Letters Section Editor: Robert M. Golub, MD, Senior Editor.
In Reply: Over the last decade, the National Cancer Institute funded 2 large randomized trials on the effect of diet on recurrent breast cancer events (WHEL and WINS). These studies enrolled different populations and studied different dietary patterns. Nevertheless, both interventions aimed to reduce dietary fat intake. The WHEL intervention initially reduced fat intake and maintained a significant between-group difference over 4 years.1 However, the intervention did not influence breast cancer outcomes, and results did not suggest a differential benefit depending on baseline dietary fat intake. This finding is at odds with the WINS interim analysis, in which a reduction in fat intake approached statistical significance on breast cancer outcomes using the appropriate a priori test.2 The question is how to interpret this apparent inconsistency.
Pierce JP, Caan BJ, Ritenbaugh C, Rock CL, Natarajan L. Diet and Breast Cancer Recurrence—Reply. JAMA. 2007;298(18):2135-2136. doi:10.1001/jama.298.18.2135-b