Adherence To The Mediterranean Diet And Cancer Risk In EPIC

Genevieve BUCKLAND, Catalan Institute of Oncology (ICO-IDIBELL), Spain
COUTO E. 2 , MOLINA-MONTES E. 3 , BAMIA C. 4,5 , TRICHOPOULOU A. 4,5 , SÁNCHEZ-PÉREZ M. 6,7 , AMIANO P. 7,8 , NAVARRO C. 7,9,10 , CHIRLAQUE-LOPEZ M. 7,9,10 , LASHERAS C. 11 , TRAVIER N. 1 , GONZALEZ C. 1 , AGUDO A. 1 , BUCKLAND G. 1

1 Unit of Nutrition and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain
2 The Norwegian Institute of Public Health, Norwegian Knowledge Centre for the Health Services, Oslo, Norway.
3 Molecular and Genetic Epidemiology Group, Spanish National Cancer Research Center CNIO, Spain.
4 Hellenic Health Foundation, Athens, Greece
5 WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Dept. of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Greece
6 Andalusian School of Public Health, Granada, Spain
7 CIBER Epidemiología y Salud Pública (CIBERESP), Spain
8 Public Health Division of Gipuzkoa, BioDonostia Research Institute, Donostia-San Sebastian, Spain
9 Murcia Regional Health Council, Murcia, Spain
10 Department of Health and Social Sciences, University of Murcia, Spain
11 Facultad de Medicina, Universidad de Oviedo, Oviedo, Spain

Purpose: To summarize the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort study results on the association between adherence to the Mediterranean diet (MD) and risk of specific cancers, including gastric adenocarcinoma (GC), breast cancer (BC), pancreatic cancer (PC), colorectal cancer (CRC), bladder cancer (BLC) and overall cancer.
Methods: EPIC includes approximately half a million subjects, aged 35-70 years, from 10 European countries. During recruitment (between 1992-2000) dietary and lifestyle information was collected. Adherence to the MD was estimated using Mediterranean diet scores (MDS) considering the combined intake of key MD components. The associations between the MDS and incidence of each cancer site were assessed through separate Cox regression models, controlling for cancer specific confounders.
Results: The mean follow-up period ranged from 8-11 years and the number of incident cases identified by cancer site was: 449 GC cases, 10,225 BC cases, 865 PC cases,  4,355 CRC cases, 1,425 BLC cases and 30,731 cancer cases overall. High compared to low MD adherence was associated with a significant reduced risk of GC (Hazard Ratio (HR) 0.67; 95% Confidence Interval (CI) 0.47, 0.94), CRC (HR 0.89; 95% CI 0.80, 0.99), BC overall (HR 0.94; 95% CI 0.88, 1.00) and particularly in hormone receptor negative BC tumours (HR 0.80; 95% CI 0.65, 0.99) and overall cancer risk (HR 0.93; 95%CI 0.90, 0.96). In contrast, no significant association was found for BLC (HR 0.84; 96%CI 0.69, 1.03) or PC (HR 0.99; 95%CI 0.77, 1.26).
Conclusions:  These results support the important role of following a MD pattern on reducing risk of certain cancers, such as GC, BC and CRC, as well as overall cancer. These findings underscore the potential scope for cancer prevention through dietary modification such as following key attributes of the traditional MD.
Funding sources:  AGAUR: Exp.2014.SGR.726, RETICC: RD12/0036/0018