Background:Although there are solid findings regarding the detrimental effect of alcohol consumption, the existing evidence on the effect of other dietary factors on breast cancer (BC) risk is inconclusive. This study aimed to evaluate the association between dietary patterns and risk of BC in Spanish women, stratifying by menopausal status and tumour subtype, and to compare the results with those of Alternate Healthy Index (AHEI) and Alternate Mediterranean Diet Score (aMED).Methods:We recruited 1017 incident BC cases and 1017 matched healthy controls of similar age (±5 years) without a history of BC. The association between ‘a priori' and ‘a posteriori' developed dietary patterns and BC in general and according to menopausal status and intrinsic tumour subtypes (ER+/PR+ and HER2− HER2+ and ER−/PR− and HER2−) was evaluated using logistic and multinomial regression models.Results:Adherence to the Western dietary pattern was related to higher risk of BC (OR for the top vs the bottom quartile 1.46 (95% CI 1.06–2.01)), especially in premenopausal women (OR=1.75; 95% CI 1.14–2.67). In contrast, the Mediterranean pattern was related to a lower risk (OR for the top quartile vs the bottom quartile 0.56 (95% CI 0.40–0.79)). Although the deleterious effect of the Western pattern was similarly observed in all tumour subtypes, the protective effect of our Mediterranean pattern was stronger for triple-negative tumours (OR=0.32; 95% CI 0.15–0.66 and Pheterogeneity=0.04). No association was found between adherence to the Prudent pattern and BC risk. The associations between ‘a priori' indices and BC risk were less marked (OR for the top vs the bottom quartile of AHEI=0.69; 95% CI 0.51–0.94 and aMED=0.74; 95% CI 0.46–1.18)).Conclusions:Our results confirm the harmful effect of a Western diet on BC risk, and add new evidence on the benefits of a diet rich in fruits, vegetables, legumes, oily fish and vegetable oils for preventing all BC subtypes, and particularly triple-negative tumours.

BackgroundAccording to the “World Cancer Research Fund” and the “American Institute of Cancer Research” (WCRF/AICR) one in four cancer cases could be prevented through a healthy diet, weight control and physical activity.ObjectiveTo explore the association between the WCRF/AICR recommendations and risk of breast cancer.MethodsDuring the period 2006 to 2011 we recruited 973 incident cases of breast cancer and 973 controls from 17 Spanish Regions. We constructed a score based on 9 of the WCRF/AICR recommendations for cancer prevention:: 1)Maintain adequate body weight; 2)Be physically active; 3)Limit the intake of high density foods; 4)Eat mostly plant foods; 5)Limit the intake of animal foods; 6)Limit alcohol intake; 7)Limit salt and salt preserved food intake; 8)Meet nutritional needs through diet; S1)Breastfeed infants exclusively up to 6 months. We explored its association with BC by menopausal status and by intrinsic tumor subtypes (ER+/PR+ & HER2-; HER2+; ER&PR-&HER2-) using conditional and multinomial logistic models respectively.ResultsOur results point to a linear association between the degree of noncompliance and breast cancer risk. Taking women who met 6 or more recommendations as reference, those meeting less than 3 showed a three-fold excess risk (OR=2.98(CI95%:1.59-5.59)), especially for postmenopausal women (OR=3.60(CI95%:1.24;10.47)) and ER+/PR+&HER2- (OR=3.60(CI95%:1.84;7.05)) and HER2+ (OR=4.23(CI95%:1.66;10.78)) tumors. Noncompliance of recommendations regarding the consumption of foods and drinks that promote weight gain in premenopausal women (OR=2.24(CI95%:1.18;4.28); p for interaction=0.014) and triple negative tumors (OR=2.93(CI95%:1.12-7.63)); the intake of plant foods in postmenopausal women (OR=2.35(CI95%:1.24;4.44)) and triple negative tumors (OR=3.48(CI95%:1.46-8.31)); and the alcohol consumption in ER+/PR+&HER2- tumors (OR=1.52 (CI95%:1.06-2.19)) showed the strongest associations.ConclusionBreast cancer prevention might be possible by following the “World Cancer Research Fund” and the “American Institute of Cancer Research” recommendations, even in settings like Spain, where a high percentage of women already comply with many of them.

We read the original article by Dominici et al 1 regarding the complete eradication of axillary lymph node metastases in patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer who were treated with trastuzumab-containing neoadjuvant chemotherapy. The exquisite sensitivity of breast cancer to this treatment may generate an axillary lymph node complete pathological response that, as a counterpart, causes the stromal and vascular changes that give rise to the appearance of lymphedema before surgery. A patient aged 48 years was diagnosed with an invasive ductal carcinoma of the left breast with positive estrogen receptors, negative progesterone receptors, and positive HER2 in clinical stage IIIB (T4bN2M0). She was treated with four 21-day cycles of doxorubicin at a dose of 60 mg/m 2 and cyclophosphamide at a dose of 600 mg/m 2 , both administered intravenously. After the fourth cycle, the patient developed left arm lymphedema. Venous thrombosis was discounted by Doppler ultrasound. The patient completed the neoadjuvant treatment with four 21-day cycles of docetaxel at a dose of 100 mg/m 2 and trastuzumab at a dose of 6 mg/kg (8-mg/kg loading dose), both administered intravenously. During this treatment, the clinical remission of the mammary and axillary disease was maintained, and the edema of the arm increased. The histopathological result of modified radical mastectomy was the total absence of tumor, and marked postchemotherapy changes. During the axillary lymphadenectomy, only 3 lymphatic ganglia were recognized, all of which were free from metastasis, with interstitial fibrosis and lymphoid depletion. Also recognized were several foci of fibrosis with a scarce lymphoid population, suggestive of pre-existing lymphatic ganglia with changes produced by the chemotherapy.To the best of our knowledge, there are no descriptions in the literature of the appearance of lymphedema in this context.

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