The Effect of Diet on Breast Cancer Recurrence: The DIANA-5 Randomized Trial.

PURPOSE: The DIANA-5 randomized controlled trial assessed the effectiveness of a diet based on Mediterranean and macrobiotic traditions (macro-Mediterranean diet) in reducing breast cancer recurrence. PATIENTS AND METHODS: The DIANA-5 study involved 1,542 patients with breast cancer at high risk of recurrence because of estrogen receptor-negative cancer, or metabolic syndrome, or high plasma levels of insulin or testosterone. Women were randomly assigned to an active dietary intervention (IG) or a control group (CG). Both groups received the 2007 American Institute for Cancer Research/World Cancer Research Fund recommendations for cancer prevention. The intervention consisted of meetings with kitchen classes, community meals, and dietary recommendations. Recommended foods included whole grain cereals, legumes, soy products, vegetables, fruit, nuts, olive oil, and fish. Foods to be avoided were refined products, potatoes, sugar and desserts, red and processed meat, dairy products, and alcoholic drinks. A compliance Dietary Index was defined by the difference between recommended and discouraged foods. RESULTS: Over the 5 years of follow-up, 95 patients of the IG and 98 of the CG developed breast cancer recurrence [HR = 0.99; 95% confidence interval (CI): 0.69-1.40]. The analysis by compliance to the dietary recommendations (IG and CG together) showed that the women in the upper tertile of Dietary Index change had an HR of recurrence of 0.59 (95% CI: 0.36-0.92) compared with women in the lower tertile. CONCLUSIONS: The DIANA-5 dietary intervention trial failed to show a reduction in breast cancer recurrence, although self-reported diet at year 1 in IG and CG combined showed a protective association with the higher Dietary Index change. See related commentary by McTiernan, p. 931.

Estimates of cancer burden in Basilicata and Calabria.

AIMS AND BACKGROUND: Basilicata and Calabria are two neighboring, low income regions of southern peninsular Italy with an overall population of about 2.5 million in 2010. Cancer registration has covered the entire Basilicata population since 2005 and the province of Catanzaro (18.3% of the Calabria population) since 2003. This paper will provide estimates and projections for the period 1970-2015 of the basic epidemiological indicators - incidence, prevalence and mortality - in the Basilicata and Calabria regions for the major cancers (lung, colon and rectum, stomach, skin mela-noma, breast, cervix and prostate). METHODS: The indicators were estimated by applying the MIAMOD statistical back-calculation method to the 1970-2002 official mortality data, and to the 1985-2002 relative survival data collected by population-based registries of the southern regions of Italy. RESULTS: The incidence rates were estimated to be still rising for breast, prostate and colorectal cancer, and for skin melanoma in men. By contrast, they were estimated to be declining for cervix and stomach cancer. The incidence increased, reaching a peak, and subsequently decreased for lung cancer in men and for skin melanoma in women. The age-standardized mortality rates were estimated to decrease for all considered cancers except prostate cancer in men and lung cancer in women, which presented quite stable mortality rates from the mid 2000s onwards. Except for cervix cancer, prevalence was increasing for all considered cancers, particularly those of the breast and prostate. CONCLUSION: These data support the need for health policies focused on primary and secondary prevention, which is the main way to reduce the overall impact of cancer and to preserve health care resources, as well as on actions aimed at ensuring equal access to cancer care and at transferring innovation into clinical practice.