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Cited by 195Phytoestrogen effects and researchNutritional Studies and DietCancer Risks and Factors

Soy isoflavones and risk of cancer recurrence in a cohort of breast cancer survivors: the Life After Cancer Epidemiology study

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Guha, Neela, Kwan, Marilyn L., Quesenberry, Charles P., Weltzien, Erin K., Castillo, Adrienne L., Caan, Bette J.·2009·Breast Cancer Research and Treatment
DOI 10.1007/s10549-009-0321-5PMC PMC3470874
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Abstract

Soy isoflavones, structurally similar to endogenous estrogens, may affect breast cancer through both hormonally mediated and non-hormonally related mechanisms. Although the effects of soy are not well understood, some breast cancer survivors increase their soy intake post-diagnosis in attempt to improve their prognosis. Therefore, we examined the role of soy isoflavone intake and the risk of breast cancer recurrence by hormone receptor status, menopausal status, and tamoxifen therapy. A cohort of 1,954 female breast cancer survivors, diagnosed during 1997-2000, was prospectively followed for 6.31 years and 282 breast cancer recurrences were ascertained. Isoflavone intake was assessed by mailing modified Block and supplemental soy food frequency questionnaires to participants, on average 23 months post-diagnosis. Risk of breast cancer recurrence, measured by hazard ratios (HR) and 95% confidence intervals (CI), was estimated using multivariable delayed entry Cox proportional hazards models. Suggestive trends for a reduced risk of cancer recurrence were observed with increasing quintiles of daidzein and glycetin intake compared to no intake among postmenopausal women (P for trend: P = 0.08 for daidzein, P = 0.06 for glycetin) and among tamoxifen users (P = 0.10 for daidzein, P = 0.05 for glycetin). Among postmenopausal women treated with tamoxifen, there was an approximately 60% reduction in breast cancer recurrence comparing the highest to the lowest daidzein intakes (>1,453 vs. <7.7 microg/day; HR, 0.48; 95% CI, 0.21-0.79, P = 0.008). Soy isoflavones consumed at levels comparable to those in Asian populations may reduce the risk of cancer recurrence in women receiving tamoxifen therapy and moreover, appears not to interfere with tamoxifen efficacy. Further confirmation is required in other large prospective studies before recommendations regarding soy intake can be issued to breast cancer survivors.

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  • Four cohort studies and three RCTs reported no significant differences in treatment outcomes or rates of adverse effects associated with soy use among women receiving tamoxifen therapy.

    “Four cohort studies [100,103,106,112] and three RCTs [128,130,131] reported no significant differences with respect to treatment outcomes or rates of adverse effects associated with use of soy among women who were receiving tamoxifen therapy.”

    From Soy, Red Clover, and Isoflavones and Breast Cancer: A Systematic Review (2013) · cites this paper as [103]

    The Results (page unavailable) report nonsignificant recurrence trends for two soy isoflavones among tamoxifen users, but a significant decrease in recurrence with increasing glycetin intake. The Conclusion (page unavailable) says soy may reduce recurrence without negating tamoxifen’s effects. This cohort therefore does not support an unqualified claim of no significant difference in treatment outcomes, and the passages do not report rates of adverse effects. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • Guha et al found no significant overall effects associated with intake of approximately 13 mg genistein, 9.5 mg daidzein, or 800 mg glycitein.

    “Guha et al found no significant effects overall associated with intake of either ~13mg genistein, ~9.5mg daidzein, or ~800mg glycitein, however there was a trend toward a protective effect among tamoxifen users, p trend =0.05 [103].”

    From Soy, Red Clover, and Isoflavones and Breast Cancer: A Systematic Review (2013) · cites this paper as [103]

    The Results report nonsignificant overall trends for daidzein and glycetin intake, and the Discussion identifies the cohort’s highest intake levels as approximately 9.6 mg/day of daidzein and 13.0 mg/day of genistein. The Results also report a protective trend among tamoxifen users for glycetin (P = .05). Our copy does not substantiate the claimed 800 mg glycitein intake, so the stated dose is unsupported. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Of five prospective studies reporting on recurrence, two (40%) showed protective effects.

    “Of five studies reporting on recurrence [97,100,103,106,112], two (40%) showed protective effects [106,112].”

    From Soy, Red Clover, and Isoflavones and Breast Cancer: A Systematic Review (2013) · cites this paper as [103]

  • Three of five prospective recurrence studies found non-significant associations.

    “Three of the five studies (60%) found non-significant associations [97,100,103]”

    From Soy, Red Clover, and Isoflavones and Breast Cancer: A Systematic Review (2013) · cites this paper as [103]

  • Guha et al found a trend toward a protective effect among tamoxifen users, p trend = 0.05.

    “Guha et al found no significant effects overall associated with intake of either ~13mg genistein, ~9.5mg daidzein, or ~800mg glycitein, however there was a trend toward a protective effect among tamoxifen users, p trend =0.05 [103].”

    From Soy, Red Clover, and Isoflavones and Breast Cancer: A Systematic Review (2013) · cites this paper as [103]

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Cited by

Sorted by citations

Authors
Guha, N., Kwan, M. L., Quesenberry, C. P., Weltzien, E. K., Castillo, A. L., & Caan, B. J.
Affiliations
  • University of California System (US)
  • Kaiser Permanente (US)
Corresponding author
  • Guha, Neela
  • Caan, Bette J.
ORCID
Venue
Breast Cancer Research and Treatment
Publisher
Springer Science and Business Media LLC
Published
2009-02-17
Volume
118
Issue
2
Pages
395-405
ISSN
  • 0167-6806 (ISSN-L)
  • 1573-7217
DOI
10.1007/s10549-009-0321-5
PMC
PMC3470874
OpenAlex
W2048640572
Cited by
195
References
1
Citations by year
2026: 5 · 2025: 8 · 2024: 6 · 2023: 6 · 2022: 7 · 2021: 9 · 2020: 9 · 2019: 3 · 2018: 9 · 2017: 10 · 2016: 11 · 2015: 15 · 2014: 5 · 2013: 22 · 2012: 24
FWCI
15.37
Type
journal article
Language
en
Open access
Licence
www.springer.com/tdm (tdm)
Locations
  • Breast Cancer Research and Treatment (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health (n01pc067000-000)
  • National Cancer Institute (R01CA129059, PC67000, R01CA080027, CA80027)
Topics
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Phytoestrogen effects and research
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
  • Health Sciences › Medicine › Oncology › Cancer Risks and Factors
Keywords
soy isoflavones, breast cancer recurrence, breast cancer survivors, daidzein, tamoxifen, hormone receptor status, menopausal status, postmenopausal women, soy consumption
MeSH terms
Aged, Breast Neoplasms, Diet Surveys, Female, Humans, Isoflavones, Middle Aged, Neoplasm Recurrence, Local, Surveys and Questionnaires, Receptors, Estrogen, Receptors, Progesterone, Risk, Tamoxifen, Proportional Hazards Models, Survivors, Antineoplastic Agents, Hormonal, Soy Foods

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