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Research on diet in breast cancer survival has been focused on single nutrients or foods, particularly dietary fat, fruits, vegetables, fiber, and alcohol. We hypothesized that diet quality indices decrease the risk of total and non breast cancer related deaths in women diagnosed with breast cancer. We evaluated 4 dietary quality scores: Alternate Healthy Eating Index (AHEI), Diet Quality Index-Revised (DQIR), Recommended Food Score (RFS), and the alternate Mediterranean Diet Score (aMED), among 2729 women from the Nurses’ Health Study with invasive stage I–III breast cancer diagnosed between 1978 and 1998 with follow up through 2004. In multivariate adjusted analyses, no association was found between diet quality indices and either total or non breast cancer related deaths. However, a higher aMED score was associated with a lower risk of non-breast cancer death in women with low physical activity; the RR comparing the highest to lowest tertile was 0.39 (95% CI, 0.20 – 0.75, P trend = 0.0004). Our results suggest that a higher quality diet after breast cancer diagnosis does not considerably change the risk of death from breast cancer. However, healthy dietary choices may be important because women are at risk of death from non breast cancer-related causes affected by diet.

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