Vegetables and ovarian cancer.
Ovarian cancer risk: Data about total vegetables 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 3,224 cases.
No (non)significant associations were found. The average RR = 0.93.
Inclusion of intermediate levels of consumption:
Data from one cohort was not presented as a categorized variable, and therefore, could not be included (8).
No (non)significant effect was found in any of the cohorts at any level of consumption.
Effect modification:
A nonsignificant protective effect was found in the pooled analysis among women diagnosed at ≥ 63 years, but not < 63 years. No effect modification
was found by parity, oral contraceptive use, postmenopausal hormone use, smoking status, alcohol consumption, or multivitamin supplement use (9).
Disease progression: No data was found.
Ovarian cancer mortality: Data about the relation with ovarian cancer mortality was provided by 1 cohort (5). A significant protective effect was found.
Conclusion: No associations were found between total vegetables and ovarian cancer risk, but a nonsignificant protective effect was found among women
diagnosed at age ≥ 63. Suggestive evidence was found for a protective effect of total vegetables against ovarian cancer risk among women diagnosed at
age ≥ 63. No level of consumption could be defined for this effect. Data about disease progression/mortality is to limited to be judged.
| Author | Cohort name | Cases | Relative Risk (RR) |
|---|---|---|---|
| 12) George SM (2008) | The NIH-AARP Diet and Health Study | 514 | RR = 1.19 (0.90-1.59; P = 0.45) |
| 9) Koushik A (2005) | Pooled analysis of 12 cohort studies | 2,129 | RR = 0.87 (0.71-1.07; P = 0.18) |
| 8) Schulz M (2005) | The EPIC Study | 581 | HR = 0.92 (0.76-1.11) |
| Total number of cases: 3,224 | Average RR = 0.93 |
| Author | Cohort name | Cases | Relative Risk (RR) |
|---|---|---|---|
| 5) Nagle CM (2003) | No cohort name defined | 372 | HR = 0.75 (0.57-0.99; P = 0.01) |
| Total number of cases: | 372 |
| 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 | Vegetables (excluding potatoes) |
RR = 1.19 (0.90-1.59; P = 0.454) for the highest vs lowest quintile of consumption. Amount specific data (range of intake [cup equivalents/1000 kcal]): 0-0.56: RR = 1. 0.56-0.79: RR = 1.07 (0.80-1.42). 0.79-1.04: RR = 1.13 (0.85-1.50). 1.04-1.43: RR = 1.01 (0.75-1.35). 1.43-4.38: RR = 1.19 (0.90-1.59). 1 cup = 237 mL. One cup is 1 cup of raw/cooked vegetable, 1 cup of 100% juice, or 2 cups of raw leafy greens. | Age, smoking, energy intake, BMI, alcohol, physical activity, education , race, marital status, family history, menopausal hormone therapy, and fruit intake. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 9) Koushik A (2005) | Pooled analysis of 12 cohort studies. | 560,441 women. | 7-22 | 2,129 | Invasive epithelial ovarian cancer risk | Total vegetables (Vegetables and vegetable juices. Excluding potatoes and mature beans) |
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). Very high vs very low consumption: 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 vegetables (excluding potatoes and other tubers, legumes, and vegetable juices |
HR = 0.92 (0.76-1.11). |
HRs are per 80 g/d increment. 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) 240 | Invasive epithelial ovarian cancer incidence | Total vegetables (Brussels sprouts, cauliflower, cabbage [white/green], kale, string beans, broad beans, spinach, endive [raw and cooked], lettuce, carrots [raw and cooked], sweet peppers, sauerkraut, tomatoes, red beets, mushrooms, gherkins, rhubarb, leek, and onions) |
RR = 0.98 (0.61-1.58; P = 0.83) for the highest vs lowest quintile of consumption. | Amount specific data (grams/day): 105: RR = 1. 147: RR = 1.10 (0.69-1.75). 180: RR = 1.15 (0.72-1.83). 220: RR = 1.25 (0.79-1.98). 291: RR = 0.98 (0.61-1.58). Age, height, current cigarette smoking, duration of cigarette smoking, number of cigarettes smoked daily, duration of oral contraceptive use, parity, and total fruit. |
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 vegetables (tomatoes, cucumber, iceberg lettuce, china cabbage, spinach, kale, cabbage, carrots, and beets) |
RR = 0.61 (0.38-0.97; P = 0.01) for the highest vs lowest quartile of consumption. | Amount specific data (servings/day): ≤ 1: RR = 1. 1.1-< 2.0: RR = 0.87 (0.65-1.16). 2.0-3.0: RR = 0.70 (0.49-1.00). ≥ 3.0: RR = 0.61 (0.38-0.97). Effect modification: Associations were similar for serous (125 cases; P = 0.11) and nonserous (P = 0.06) 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 vegetables (not defined) |
RR = 0.77 (0.48-1.24; P = 0.30) for the highest vs lowest quintile of consumption. | Amount specific data (servings/day): < 1.8: RR = 1. 1.8-2.5: RR = 0.90 (0.61-1.32). 2.6-3.2: RR = 0.84 (0.56-1.26). 3.3-4.3: RR = 0.81 (0.52-1.25). 4.4+: RR = 0.77 (0.48-1.24). 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 | Vegetables (not defined) |
RR = 0.76 (0.42-1.37; P = 0.21) for the highest vs lowest quartile of consumption. | Amount specific data (Servings/week): < 16: RR = 1. 16-23: RR = 1.25 (0.77-2.02). 24-31: RR = 0.87 (0.51-1.48). > 31: RR = 0.76 (0.42-1.37). 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. |
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