Dietary factors and in situ and invasive cervical cancer risk in the European prospective investigation into cancer and nutrition study
Corresponding Author
Carlos A. González
Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology, Barcelona (ICO-IDIBELL), Spain
Fax: +34-932607787
Unit of Nutrition Environment and Cancer, Cancer Research Program, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, SpainSearch for more papers by this authorNoemie Travier
Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology, Barcelona (ICO-IDIBELL), Spain
Search for more papers by this authorLeila Luján-Barroso
Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology, Barcelona (ICO-IDIBELL), Spain
Search for more papers by this authorXavier Castellsagué
Unit of Infections and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology, Barcelona (ICO-IDIBELL), CIBERESP, Spain
Search for more papers by this authorF. Xavier Bosch
Unit of Infections and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology, Barcelona (ICO-IDIBELL), CIBERESP, Spain
Search for more papers by this authorEsther Roura
Unit of Infections and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology, Barcelona (ICO-IDIBELL), CIBERESP, Spain
Search for more papers by this authorH. Bas Bueno-de-Mesquita
Centre of Chronic Diseases Epidemiology, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
Search for more papers by this authorDomenico Palli
Molecular and Nutritional Epidemiology Unit, CSPO–Scientific Institute of Tuscany, Florence, Italy
Search for more papers by this authorHeiner Boeing
Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany
Search for more papers by this authorValeria Pala
Nutritional Epidemiology Unit, Istituto Nazionale dei Tumori, Milan, Italy
Search for more papers by this authorCarlotta Sacerdote
Centre for Cancer Epidemiology and Prevention (CPO Piemonte), Turin, Italy
Search for more papers by this authorRosario Tumino
Cancer Registry, Azienda Ospedaliera “Civile M.P. Arezzo”, Ragusa, Italy
Search for more papers by this authorSalvatore Panico
Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy
Search for more papers by this authorJonas Manjer
Department of Surgery, Malmö University Hospital, Lund University, Malmö, Sweden
Search for more papers by this authorJoakim Dillner
Department of Medical Microbiology, Malmö University Hospital, Lund University, Malmö, Sweden
Search for more papers by this authorGöran Hallmans
Department of Nutritional Research, University of Umeå, Umeå, Sweden
Search for more papers by this authorLennart Kjellberg
Department of Obstetrics and Gynaecology, Umea University Hospital, Umea, Sweden
Search for more papers by this authorMaría-José Sanchez
Granada Cancer Registry, Andalusian School of Public Health, CIBERESP, Granada, Spain
Search for more papers by this authorJone M. Altzibar
Public Health Division of Guipuzkoa, Basque Government, CIBERESP, San Sebastian, Spain
Search for more papers by this authorAurelio Barricarte
Public Health Institute of Navarra, CIBERESP, Pamplona, Spain
Search for more papers by this authorCarmen Navarro
Epidemiology Department, Health Council of Murcia, CIBERESP, Spain
Search for more papers by this authorLaudina Rodriguez
Public Health and Participation Directorate, Health and Health Care Services Council, Asturias, Spain
Search for more papers by this authorNaomi Allen
Cancer Epidemiology Unit, University of Oxford, Oxford, United Kingdom
Search for more papers by this authorTimothy J. Key
Cancer Epidemiology Unit, University of Oxford, Oxford, United Kingdom
Search for more papers by this authorRudolf Kaaks
German Cancer Research Center (DKFZ), Heidelberg, Germany
Search for more papers by this authorSabine Rohrmann
German Cancer Research Center (DKFZ), Heidelberg, Germany
Search for more papers by this authorKim Overvad
Department of Clinical Epidemiology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark
Search for more papers by this authorAnja Olsen
Diet Cancer and Health, Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark
Search for more papers by this authorAnne Tjønneland
Diet Cancer and Health, Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark
Search for more papers by this authorChristian Munk
Department of Virus, Hormones and Cancer, Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark
Search for more papers by this authorSusanne Krüger Kjaer
Gynecologic Clinic, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
Search for more papers by this authorPetra H.M. Peeters
Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands
Search for more papers by this authorFränzel J.B. van Duijnhoven
Centre of Chronic Diseases Epidemiology, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
Search for more papers by this authorFrançoise Clavel-Chapelon
Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Gustave Roussy, Villejuif, France
Search for more papers by this authorMarie-Christine Boutron-Ruault
Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Gustave Roussy, Villejuif, France
Search for more papers by this authorAntonia Trichopoulou
Who Collaborating Center for Food and Nutrition Policies, Department of Hygiene and Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
Search for more papers by this authorVasiliki Benetou
Who Collaborating Center for Food and Nutrition Policies, Department of Hygiene and Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
Search for more papers by this authorAndroniki Naska
Who Collaborating Center for Food and Nutrition Policies, Department of Hygiene and Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
Search for more papers by this authorEiliv Lund
Institute of Community Medicine, University of Tromso, Tromso, Norway
Search for more papers by this authorDagrun Engeset
Institute of Community Medicine, University of Tromso, Tromso, Norway
Search for more papers by this authorGuri Skeie
Institute of Community Medicine, University of Tromso, Tromso, Norway
Search for more papers by this authorSilvia Franceschi
Section of Infections, International Agency for Research on Cancer, Lyon, France
Search for more papers by this authorNadia Slimani
Dietary Exposure Assessment Group, International Agency for Research on Cancer, Lyon, France
Search for more papers by this authorSabina Rinaldi
Dietary Exposure Assessment Group, International Agency for Research on Cancer, Lyon, France
Search for more papers by this authorElio Riboli
Division of Epidemiology, Public Health and Primary Care, Faculty of Medicine, Imperial College, London, United Kingdom
Search for more papers by this authorCorresponding Author
Carlos A. González
Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology, Barcelona (ICO-IDIBELL), Spain
Fax: +34-932607787
Unit of Nutrition Environment and Cancer, Cancer Research Program, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, SpainSearch for more papers by this authorNoemie Travier
Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology, Barcelona (ICO-IDIBELL), Spain
Search for more papers by this authorLeila Luján-Barroso
Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology, Barcelona (ICO-IDIBELL), Spain
Search for more papers by this authorXavier Castellsagué
Unit of Infections and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology, Barcelona (ICO-IDIBELL), CIBERESP, Spain
Search for more papers by this authorF. Xavier Bosch
Unit of Infections and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology, Barcelona (ICO-IDIBELL), CIBERESP, Spain
Search for more papers by this authorEsther Roura
Unit of Infections and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology, Barcelona (ICO-IDIBELL), CIBERESP, Spain
Search for more papers by this authorH. Bas Bueno-de-Mesquita
Centre of Chronic Diseases Epidemiology, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
Search for more papers by this authorDomenico Palli
Molecular and Nutritional Epidemiology Unit, CSPO–Scientific Institute of Tuscany, Florence, Italy
Search for more papers by this authorHeiner Boeing
Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany
Search for more papers by this authorValeria Pala
Nutritional Epidemiology Unit, Istituto Nazionale dei Tumori, Milan, Italy
Search for more papers by this authorCarlotta Sacerdote
Centre for Cancer Epidemiology and Prevention (CPO Piemonte), Turin, Italy
Search for more papers by this authorRosario Tumino
Cancer Registry, Azienda Ospedaliera “Civile M.P. Arezzo”, Ragusa, Italy
Search for more papers by this authorSalvatore Panico
Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy
Search for more papers by this authorJonas Manjer
Department of Surgery, Malmö University Hospital, Lund University, Malmö, Sweden
Search for more papers by this authorJoakim Dillner
Department of Medical Microbiology, Malmö University Hospital, Lund University, Malmö, Sweden
Search for more papers by this authorGöran Hallmans
Department of Nutritional Research, University of Umeå, Umeå, Sweden
Search for more papers by this authorLennart Kjellberg
Department of Obstetrics and Gynaecology, Umea University Hospital, Umea, Sweden
Search for more papers by this authorMaría-José Sanchez
Granada Cancer Registry, Andalusian School of Public Health, CIBERESP, Granada, Spain
Search for more papers by this authorJone M. Altzibar
Public Health Division of Guipuzkoa, Basque Government, CIBERESP, San Sebastian, Spain
Search for more papers by this authorAurelio Barricarte
Public Health Institute of Navarra, CIBERESP, Pamplona, Spain
Search for more papers by this authorCarmen Navarro
Epidemiology Department, Health Council of Murcia, CIBERESP, Spain
Search for more papers by this authorLaudina Rodriguez
Public Health and Participation Directorate, Health and Health Care Services Council, Asturias, Spain
Search for more papers by this authorNaomi Allen
Cancer Epidemiology Unit, University of Oxford, Oxford, United Kingdom
Search for more papers by this authorTimothy J. Key
Cancer Epidemiology Unit, University of Oxford, Oxford, United Kingdom
Search for more papers by this authorRudolf Kaaks
German Cancer Research Center (DKFZ), Heidelberg, Germany
Search for more papers by this authorSabine Rohrmann
German Cancer Research Center (DKFZ), Heidelberg, Germany
Search for more papers by this authorKim Overvad
Department of Clinical Epidemiology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark
Search for more papers by this authorAnja Olsen
Diet Cancer and Health, Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark
Search for more papers by this authorAnne Tjønneland
Diet Cancer and Health, Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark
Search for more papers by this authorChristian Munk
Department of Virus, Hormones and Cancer, Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark
Search for more papers by this authorSusanne Krüger Kjaer
Gynecologic Clinic, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
Search for more papers by this authorPetra H.M. Peeters
Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands
Search for more papers by this authorFränzel J.B. van Duijnhoven
Centre of Chronic Diseases Epidemiology, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
Search for more papers by this authorFrançoise Clavel-Chapelon
Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Gustave Roussy, Villejuif, France
Search for more papers by this authorMarie-Christine Boutron-Ruault
Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Gustave Roussy, Villejuif, France
Search for more papers by this authorAntonia Trichopoulou
Who Collaborating Center for Food and Nutrition Policies, Department of Hygiene and Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
Search for more papers by this authorVasiliki Benetou
Who Collaborating Center for Food and Nutrition Policies, Department of Hygiene and Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
Search for more papers by this authorAndroniki Naska
Who Collaborating Center for Food and Nutrition Policies, Department of Hygiene and Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
Search for more papers by this authorEiliv Lund
Institute of Community Medicine, University of Tromso, Tromso, Norway
Search for more papers by this authorDagrun Engeset
Institute of Community Medicine, University of Tromso, Tromso, Norway
Search for more papers by this authorGuri Skeie
Institute of Community Medicine, University of Tromso, Tromso, Norway
Search for more papers by this authorSilvia Franceschi
Section of Infections, International Agency for Research on Cancer, Lyon, France
Search for more papers by this authorNadia Slimani
Dietary Exposure Assessment Group, International Agency for Research on Cancer, Lyon, France
Search for more papers by this authorSabina Rinaldi
Dietary Exposure Assessment Group, International Agency for Research on Cancer, Lyon, France
Search for more papers by this authorElio Riboli
Division of Epidemiology, Public Health and Primary Care, Faculty of Medicine, Imperial College, London, United Kingdom
Search for more papers by this authorAbstract
Some dietary factors could be involved as cofactors in cervical carcinogenesis, but evidence is inconclusive. There are no data about the effect of fruits and vegetables intake (F&V) on cervical cancer from cohort studies. We examined the association between the intake of F&V and selected nutrients and the incidence of carcinoma in situ (CIS) and invasive squamous cervical cancer (ISC) in a prospective study of 299,649 women, participating in the European Prospective Investigation into Cancer and Nutrition study. Cox proportional hazard models were used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (95% CI). A calibration study was used to control measurement errors in the dietary questionnaire. After a mean of 9 years of follow-up, 253 ISC and 817 CIS cases were diagnosed. In the calibrated model, we observed a statistically significant inverse association of ISC with a daily increase in intake of 100 g of total fruits (HR 0.83; 95% CI 0.72–0.98) and a statistically nonsignificant inverse association with a daily increase in intake of 100 g of total vegetables (HR 0.85: 95% CI 0.65–1.10). Statistically nonsignificant inverse associations were also observed for leafy vegetables, root vegetables, garlic and onions, citrus fruits, vitamin C, vitamin E and retinol for ISC. No association was found regarding beta-carotene, vitamin D and folic acid for ISC. None of the dietary factors examined was associated with CIS. Our study suggests a possible protective role of fruit intake and other dietary factors on ISC that need to be confirmed on a larger number of ISC cases.
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