Dietary attitudes and changes as well as use of
supplements and complementary therapies by
Australian and Finnish women following the diagnosis
of breast cancer
E Salminen1*, M Bishop3, T Poussa2, R Drummond3and S Salminen4
1Department of Radiotherapy and Oncology, University of Turku, Finland;2STAT Consulting, Tampere, Finland;3Radiation Oncology,
Peter MacCallum Cancer Institute, Melbourne, Australia; and4Department of Biochemistry and Food Chemistry, University of Turku,
Objective: This study investigated self-reported dietary attitudes and changes, and use of complementary approaches among
breast cancer patients in relation to age, education and time since diagnosis.
Design and setting: Australian (ABC, N¼215) and Finnish (FBC, N¼139) breast cancer patients were surveyed at the university
cancer centres with voluntary participation. Logistic regression models were used to adjust for differences in demographic
patient characteristics between the groups. The influence of demographic variables was further studied separately or combined.
Results: In all, 30% of FBC patients and 39% of ABC patients reported having changed their diet (P¼0.033). Higher education,
younger age and longer time from diagnosis were significantly associated with the probability of changes. The main changes
reported included reduced consumption of animal fat, sugar and red meat, and increased consumption of fruits and vegetables.
In all, 6% of ABC and 4% of FBC patients had stopped smoking and 24% of ABC and 27% of FBC patients reported to have
increased their level of physical exercise. Choices were associated with age (Po0.007), length of the disease history (P o0.01)
and level of education (P o0.002).
Conclusion: One-third of breast cancer patients surveyed reported to have changed their dietary habits. Both populations
reported a need for dietary and lifestyle counselling. This need was experienced as poorly recognised by the physicians at
present, and warrants future studies in dietary behaviour of breast cancer patients.
European Journal of Clinical Nutrition (2004) 58, 137–144. doi:10.1038/sj.ejcn.1601760
Keywords: breast cancer; dietary changes; vitamins; complementary approaches
Breast cancer is considered a lifestyle cancer by reason
of its high incidence in Western society (Levi, 1999).
Breastcancer is themost
countries among female patients, with increasing incidence
in menopause. Although multiple factors appear to increase
the risk of breast cancer, diet is one of the most important
lifestyle factors associated with it (Doll & Peto, 1981;
Willett, 1995; Rock et al, 1997). The evidence from
epidemiological studies is based mainly on observations
common cancer inmost
and case–control studies, in which recall and selection
bias may influence the results (Smith-Warner et al, 2001).
Pooled analysis of cohort studies has not shown clear
evidence for effects of dietary modification in the adulthood
to associate with reduced breast cancer risk (Smith-Warner
et al, 2001).
Current nutrition recommendations and dietary guide-
lines (National Health and Medical Research Council, 1991;
Ministry of Agriculture and Forestry, 1998) include a varied
diet, balance between energy intake and expenditure,
increase in proportion of carbohydrates, reduced intake of
saturated fat and sodium and only moderate alcohol
consumption. Also, regular physical exercise is advocated
(Byers et al, 2002). These are in line with the American
Cancer Society’s current recommendations for reduction of
breast cancer risk (Byers et al, 2002).
Received 25 January 2003; revised 23 February 2003;
accepted 25 February 2003
*Correspondence: E Salminen, Department of Oncology, Turku University
Hospital, Kiinamyllynkatu 4-8, 20520, Turku, Finland.
European Journal of Clinical Nutrition (2004) 58, 137–144
& 2004 Nature Publishing Group All rights reserved 0954-3007/04 $25.00
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Dietary attitudes and changes
E Salminen et al
European Journal of Clinical Nutrition