Effects at Two Years of a Low-Fat, High-Carbohydrate Diet on Radiologic Features of the Breast: Results From a Randomized Trial

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Abstract
Background: The appearance of breast tissue on mammography varies according to its composition. Fat is radiolucent and appears dark on mammography, while stromal and epithelial tissue has greater optical density and appears light. Extensive areas of radiologically dense breast tissue seen on mammography are associated with an increased risk of breast cancer. Purpose: The purpose of the present study was to determine whether the adoption of a low-fat, high- carbohydrate diet for 2 years would reduce breast density. Methods: Women with radiologic densities in more than 50% of the breast area on mammography were recruited and randomly allocated to an intervention group taught to reduce intake of dietary fat (mean, 21% of calories) and increase complex carbohydrate (mean, 61% of calories) or to a control group (mean, 32% of calories from fat and 50% of calories from carbohydrates). Mammographic images from 817 subjects were taken at baseline and compared with those taken 2 years after random allocation by use of a quantitative image analysis system, without knowledge of the dietary group of the subjects or of the sequence in which pairs of images had been taken. The effects of the intervention on the mammographic features of breast area, area of dense tissues in the breast, and the percent of the breast occupied by dense tissue were examined using t tests. Multiple regression was used to examine these effects while accounting for age at trial entry, weight change, and menopausal status. Results: After 2 years, the total area of the breast was reduced by an average of 233.7 mm 2 (2.4%) (95% confidence interval [CI] = 106.9−360.6) in the intervention group compared with an average increase of 26.3 mm 2 (0.3%) (95% CI = −108.0160.5) in the control group ( P = .01). The area of density was reduced by 374.4 mm 2 (6.1%) (95% CI = 235.1−513.8) in the intervention group compared with an average of 127.7 mm 2 (2.1%) (95% CI = 8.6−246.7) in the control group (P = .01). Weight loss was associated with a reduction in breast area. The effect of the intervention on breast area was only marginally statistically significant after weight change, menopausal status, and age at trial entry were taken into account ( P = .06). Greater weight loss and becoming postmenopausal were associated with statistically significant reductions in the area of density on the mammographic image at 2 years ( P = .04 and P<.001, respectively). Age at entry into the trial was marginally significant in the same direction ( P = .06). The effect of the intervention on area of density remained statistically significant after controlling for weight loss, age at entry, and menopausal status ( P = .03). The change in the percentage of dense tissue in the mammographic image was not significantly different between the two groups ( P = .71). Conclusions and Implications: These results show that after 2 years, a low-fat, high-carbohydrate diet reduced the area of mammographic density, a radiographic feature of the breast that is a risk factor for breast cancer. Longer observation of a larger number of subjects will be required to determine whether these effects are associated with changes in risk of breast cancer.