{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T17:50:56Z","timestamp":1787161856223,"version":"build-2736575974"},"reference-count":38,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2019,1,7]],"date-time":"2019-01-07T00:00:00Z","timestamp":1546819200000},"content-version":"vor","delay-in-days":98,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"National Heart, Lung and Blood Institute, National Institutes of Health"},{"name":"Department of Health and Human Services","award":["N01WH22110"],"award-info":[{"award-number":["N01WH22110"]}]},{"name":"Department of Health and Human Services","award":["24152"],"award-info":[{"award-number":["24152"]}]},{"name":"Department of Health and Human Services","award":["32100-2"],"award-info":[{"award-number":["32100-2"]}]},{"name":"Department of Health and Human Services","award":["32105-6"],"award-info":[{"award-number":["32105-6"]}]},{"name":"Department of Health and Human Services","award":["32108-9"],"award-info":[{"award-number":["32108-9"]}]},{"name":"Department of Health and Human Services","award":["32111-13"],"award-info":[{"award-number":["32111-13"]}]},{"name":"Department of Health and Human Services","award":["32115"],"award-info":[{"award-number":["32115"]}]},{"name":"Department of Health and Human Services","award":["32118-32119"],"award-info":[{"award-number":["32118-32119"]}]},{"name":"Department of Health and Human Services","award":["32122"],"award-info":[{"award-number":["32122"]}]},{"name":"Department of Health and Human Services","award":["42107-26"],"award-info":[{"award-number":["42107-26"]}]},{"name":"Department of Health and Human Services","award":["42129-32"],"award-info":[{"award-number":["42129-32"]}]},{"name":"Department of Health and Human Services","award":["44221"],"award-info":[{"award-number":["44221"]}]},{"DOI":"10.13039\/100000969","name":"American Institute for Cancer Research","doi-asserted-by":"publisher","award":["30210-01"],"award-info":[{"award-number":["30210-01"]}],"id":[{"id":"10.13039\/100000969","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,10,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>In the Women\u2019s Health Initiative Dietary Modification trial, a low-fat dietary pattern reduced deaths after breast cancer. Mortality from other cancer sites has not been reported.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A low-fat dietary pattern influence on deaths from and after site-specific cancers was examined during 8.5\u2009years (median) of dietary intervention and cumulatively during 17.7\u2009years (median) of follow-up. A total 48\u00a0835 postmenopausal women, ages 50\u201379 years, were randomly assigned from 1993 to 1998 at 40 US clinical centers to dietary intervention (40%, n\u2009=\u200919\u00a0541 or a usual diet comparison group (60%, n\u2009=\u200929\u00a0294). Dietary intervention influence on mortality from protocol-specified cancers (breast, colon and rectum, endometrium and ovary), individually and as a composite, represented the primary analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>During the dietary intervention period, a reduction in deaths after breast cancer (HR = 0.65 95% CI = 0.45 to 0.94, P\u2009=\u2009.02) was the only statistically significant cancer mortality finding. During intervention, the HRs for deaths after the protocol-specified cancer composite were 0.90 (95% CI = 0.73 to 1.10) and 0.95 (95% CI = 0.85 to 1.06) for deaths after all cancers. During 17.7\u2009years of follow-up with 3867 deaths after all cancers, reduction in deaths after breast cancer continued in the dietary intervention group (HR = 0.85, 95% CI = 0.74 to 0.99, P\u2009=\u2009.03). However, no dietary intervention influence on deaths from or after any other cancer or cancer composite was seen.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A low-fat dietary pattern reduced deaths after breast cancer. No reduction in mortality from or after any other cancer or cancer composite was seen.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jncics\/pky065","type":"journal-article","created":{"date-parts":[[2018,11,28]],"date-time":"2018-11-28T15:11:38Z","timestamp":1543417898000},"source":"Crossref","is-referenced-by-count":19,"title":["Low-Fat Dietary Pattern and Cancer Mortality in the Women\u2019s Health Initiative (WHI) Randomized Controlled Trial"],"prefix":"10.1093","volume":"2","author":[{"given":"Rowan T","family":"Chlebowski","sequence":"first","affiliation":[{"name":"Los Angeles Biomedical Research Institute, Torrance, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Garnet L","family":"Anderson","sequence":"additional","affiliation":[{"name":"Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JoAnn E","family":"Manson","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Brigham and Women\u2019s Hospital, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ross L","family":"Prentice","sequence":"additional","affiliation":[{"name":"Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron K","family":"Aragaki","sequence":"additional","affiliation":[{"name":"Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Snetselaar","sequence":"additional","affiliation":[{"name":"University of Iowa, Iowa City\/Davenport, IA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shirley A A","family":"Beresford","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, University of Washington, Seattle, WA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lewis H","family":"Kuller","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine, University of Tennessee, Memphis, TN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorothy","family":"Lane","sequence":"additional","affiliation":[{"name":"Preventive Medicine, Stony Brook University, Stony Brook, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juhua","family":"Luo","sequence":"additional","affiliation":[{"name":"School of Public Health, University of Indiana, Bloomington, IN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas E","family":"Rohan","sequence":"additional","affiliation":[{"name":"Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Jiao","sequence":"additional","affiliation":[{"name":"Department of Medicine, Baylor College of Medicine, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Barac","sequence":"additional","affiliation":[{"name":"MedStar Health Research Institute and Georgetown\/Howard Universities Center for Clinical and Translational Sciences, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Womack","sequence":"additional","affiliation":[{"name":"Methodist Healthcare, Memphis, TN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mace","family":"Coday","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine, University of Tennessee, Memphis, TN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mridul","family":"Datta","sequence":"additional","affiliation":[{"name":"School of Public Health, University of Purdue, West Lafayette, IN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cynthia A","family":"Thomson","sequence":"additional","affiliation":[{"name":"Mel and Enid Zuckerman College of Public Health, University of Arizona Cancer Center, Tucson, AZ"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,1,7]]},"reference":[{"issue":"6","key":"2019070511530766200_pky065-B1","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1001\/jama.295.6.629","article-title":"Low-fat dietary pattern and risk of invasive breast cancer: the Women\u2019s Health Initiative Randomized Controlled Dietary Modification Trial","volume":"295","author":"Prentice","year":"2006","journal-title":"JAMA"},{"issue":"6","key":"2019070511530766200_pky065-B2","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1001\/jama.295.6.643","article-title":"Low-fat dietary pattern and risk of colorectal cancer: the Women\u2019s Health Initiative Randomized Controlled Dietary Modification Trial","volume":"295","author":"Beresford","year":"2006","journal-title":"JAMA"},{"issue":"25","key":"2019070511530766200_pky065-B3","doi-asserted-by":"crossref","first-page":"2919","DOI":"10.1200\/JCO.2016.72.0326","article-title":"Low-fat dietary pattern and breast cancer mortality in the Women\u2019s Health Initiative randomized controlled trial","volume":"35","author":"Chlebowski","year":"2017","journal-title":"J Clin Oncol"},{"issue":"10","key":"2019070511530766200_pky065-B4","doi-asserted-by":"crossref","first-page":"e181212","DOI":"10.1001\/jamaoncol.2018.1212","article-title":"Association of low-fat dietary pattern with breast cancer overall survival: A secondary analysis of the Women\u2019s Health Initiative randomized clinical trial","volume":"4","author":"Chlebowski","year":"2018","journal-title":"JAMA Oncol."},{"issue":"20","key":"2019070511530766200_pky065-B5","doi-asserted-by":"crossref","first-page":"1534","DOI":"10.1093\/jnci\/djm159","article-title":"Low-fat dietary pattern and cancer incidence in the Women\u2019s Health Initiative Dietary Modification randomized controlled trial","volume":"99","author":"Prentice","year":"2007","journal-title":"J Natl Cancer Inst"},{"issue":"9","key":"2019070511530766200_pky065-B6","doi-asserted-by":"crossref","first-page":"1509","DOI":"10.1158\/1055-9965.EPI-13-0341","article-title":"Low-fat diet and skin cancer risk: the Women\u2019s Health Initiative randomized controlled dietary modification trial","volume":"22","author":"Gamba","year":"2013","journal-title":"Cancer Epidemiol Biomarkers Prev"},{"issue":"12","key":"2019070511530766200_pky065-B7","doi-asserted-by":"crossref","first-page":"2924","DOI":"10.1158\/1055-9965.EPI-14-0922","article-title":"Cancer incidence and mortality during the intervention and post-intervention periods of the Women\u2019s Health Initiative Dietary Modification Trial","volume":"23","author":"Thomson","year":"2014","journal-title":"Cancer Epidemiol Biomarkers Prev"},{"issue":"1","key":"2019070511530766200_pky065-B8","doi-asserted-by":"crossref","first-page":"djx117","DOI":"10.1093\/jnci\/djx117","article-title":"Low-fat dietary pattern and pancreatic cancer risk in the Women's Health Initiative Dietary Modification Randomized Controlled Trial","volume":"110","author":"Jiao","year":"2018","journal-title":"J Natl Cancer Inst"},{"issue":"9 suppl","key":"2019070511530766200_pky065-B9","doi-asserted-by":"crossref","first-page":"S5","DOI":"10.1016\/S1047-2797(03)00043-7","article-title":"Implementation of the Women\u2019s Health Initiative study design","volume":"13","author":"Anderson","year":"2003","journal-title":"Ann Epidemiol"},{"issue":"9","key":"2019070511530766200_pky065-B10","doi-asserted-by":"crossref","first-page":"S87","DOI":"10.1016\/S1047-2797(03)00044-9","article-title":"The Women\u2019s Health Initiative Dietary Modification Trial: overview and baseline characteristics of participants","volume":"13","author":"Ritenbaugh","year":"2003","journal-title":"Ann Epidemiol"},{"issue":"8","key":"2019070511530766200_pky065-B11","doi-asserted-by":"crossref","first-page":"794","DOI":"10.1056\/NEJMsr1606602","article-title":"Body fatness and cancer-viewpoint of the IARC working group","volume":"375","author":"Lauby-Secretan","year":"2016","journal-title":"N Engl J Med"},{"key":"2019070511530766200_pky065-B12","doi-asserted-by":"crossref","first-page":"16693.","DOI":"10.1038\/srep16693","article-title":"Dietary fat intake and endometrial cancer risk: dose-response meta-analysis of epidemiological studies","volume":"5","author":"Jiang","year":"2015","journal-title":"Sci Rep"},{"issue":"5","key":"2019070511530766200_pky065-B13","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1093\/oxfordjournals.aje.a113804","article-title":"Test of the national death index","volume":"119","author":"Stampfer","year":"1984","journal-title":"Am J Epidemiol"},{"key":"2019070511530766200_pky065-B14","doi-asserted-by":"crossref","first-page":"S30","DOI":"10.1016\/j.breast.2013.07.006","article-title":"Nutrition and physical activity influence on breast cancer incidence and outcome","volume":"22","author":"Chlebowski","year":"2013","journal-title":"Breast"},{"issue":"1","key":"2019070511530766200_pky065-B15","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1007\/BF00053187","article-title":"Dietary fat and cancer: consistency of the epidemiologic data, and disease prevention that may follow from a practical reduction in fat consumption","volume":"1","author":"Prentice","year":"1990","journal-title":"Cancer Causes Control"},{"issue":"24","key":"2019070511530766200_pky065-B16","doi-asserted-by":"crossref","first-page":"37390","DOI":"10.18632\/oncotarget.8940","article-title":"Dietary fat intake and ovarian cancer risk: a meta-analysis of epidemiological studies","volume":"7","author":"Qiu","year":"2016","journal-title":"Oncotarget"},{"issue":"8","key":"2019070511530766200_pky065-B17","doi-asserted-by":"crossref","first-page":"1894","DOI":"10.1002\/ijc.29938","article-title":"Dietary total fat and fatty acids intake, serum fatty acids and risk of breast cancer: a meta-analysis of prospective cohort studies","volume":"138","author":"Cao","year":"2016","journal-title":"Int J Cancer"},{"issue":"4","key":"2019070511530766200_pky065-B18","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1097\/CEJ.0000000000000073","article-title":"Total fat consumption and pancreatic cancer risk: a meta-analysis of epidemiologic studies","volume":"24","author":"Shen","year":"2015","journal-title":"Eur J Cancer Prev"},{"issue":"5","key":"2019070511530766200_pky065-B19","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1097\/CEJ.0b013e32833b48fa","article-title":"Processed meat and colorectal cancer: a quantitative review of prospective epidemiologic studies","volume":"19","author":"Alexander","year":"2010","journal-title":"Eur J Cancer Prev"},{"issue":"11","key":"2019070511530766200_pky065-B20","doi-asserted-by":"crossref","first-page":"1663","DOI":"10.1093\/aje\/kwt198","article-title":"Regression calibration in nutritional epidemiology: example of fat density and total energy in relationship to postmenopausal breast cancer","volume":"178","author":"Prentice","year":"2013","journal-title":"Am J Epidemiol"},{"issue":"4","key":"2019070511530766200_pky065-B21","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1002\/ijc.2910150411","article-title":"Environmental factors and cancer incidence and mortality in different countries, with special reference to dietary practices","volume":"15","author":"Armstrong","year":"1975","journal-title":"Int J Cancer"},{"issue":"9","key":"2019070511530766200_pky065-B22","doi-asserted-by":"crossref","first-page":"616","DOI":"10.1093\/jnci\/djt027","article-title":"High-and low-fat dairy intake, recurrence, and mortality after breast cancer diagnosis","volume":"105","author":"Kroenke","year":"2013","journal-title":"J Natl Cancer Inst"},{"issue":"2","key":"2019070511530766200_pky065-B23","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1007\/s10549-014-3005-8","article-title":"Dietary fat intake in relation to lethal breast cancer in two large prospective cohort studies","volume":"146","author":"Boeke","year":"2014","journal-title":"Breast Cancer Res Treat"},{"issue":"1","key":"2019070511530766200_pky065-B24","doi-asserted-by":"crossref","first-page":"35","DOI":"10.3945\/ajcn.117.153270","article-title":"Low-fat dietary pattern and cardiovascular disease: results from the Women\u2019s Health Initiative randomized controlled trial","volume":"106","author":"Prentice","year":"2017","journal-title":"Am J Clin Nutr"},{"issue":"4","key":"2019070511530766200_pky065-B25","doi-asserted-by":"crossref","first-page":"680","DOI":"10.2337\/dc17-0534","article-title":"A low-fat dietary pattern and diabetes: a secondary anaylsis from the Women\u2019s Health Initiative Dietary Modification Trial","volume":"41","author":"Howard","year":"2018","journal-title":"Diabetes Care"},{"issue":"2","key":"2019070511530766200_pky065-B26","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1016\/j.jand.2015.07.016","article-title":"Low-fat dietary pattern intervention and health-related quality of life: the Women\u2019s Health Initiative randomized controlled dietary modification trial","volume":"116","author":"Assaf","year":"2016","journal-title":"J Acad Nutr Diet"},{"issue":"3","key":"2019070511530766200_pky065-B27","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1093\/annonc\/mds430","article-title":"Progesterone receptor loss identifies Luminal B breast cancer subgroups at higher risk of relapse","volume":"24","author":"Cancello","year":"2013","journal-title":"Ann Oncol"},{"issue":"3","key":"2019070511530766200_pky065-B28","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1200\/JCO.2005.09.121","article-title":"American Society of Clinical Oncology technology assessment on the use of aromatase inhibitors as adjuvant therapy for postmenopausal women with hormone receptor\u2013positive breast cancer: status report 2004","volume":"23","author":"Winer","year":"2005","journal-title":"J Clin Oncol"},{"issue":"3","key":"2019070511530766200_pky065-B29","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1001\/jamaoncol.2015.0494","article-title":"Breast cancer after use of estrogen plus progestin and estrogen alone: analyses of data from 2 Women\u2019s Health Initiative randomized clinical trials","volume":"1","author":"Chlebowski","year":"2015","journal-title":"JAMA Oncol"},{"issue":"23","key":"2019070511530766200_pky065-B30","doi-asserted-by":"crossref","first-page":"7060","DOI":"10.1158\/0008-5472.CAN-14-1784","article-title":"Molecular modulation of estrogen-induced apoptosis by synthetic progestins in hormone replacement therapy: an insight into the Women\u2019s Health Initiative study","volume":"74","author":"Sweeney","year":"2014","journal-title":"Cancer Res"},{"issue":"3","key":"2019070511530766200_pky065-B31","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1001\/jamaoncol.2015.0512","article-title":"Progesterone exposure and breast cancer risk: understanding the biological roots","volume":"1","author":"Joshi","year":"2015","journal-title":"JAMA Oncol"},{"issue":"9","key":"2019070511530766200_pky065-B32","doi-asserted-by":"crossref","first-page":"1499","DOI":"10.1007\/s11695-014-1276-0","article-title":"Incidence of cancer following bariatric surgery: systematic review and meta\u2014analysis","volume":"24","author":"Casagrande","year":"2014","journal-title":"Obes Surg"},{"issue":"9814","key":"2019070511530766200_pky065-B33","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1016\/S0140-6736(11)61625-5","article-title":"Comparisons between different polychemotherapy regimens for early breast cancer: meta-analyses of long-term outcome among 100\u2009000 women in 123 randomised trials","volume":"379","author":"Early Breast Cancer Trialists' Collaborative Group","year":"2012","journal-title":"Lancet"},{"issue":"10001","key":"2019070511530766200_pky065-B34","doi-asserted-by":"crossref","first-page":"1341","DOI":"10.1016\/S0140-6736(15)61074-1","article-title":"Aromatase inhibitors versus tamoxifen in early breast cancer: patient-level meta-analysis of the randomised trials","volume":"386","author":"Early Breast Cancer Trialists' Collaborative Group","year":"2015","journal-title":"Lancet"},{"issue":"33","key":"2019070511530766200_pky065-B35","doi-asserted-by":"crossref","first-page":"3744","DOI":"10.1200\/JCO.2014.55.5730","article-title":"Trastuzumab plus adjuvant chemotherapy for human epidermal growth factor receptor 2-positive breast cancer: planned joint analysis of overall survival from NSABP B-31 and NCCTG N9831","volume":"32","author":"Perez","year":"2014","journal-title":"J Clin Oncol"},{"issue":"21","key":"2019070511530766200_pky065-B36","doi-asserted-by":"crossref","first-page":"2231","DOI":"10.1200\/JCO.2013.53.1517","article-title":"Randomized trial of a telephone-based weight loss intervention in postmenopausal women with breast cancer receiving letrozol; the LISA trial","volume":"32","author":"Goodwin","year":"2014","journal-title":"J Clin Oncol"},{"issue":"3","key":"2019070511530766200_pky065-B37","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1111\/ajco.12629","article-title":"The living well after breast cancer pilot trial: a weight loss intervention for women following treatment for breast cancer","volume":"13","author":"Reeves","year":"2017","journal-title":"Asia Pac J Clin Oncol"},{"key":"2019070511530766200_pky065-B38","article-title":"Diet, Nutrition, Physical Activity and Cancer: A Global Perspective","author":"World Cancer Research Fund\/American Institute for Cancer Research","year":"2018","journal-title":"Continuous Update Project Expert Report"}],"container-title":["JNCI Cancer Spectrum"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/jncics\/article-pdf\/2\/4\/pky065\/28907971\/pky065.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2019,9,20]],"date-time":"2019-09-20T14:46:48Z","timestamp":1568990808000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jncics\/article\/doi\/10.1093\/jncics\/pky065\/5278702"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,10,1]]},"references-count":38,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2019,1,7]]},"published-print":{"date-parts":[[2018,10,1]]}},"URL":"https:\/\/doi.org\/10.1093\/jncics\/pky065","relation":{},"ISSN":["2515-5091"],"issn-type":[{"value":"2515-5091","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2018,10]]},"published":{"date-parts":[[2018,10,1]]},"article-number":"pky065"}}