Animal experiments and human ecological studies suggest that dietary fat intake is associated with a risk of breast cancer, but individual-based studies have given contradictory results. We have carried out a meta-analysis of this association to include all papers published up to July 2003. Case -control and cohort studies that examined the association of dietary fat, or fat-containing foods, with risk of breast cancer were identified. A total of 45 risk estimates for total fat intake were obtained. Descriptive data from each study were extracted with an estimate of relative risk and its associated 95% confidence interval (CI), and were analysed using the random effects model of DerSimonian and Laird. The summary relative risk, comparing the highest and lowest levels of intake of total fat, was 1.13 (95% CI: 1.03 -1.25). Cohort studies (N ¼ 14) had a summary relative risk of 1.11 (95% CI: 0.99 -1.25) and case -control studies (N ¼ 31) had a relative risk of 1.14 (95% CI 0.99 -1.32). Significant summary relative risks were also found for saturated fat (RR, 1.19; 95% CI: 1.06 -1.35) and meat intake (RR, 1.17; 95% CI 1.06 -1.29). Combined estimates of risk for total and saturated fat intake, and for meat intake, all indicate an association between higher intakes and an increased risk of breast cancer. Case -control and cohort studies gave similar results. British Journal of Cancer (2003) Breast cancer is the leading cause of cancer death, and the most frequently diagnosed cancer in women worldwide (Lacey et al, 2002). Large differences in rates of the disease exist between countries, with higher rates in North America and Western Europe, and lower rates in Asia and South America (Lacey et al, 2002). These differences are likely to be due to environmental rather than genetic factors. The rates of breast cancer change in migrants from low-to high-risk countries, who eventually acquire the rates of their adopted country (Ziegler et al, 1993;Pike et al, 2002). Menstrual and reproductive risk factors for breast cancer do not appear to account for these differences in rates (Wu et al, 1996).The differences in dietary practices between countries are well established, and could contribute to the differences in breast cancer risk. Support for an influence of dietary fat on breast cancer rates comes from its effect on mammary carcinogenesis in animals, and human ecological data.Two major meta-analyses, combining results from over 140 studies examining the relationship between dietary fat and breast cancer risk in rats and mice, show dietary fat to be a promoter of mammary carcinogenesis (Fay et al, 1997). This effect is independent of the effects of caloric intake (Freedman et al, 1990). Human ecological studies show a strong correlation (0.7 or more) between dietary fat intake, estimated from national food balance data, and incidence and mortality of breast cancer worldwide. (Prentice and Sheppard, 1990).However, case -control and cohort studies that have examined the relationship between dietary fat and breast cancer risk...