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May 11, 2005

Consumption of Vegetables and Fruits and Risk of Breast Cancer—Reply

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2005;293(18):2209-2210. doi:10.1001/jama.293.18.2210-a

In Reply: We agree with Dr Laigou and colleagues that high consumers of fruits and vegetables are generally health conscious women who are more likely to be tested with breast examination. If, for this reason, more breast tumors are detected in high consumers than in low consumers this may conceal an inverse association between breast cancer and intake of vegetables or fruits. However, the higher frequency of detection of breast cancer in mammography-screened populations is largely due to the increased detection of ductal carcinoma in situ,1 and our study only included invasive breast tumors. One might argue that the number of invasive cancers will be relatively lower in regularly screened populations than in unscreened populations because in screened populations tumors will be detected in an earlier stage. This would, however, lead to a relative overestimation of any protective effects. We therefore think that confounding by screening participation cannot explain the absence of an association between fruit and vegetable consumption and the risk of invasive breast cancer.

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