of consumption were compared, results were consistent with no association (results not shown). Parity, oral contraceptive use, menopausal status and postmenopausal hormone use, age at menarche, BMI, physical activity, smoking status, and total energy intake. Age in years and year of questionnaire return were included as stratification variables. |
8) Schulz M (2005) | The EPIC Study | 325,640 women from 10 European countries. | 6.3 | 1992-2000 to 2001-2004 581? | Invasive epithelial ovarian cancer incidence | (excluding in situ and metastatic cases) Total fruits (mainly fresh fruit, but including dried and canned fruits as well, excluding fruit juices) |
A nonsignificant positive association: HR = 1.08 (0.99-1.18). |
HRs are per 80 g/d increment. There was evidence for an increased risk of ovarian cancer for both low (< 150 g/d) and high intake (> 250 g/d). These associations were more pronounced for serous than for nonserous tumours. Age, center, BMI, energy from fat sources, energy from nonfat sources, unilateral ovariectomy, parity, menopausal status, education, smoking, alcohol drinking, HRT use, and nonconsumer status. |
7) Mommers M (2005) | The Netherlands Cohort Study | 62,573 postmenopausal women aged 55-69. | 11,3 | (1986-1997) 252 | Invasive epithelial ovarian cancer incidence | Total fruit (mandarins, oranges, grapefruits, orange/grapefruit juice, grapes, bananas, apples/pears, and strawberries) |
RR = 1.11 (0.70-1.78; P = 0.46) for the highest vs lowest quintile of consumption. | Amount specific data (grams/day): 62: RR = 1. 124: RR = 1.32 (0.83-2.09). 177: RR = 1.06 (0.66-1.71). 238: RR = 1.42 (0.91-2.22). 343: RR = 1.11 (0.70-1.78). Age, height, current cigarette smoking, duration of cigarette smoking, number of cigarettes smoked daily, duration of oral contraceptive use, parity, and total vegetables. |
Test for other possible confounders included hormone therapy, weight, BMI, family history of ovarian or breast carcinoma, hysterectomy, age at menarche, age ate menopause, tubal ligation, and socioeconomic status. 6) Larsson SC (2004) | The Swedish Mammography Cohort | 61,084 women aged 38-76. | 13.5 | (1987-90 to 2003) 266 | Invasive epithelial ovarian cancer incidence | Total fruit (apples, pears, bananas, oranges, mandarins, and grapefruit) |
RR = 1.37 (0.90-2.06; P = 0.07) for the highest vs lowest quartile of consumption. | Amount specific data (servings/day): ≤ 1: RR = 1. 1.1-< 2.0: RR = 1.14 (0.84-1.55). 2.0-3.0: RR = 1.31 (0.95-1.82). ≥ 3.0: RR = 1.37 (0.90-2.06). Adding fruit juice to total fruit consumption yielded similar results (RR = 1.33; 95% CI = 0.91-1.95). Effect modification: Associations were similar for serous (125 cases; P = 0.14) and nonserous (P = 0.27) histologic subtypes of ovarian cancer, and were consistent across subgroups defined by age, body mass index, parity, and use of oral contraceptives (data not shown). Age at baseline, BMI, education, parity, oral contraceptive use, fish consumption, and dietary lactose. |
4) Fairfield KM (2001) | The Nurses' Health Study | 80,326 women aged 34-59. Excluding women with a history of bilateral oophorectomy, hysterectomy with unknown number of ovaries removed, or history of pelvic irradiation. | (USA) 16 | (1980-1996) 263 | Invasive epithelial ovarian cancer incidence | Total fruits (not defined) |
RR = 1.27 (0.80-2.02; P = 0.20) for the highest vs lowest quintile of consumption. | Amount specific data (servings/day): < 1.1: RR = 1. 1.1-1.6: RR = 1.02 (0.67-1.54). 1.7-2.3: RR = 1.14 (0.74-1.73). 2.4-3.1: RR = 1.36 (0.89-2.08). 3.2+: RR = 1.27 (0.80-2.02). No differential efects were found among strata of any of the variables in the model (e.g., smokers vs nonsmokers). Age, BMI, duration of oral contraceptive use, smoking history, parity, history of tubal ligation, total energy, and dietary fiber. |
3) Kushi LH (1999) | The Iowa Women's Health Study | 29,083 postmenopausal women aged 55-69 without a history of bilateral oophorectomy. | 10 | (1986-1995) 139 | Epithelial ovarian cancer incidence | Fruit (not defined) |
RR = 1.13 (0.66-1.93; P = 0.51) for the highest vs lowest quartile of consumption. | Amount specific data (Servings/week): < 11: RR = 1. 11-16: RR = 0.86 (0.50-1.47). 17-23: RR = 1.05 (0.63-1.76). > 23: RR = 1.13 (0.66-1.93). Age, total energy intake, number of livebirths, age at menopause, family history of ovarian cancer, hysterectomy/unilateral oophorectomy status, waist-to-hip ratio, level of physical activity, cigarette smoking, and education. |
1) Kiani F (2006) | The Adventist Health Study | 13,281 non-Hispanic white California Seventh-day Adventist women aged ≥ 25 without a history of hysterectomy. | (USA) 1976-1992 | 48 | (of which 40 postmenopausal) Epithelial ovarian cancer risk | Fruit index (canned or frozen fruit, citrus fruit (not juice), winter fruit (fresh fruit commonly available in winter, such as apples, bananas, pears, etc.), dry fruit (raisins, dates, etc.), and other fresh fruit) |
|
The associations remained after additional adjustment for either meat, tomatoes, or cheese. Age, parity, BMI, and for age at menopause and HRT in postmenopausal analyses. |
|