Review Article

Adherence to a Mediterranean Dietary Pattern and Risk of Breast and Endometrial Cancers: A Systematic Review


Breast and endometrial cancers are the most prevalent cancers among women all over the world, with breast cancer being the first cause of cancer mortality in women. Major known risk factors for breast and endometrial cancers are obesity, low physical activity, and unhealthy and poor diet, contributing to about 30%-35% of cancer incidence. Recent evidence supports that adherence to a healthy dietary pattern such as the Mediterranean diet (MD) is associated with reduced risk of certain types of cancer, including breast and endometrial cancers. The data for the current review were identified through a systematic search on PubMed, Scopus, and Cochrane databases using the following search terms/keywords: “Mediterranean diet,” “Mediterranean dietary pattern,” “breast,” “mammary,” “endometrial,” “cancer,” “carcinoma,” and “neoplasm.” The reference lists of the included papers were also searched manually. Through the review process, eight case-control studies, four cohort studies, and one clinical trial were identified. The included studies were conducted among postmenopausal and premenopausal women in the United States and some European countries. The review suggests a protective role for the MD against breast cancer risk in both populations. According to the fact that there was insufficient research on the association of the MD pattern and endometrial cancer risk, its protective effect cannot be interpreted with certainty. Further studies in this area, especially interventional studies, are needed to determine causality.

1. Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015; 136(5):E359-86.
2. Bray F, Ren JS, Masuyer E, Ferlay J. Global estimates of cancer prevalence for 27 sites in the adult population in 2008. Int J Cancer. 2013; 132(5):1133-45.
3. Anand P, Kunnumakkara AB, Sundaram C, Harikumar KB, Tharakan ST, Lai OS, et al. Cancer is a preventable disease that requires major lifestyle changes. Pharm Res. 2008;25(9):2097-116.
4. George SM, Ballard R, Shikany JM, Crane TE, Neuhouser ML. A prospective analysis of diet quality and endometrial cancer among 84,415 postmenopausal women in the Women's Health Initiative. Ann Epidemiol. 2015;25(10):788-93.
5. Toledo E, Salas-Salvado J, Donat-Vargas C, Buil-Cosiales P, Estruch R, Ros E, et al. Mediterranean Diet and Invasive Breast Cancer Risk Among Women at High Cardiovascular Risk in the PREDIMED Trial: A Randomized Clinical Trial. JAMA Intern Med. 2015;175(11):1752-1760.
6. Trichopoulou A, Kouris-Blazos A, Wahlqvist ML, Gnardellis C, Lagiou P, Polychronopoulos E, et al. Diet and overall survival in elderly people. BMJ. 1995;311(7018):1457-60.
7. Mourouti N, Kontogianni MD, Papavagelis C, Plytzanopoulou P, Vassilakou T, Malamos N, et al. Adherence to the Mediterranean diet is associated with lower likelihood of breast cancer: a case-control study. Nutr Cancer. 2014;66(5):810-7.
8. Castello A, Pollan M, Buijsse B, Ruiz A, Casas AM, Baena-Canada JM, et al. Spanish Mediterranean diet and other dietary patterns and breast cancer risk: case-control EpiGEICAM study. Br J Cancer. 2014;111(7):1454-62.
9. Demetriou CA, Hadjisavvas A, Loizidou MA, Loucaides G, Neophytou I, Sieri S, et al. The mediterranean dietary pattern and breast cancer risk in Greek-Cypriot women: a case-control study. BMC cancer. 2012;12:113.
10. Murtaugh MA, Sweeney C, Giuliano AR, Herrick JS, Hines L, Byers T, et al. Diet patterns and breast cancer risk in Hispanic and non-Hispanic white women: the Four-Corners Breast Cancer Study. Am J Clin Nutr. 2008;87(4):978-84.
11. Buckland G, Travier N, Cottet V, Gonzalez CA, Lujan-Barroso L, Agudo A, et al. Adherence to the mediterranean diet and risk of breast cancer in the European prospective investigation into cancer and nutrition cohort study. Int J Cancer. 2013;132(12):2918-27.
12. Couto E, Sandin S, Lof M, Ursin G, Adami HO, Weiderpass E. Mediterranean dietary pattern and risk of breast cancer. PloS one. 2013;8(2):e55374.
13. Castello A, Boldo E, Perez-Gomez B, Lope V, Altzibar JM, Martin V, et al. Adherence to the Western, Prudent and Mediterranean dietary patterns and breast cancer risk: MCC-Spain study. Maturitas. 2017;103:8-15.
14. Dalvi TB, Canchola AJ, Horn-Ross PL. Dietary patterns, Mediterranean diet, and endometrial cancer risk. Cancer Causes Control. 2007;18(9):957-66.
15. Cade JE, Taylor EF, Burley VJ, Greenwood DC. Does the Mediterranean dietary pattern or the Healthy Diet Index influence the risk of breast cancer in a large British cohort of women? Eur J Clin Nutr. 2011;65(8):920-8.
16. Higgins J, Green S. Cochrane handbook for systematic reviews of interventions (Vol. 5): Wiley Online Library. 2008.
17. Turati F, Carioli G, Bravi F, Ferraroni M, Serraino D, Montella M, et al. Mediterranean Diet and Breast Cancer Risk. Nutrients. 2018;10(3):326.
18. Ricceri F, Giraudo MT, Fasanelli F, Milanese D, Sciannameo V, Fiorini L, et al. Diet and endometrial cancer: a focus on the role of fruit and vegetable intake, Mediterranean diet and dietary inflammatory index in the endometrial cancer risk. BMC Cancer. 2017;17(1):757.
19. Chrysohoou C, Panagiotakos DB, Pitsavos C, Das UN, Stefanadis C. Adherence to the Mediterranean diet attenuates inflammation and coagulation process in healthy adults: The ATTICA Study. J Am Coll Cardiol. 2004;44(1):152-8.
20. Esposito K, Ciotola M, Giugliano D. Mediterranean diet, endothelial function and vascular inflammatory markers. Public Health Nutr. 2006;9(8A):1073-6.
21. Panagiotakos DB, Dimakopoulou K, Katsouyanni K, Bellander T, Grau M, Koenig W, et al. Mediterranean diet and inflammatory response in myocardial infarction survivors. Int J Epidemiol. 2009;38(3):856-66.
22. Nunez-Cordoba JM, Valencia-Serrano F, Toledo E, Alonso A, Martinez-Gonzalez MA. The Mediterranean diet and incidence of hypertension: the Seguimiento Universidad de Navarra (SUN) Study. Am J Epidemiol. 2009;169(3):339-46.
23. Verberne L, Bach-Faig A, Buckland G, Serra-Majem L. Association between the Mediterranean diet and cancer risk: a review of observational studies. Nutr Cancer. 2010;62(7):860-70.
24. Mitjavila MT, Fandos M, Salas-Salvado J, Covas MI, Borrego S, Estruch R, et al. The Mediterranean diet improves the systemic lipid and DNA oxidative damage in metabolic syndrome individuals. A randomized, controlled, trial. Clin Nutr. 2013;32(2):172-8.
25. Visioli F, Grande S, Bogani P, Galli C. The role of antioxidants in the mediterranean diets: focus on cancer. Eur J Cancer Prev. 2004;13(4):337-43.
26. Wu AH, Yu MC, Tseng CC, Stanczyk FZ, Pike MC. Dietary patterns and breast cancer risk in Asian American women. Am J Clin Nutr. 2009;89(4):1145-54.
27. Colditz GA, Rosner BA, Chen WY, Holmes MD, Hankinson SE. Risk factors for breast cancer according to estrogen and progesterone receptor status. J Natl Cancer Inst. 2004;96(3):218-28.
28. Carruba G, Granata OM, Pala V, Campisi I, Agostara B, Cusimano R, et al. A traditional Mediterranean diet decreases endogenous estrogens in healthy postmenopausal women. Nutr Cancer. 2006;56(2):253-9.
29. Filomeno M, Bosetti C, Bidoli E, Levi F, Serraino D, Montella M, et al. Mediterranean diet and risk of endometrial cancer: a pooled analysis of three Italian case-control studies. Br J Cancer. 2015;112(11):1816-21.
30. Xu WH, Dai Q, Xiang YB, Zhao GM, Ruan ZX, Cheng JR, et al. Nutritional factors in relation to endometrial cancer: a report from a population-based case-control study in Shanghai, China. Int J Cancer. 2007;120(8):1776-81.
IssueVol 5, No 1/2 (Winter/Spring 2019) QRcode
SectionReview Article(s)
Breast cancer Endometrial cancer Mediterranean dietary pattern Women

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How to Cite
Mazandaranian M, Rezazadeh A, Bahrami A. Adherence to a Mediterranean Dietary Pattern and Risk of Breast and Endometrial Cancers: A Systematic Review. J Nutr Sci & Diet. 2019;5(1-2):40-49.