Food sources of phytoestrogens and breast cancer risk in Mexican women

Traditional Mexican dietary pattern and cancer risk among women of Mexican descent

PURPOSE

To examine the association of a traditional Mexican diet score with risk of total, breast, and colorectal cancer among women of Mexican ethnic descent in the Women's Health Initiative (WHI).

METHODS

Participants were WHI enrollees who self-identified as being of Mexican descent. Data from food frequency questionnaires self-administered at study baseline were used to calculate the MexD score, with higher scores indicating greater adherence to an a priori-defined traditional Mexican diet (high in dietary fiber, vegetables, and legumes). Incident cancers were self-reported by participants from 1993 to 2020 and adjudicated by trained physicians. We used multivariable-adjusted Cox proportional hazards models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs).

RESULTS

Among 2,343 Mexican descent women (median baseline age: 59 years), a total of 270 cancers (88 breast, 37 colorectal) occurred during a mean follow-up of 14.4 years. The highest tertile of MexD score was associated with a lower risk of all-cancer incidence (HR: 0.67; 95% CI 0.49-0.91; p-trend: 0.01) and colorectal cancer (HR: 0.38; 95% CI 0.14-0.998; p-trend < 0.05), with each unit increase in the MexD score associated with a 6% lower risk of all-cancer incidence (HR: 0.94; 95% CI 0.88-0.99). There was no statistically significant association with risk of breast cancer.

CONCLUSION

Consumption of a traditional Mexican diet was associated with a significantly lower risk of all-cancer incidence and colorectal cancer. Confirmation of these findings in future studies is important, given the prevalence of colorectal cancer and a growing U.S. population of women of Mexican descent.

The effect of orally consumed Lactuca sativa syrup on human milk volume and weight gain in the preterm infant: a randomized controlled clinical trial

Human milk feeding can support premature infants to thrive. Yet those with premature infants can be challenged in human milk production. Considering this, and the use of potentially harmful human milk enhancers, the present study was conducted with the aim of determining the effect of orally consumed Lactuca sativa (L. sativa) syrup (lettuce extract) on human milk volume and subsequent weight gain in the preterm infant. Extracts from lettuce and other plants such as silymarin are already evidenced to be safe for use during lactation and have other therapeutic effects in humans. Yet this is the first study of its kind. This parallel randomized clinical trial included lactating participants with their preterm infants who were born at < 32 weeks' gestation and admitted to an intensive care unit. Convenience sampling was used to recruit participants. Eligible participants were allocated to groups randomly: intervention (n = 47), placebo (n = 46), and control (n = 47). The intervention group received one tablespoon of Lactuca sativa (L. sativa) syrup, and the placebo group received one tablespoon of placebo syrup 3 times a day for 1 week. Those in the control group did not receive any herbal or chemical milk-enhancing compounds. Routine care was provided to all three groups. Participants recorded their milk volume for 7 days in a daily information recorder form. Infant weight was measured prior to the intervention, and on the third, fifth and seventh days of the intervention period. There was a statistically significant difference observed in the adjusted mean volume of milk on the fourth and fifth days between the intervention, placebo, and control groups (P < 0.05). The adjusted mean milk volume of those in the intervention group on the first day was significantly higher than those in the control group and those in the placebo group. On the second day, the adjusted mean milk volume of those in the intervention group was higher than in those from the control group; and on the fourth day it was higher than in those from both the control and placebo groups; on the fifth day it was higher than in those in the placebo group; on the sixth day it was higher than in those in the control group and on the seventh day it was higher than in those in the control group (P < 0.05). There was no statistically significant difference in terms of the mean changes (with or without adjustment) in the weight of preterm infants between any of the groups. Lactuca sativa (L. sativa) syrup increases the volume of human milk production and no specific side effects have been reported in its use. Therefore, Lactuca sativa syrup can be recommended for use as one of the compounds that increase human milk volume.

Onco-Preventive and Chemo-Protective Effects of Apple Bioactive Compounds

Cancer is one of the leading causes of death globally. Epidemiological studies have strongly linked a diet high in fruits to a lower incidence of cancer. Furthermore, extensive research shows that secondary plant metabolites known as phytochemicals, which are commonly found in fruits, have onco-preventive and chemo-protective effects. Apple is a commonly consumed fruit worldwide that is available all year round and is a rich source of phytochemicals. In this review, we summarize the association of apple consumption with cancer incidence based on findings from epidemiological and cohort studies. We further provide a comprehensive review of the main phytochemical patterns observed in apples and their bioavailability after consumption. Finally, we report on the latest findings from in vitro and in vivo studies highlighting some of the key molecular mechanisms targeted by apple phytochemicals in relation to inhibiting multiple 'hallmarks of cancer' that are important in the progression of cancer.

Dietary flavonoid patterns and prostate cancer: evidence from a Mexican population-based case-control study

Flavonoids are a broad group of bioactive compounds with anticarcinogenic effects on the prostate that have been scarcely evaluated in Latin American populations. Our objective was to evaluate the association between dietary patterns of flavonoid intake and prostate cancer (PC) in a population-based case-control study carried out in Mexico City. Based on a semi-quantitative FFQ with a frame reference of 3 years before diagnosis or interview, we used an updated database for estimating the daily intake (mg/d) of flavones, flavonols and flavanols for 395 confirmed incident PC cases and 797 population controls matched by age (± 5 years). Histological PC differentiation was evaluated using the Gleason score at diagnosis. Flavonoid dietary intake patterns (FDIP) were determined through principal component analysis, and their association with PC was estimated using logistic regression models. Three FDIP were identified: gallate pattern (GP) characterised by (-)-epicatechin-3-O-gallate, (-)-epigallocatechin-3-O-gallate and (+)-gallocatechin; luteolin pattern (LP) characterised by luteolin and (-)-epigallocatechin-3-O-gallate; and a mixed pattern (MP) that included (+)-catechin, (-)-epicatechin and quercetin. A higher GP (ORT3 v.T1 = 0·47; 95 % CI 0·33, 0·66) and LP intake (ORT3 v. T1 = 0·39; 95 % CI 0·27, 0·59) were associated with a decreased PC likelihood. In contrast, a higher MP intake (ORT3 v. T1 = 2·32; 95 % CI 1·67, 3·23) increased PC likelihood. The possible differential and synergistic anticarcinogenic role of flavonoid compounds in PC deserves further study.

Health Benefits of Plant-Derived Sulfur Compounds, Glucosinolates, and Organosulfur Compounds

The broad spectrum of the mechanism of action of immune-boosting natural compounds as well as the complex nature of the food matrices make researching the health benefits of various food products a complicated task. Moreover, many routes are involved in the action of most natural compounds that lead to the inhibition of chronic inflammation, which results in a decrease in the ability to remove a pathogen asymptomatically and is connected to various pathological events, such as cancer. A number of cancers have been associated with inflammatory processes. The current review strives to answer the question of whether plant-derived sulfur compounds could be beneficial in cancer prevention and therapy. This review focuses on the two main sources of natural sulfur compounds: alliaceous and cruciferous vegetables. Through the presentation of scientific data which deal with the study of the chosen compounds in cancer (cell lines, animal models, and human studies), the discussion of food processing’s influence on immune-boosting food content is presented. Additionally, it is demonstrated that there is still a need to precisely demonstrate the bioavailability of sulfur-containing compounds from various types of functional food, since the inappropriate preparation of vegetables can significantly reduce the content of beneficial sulfur compounds. Additionally, there is an urgent need to carry out more epidemiological studies to reveal the benefits of several natural compounds in cancer prevention and therapy.

Onion and Garlic Intake and Breast Cancer, a Case-Control Study in Puerto Rico

Studies show an inverse association between onion and garlic intake and risk of cancers of the lung, prostate, and stomach. There is limited evidence on the association between onion and garlic intake and breast cancer. We assessed this association in a population-based, case-control study in Puerto Rico. Incident, primary breast cancer cases (n = 314) were identified among women aged 30-79 from hospital and clinic records. Controls (n = 346) were women with no history of cancer other than nonmelanoma skin cancer, residents of the same area. Dietary intake was estimated using a food frequency questionnaire. Total onion and garlic intake included sofrito (a popular garlic- and onion-based condiment) intake frequency. Unconditional logistic regression assessed the association between onion and garlic consumption and breast cancer adjusting for age, education, parity, family history, body mass index, age at menarche, total energy, and smoking. Inverse associations with breast cancer were observed for moderate (OR (odds ratio) = 0.59, 95% CI (confidence interval): 0.35, 1.01) and high consumption (OR = 0.51, 95% CI: 0.30, 0.87) compared to low consumption of onion and garlic (P_trend = 0.02). Results were similar when stratified by menopausal status. Study results suggest that high onion and garlic consumption is protective against breast cancer in this population.

Apple intake and cancer risk: a systematic review and meta-analysis of observational studies

OBJECTIVE

Conflicting results on the association between fruit consumption and cancer risk have been reported. Little is known about the cancer preventive effects of different fruit types. The present meta-analysis investigates whether an association exists between apple intake and cancer risk.

DESIGN

Relevant observational studies were identified by literature search (PubMed, Web of Science and Embase). A random-effect model was used to estimate the cancer risk in different anatomical sites. Between-study heterogeneity and publication bias were assessed using adequate statistical tests.

RESULTS

Twenty case-control (three on lung, five on colorectal, five on breast, two on oesophageal, three on oral cavity, two on prostate and one each on pancreas, bladder, larynx, ovary, kidney and brain cancer) and twenty-one cohort (seven on lung, two on colorectal, three on breast and one each on oesophageal, pancreas, bladder, kidney, endometrial, head-neck, urothelial and stomach cancer) studies met the inclusion criteria. Comparing the highest v. lowest level of apple consumption, the reduction of lung cancer risk was statistically highly significant in both case-control (OR=0·75; 95% CI 0·63, 0·88; P=0·001, I 2=0 %) and cohort studies (relative risk=0·89; 95% CI 0·84, 0·94; P<0·001, I 2=53 %). Instead, in the case of colorectal (OR=0·66; 95% CI 0·54, 0·81; P<0·001, I 2=55%), breast (OR=0·79; 95% CI 0·73, 0·87; P<0·001, I 2=1 %) and overall digestive tract (OR=0·50; 95% CI 0·36, 0·69; P<0·001, I 2=90 %) cancers a significant preventive effect of apples was found only in case-control studies while prospective studies indicated no effect. No evidence of publication bias could be detected for colorectal, oral cavity, oesophageal and breast cancer. However, some confounding effects may be present and related to the consumption of other fruit which have not been considered as adjusting factors.

CONCLUSIONS

The present meta-analysis indicates that consumption of apples is associated with a reduced risk of cancer in different anatomical sites.

Tea, coffee, and milk consumption and colorectal cancer risk

BACKGROUND

Data regarding the effects of tea, coffee, and milk on the risk of colorectal cancer are inconsistent. We investigated associations of tea, coffee, and milk consumption with colorectal cancer risk and attempted to determine if these exposures were differentially associated with the risks of proximal colon, distal colon, and rectal cancers.

METHODS

Data from 854 incident cases and 948 controls were analyzed in a case-control study of colorectal cancer in Western Australia during 2005-07. Multivariable logistic regression was used to analyze the associations of black tea (with and without milk), green tea, herbal tea, hot coffee, iced coffee, and milk with colorectal cancer.

RESULTS

Consumption of 1 or more cups of herbal tea per week was associated with a significantly decreased risk of distal colon cancer (adjusted odds ratio, 0.37; 95% CI, 0.16-0.82; PTrend = 0.044), and consumption of 1 or more cups of iced coffee per week was associated with increased risk of rectal cancer (adjusted odds ratio, 1.52; 95% CI, 0.91-2.54; PTrend = 0.004). Neither herbal tea nor iced coffee was associated with the risk of proximal colon cancer. Hot coffee was associated with a possible increased risk of distal colon cancer. Black tea (with or without milk), green tea, decaffeinated coffee, and milk were not significantly associated with colorectal cancer risk.

CONCLUSIONS

Consumption of herbal tea was associated with reduced risk of distal colon cancer, and consumption of iced coffee was associated with increased rectal cancer risk.

Effects of photoperiod and food restriction on the reproductive physiology of female California mice

Many temperate-zone animals use changes in photoperiod to time breeding. Shorter term cues, like food availability, are integrated with photoperiod to adjust reproductive timing under unexpected conditions. Many mice of the genus Peromyscus breed in the summer. California mice (Peromyscus californicus), however, can breed year round, but tend to begin breeding in the winter. Glial cells may be involved in transduction of environmental signals that regulate gonadotrophin releasing hormone I (GnRH) activity. We examined the effects of diet and photoperiod on reproduction in female California mice. Mice placed on either short days (8L:16D) or long days (16L:8D) were food restricted (80% of normal intake) or fed ad libitum. Short day-food restricted mice showed significant regression of the reproductive system. GnRH-immunoreactivity was increased in the tuberal hypothalamus of long day-food restricted mice. This may be associated with the sparing effect long days have when mice are food restricted. The number of GFAP-immunoreactive fibers in proximity to GnRH nerve terminals correlated negatively with uterine size in ad libitum but not food restricted mice, suggesting diet may alter glial regulation of the reproductive axis. There was a trend towards food restriction increasing uterine expression of c-fos mRNA, an estrogen dependent gene. Similar to other seasonally breeding rodents, short days render the reproductive system of female California mice more susceptible to effects of food restriction. This may be vestigial, or it may have evolved to mitigate consequences of unexpectedly poor winter food supplies.

Urinary polyphenols and breast cancer risk: results from the Shanghai Women's Health Study

Polyphenols, the most abundant dietary antioxidants, also possess many other anticarcinogenic activities. Urinary metabolites of polyphenols could complement dietary assessment of the bioavailability of these nutrients. We conducted a study of 353 incident breast cancer cases and 701 individually matched controls nested within the Shanghai Women's Health Study cohort of women aged 40-70 years at baseline. Liquid chromatography photo-diode array electrospray mass spectrometry was used to measure tea polyphenols (epicatechin, epigallocatechin, and their metabolites) and flavonols (e.g., quercetin and kaempferol). Multivariate conditional logistic regression analyses were used to assess associations between breast cancer risk and urinary excretion rates of polyphenols. Urinary excretion of tea polyphenols increased with increasing tea leaves consumed among controls, but not among breast cancer cases. Compared with cases, controls had higher levels of urinary total polyphenols and tea polyphenols, particularly epicatechin. In contrast, we did not find any dose-response relationship between urinary polyphenols and breast cancer risk. Urinary excretion of epicatechin was inversely associated with breast cancer risk [odds ratio (OR) and 95% confidence interval (CI) of 0.59 (0.39-0.88) for the intermediate tertile]. In spline regression, we found an overall dose-response relationship between epicatechin level and risk of breast cancer, although it was not apparent in low and middle urinary excretion range. In conclusion, high epicatechin may be related to a reduced risk of breast cancer. Further studies are warranted to confirm our findings.

Dietary consumption of phytochemicals and breast cancer risk in Mexican women

Objective

To perform an evaluation of selected phytochemicals intake and breast cancer (BC) risk in Mexican women.

Design

We conducted hospital-based case–control study.

Setting

Mexico City between 1994 and 1996.

Subjects

A total of 141 histologically confirmed BC cases were age-matched (±3 years) to an equal number of hospital controls. The reproductive history of each woman was obtained by direct interview. The dietary consumption of flavonols, flavones, flavan-3-ols, cinnamic acid, lariciresinol, pinoresinol, secoisolariciresinol, matairesinol and coumestrol was obtained by means of a validated FFQ.

Results

Among postmenopausal women, high dietary intake of flavonols and flavones was associated with a significant reduction of BC risk (high v. low tertile: OR = 0·21, 95 % CI 0·07, 0·60, P for trend = 0·004 and OR = 0·29, 95 % CI 0·10, 0·82, P for trend = 0·025, respectively); consumption of lignans (lariciresinol and pinoresinol) showed a similar effect, but only among premenopausal women (high v. low tertile: OR = 0·32, 95 % CI 0·10, 0·99, P for trend = 0·051 and OR = 0·19, 95 % CI 0·06, 0·62, P for trend = 0·006, respectively).

Conclusions

Our results support a protective role of specific dietary phytochemicals in BC risk by menopausal status, independent of other reproductive factors.

Nutritional factors and breast cancer in Mexico

Breast cancer (BC) morbidity and mortality in Mexico are on the rise, affecting younger women with more frequency. Nutritional factors are often mentioned as determinants of BC but their relevance is not well established in Latin-American countries, where dietary habits show great variation. From a study population previously assembled in Mexico City, 141 histologically confirmed cases of BC were matched by age (+/-3 yr) to an equal number of hospital controls. A food frequency questionnaire was administered to all subjects and the risk of BC was estimated in relation to the intake of selected nutrients. The findings of this study show a protective effect against BC due to a high intake of polyunsaturated fat (odds ratio, OR = 0.10, 95% CI = 0.02-0.40, P for trend = 0.001) and vitamin E (OR = 0.10, 95% CI = 0.02-0.44, P for trend = 0.003) among postmenopausal women. In addition, our findings also suggest that a high intake of total fiber (OR = 0.29, 95% CI = 0.08-1.10, P for trend = 0.080) and carotenes (OR = 0.42, 95% CI = 0.16-1.14, P for trend = 0.088) lowers BC risk among premenopausal women. The relationship between the intake of nutrients and BC risk needs further confirmation.

Exercise and Estrogen or Estrogen Alternatives (Phytoestrogens, Bisphosphonates) for Preservation of Bone Mineral in Postmenopausal Women

Research in animal models indicates that without estrogen, the effectiveness of exercise for increasing bone mineral in females is reduced. With decreased estrogen levels, there is an increase in the threshold at which strains are detected by bone, in turn reducing the transmission of mechanical to biochemical signals for bone formation. Studies combining estrogen replacement and exercise training in postmenopausal women have yielded mixed results but indicate that the combination of interventions may be more effective than either intervention alone for increasing bone mass. Given the continued debate over the risks and benefits of estrogen replacement, other compounds such as bisphosphonates or phytoestrogens may be preferred in combination with exercise training for optimally increasing bone mass and preventing osteoporotic fracture. Studies on animals show that the combination of bisphosphonate or phytoestrogen supplementation with exercise training is effective, but trials in humans are lacking. Key words: osteoporosis, hormone replacement therapy, bisphosphonates, phytoestrogens, isoflavones

A Natural Antioxidant Mixture from Spinach Does Not Have Estrogenic or Antiestrogenic Activity in Immature CD-1 Mice

The use of natural antioxidants and flavonoids in nutritional and pharmaceutical applications is increasing. Because some phytochemicals such as genistein, found in soy products, have estrogenic activity, we investigated the estrogenic potential of a natural antioxidant mixture (NAO) isolated from spinach leaves, using an in vivo uterotrophic bioassay and an in vitro transcriptional activation assay for the estrogen receptor (ER). Outbred female CD-1 mice (17 d old) were given subcutaneous injections of 17beta-estradiol or genistein [500 and 500,000 microg /(kg x d), respectively] as positive controls or NAO [1000 to 1,000,000 microg/(kg x d)] for 3 d. Uterine wet weight/body weight ratios were determined. Both 17beta-estradiol and genistein significantly increased uterine wet weight ratios compared with untreated controls, but NAO did not. Histological examination of the uterus showed that 17beta-estradiol and genistein increased epithelial cell height, number and gland development, but NAO did not. Estrogenic activity of NAO was investigated in vitro using the ER transcriptional activation assay. BG1Luc4E2 cells expressing ER were stably transfected with a luciferase reporter gene responsive to estrogens. 17beta-estradiol dose dependently increased luciferase activity; NAO had no effect. When NAO was tested for antiestrogenic activity, it did not lessen the effects of 17beta-estradiol. These data suggest that NAO does not have estrogenic or antiestrogenic activity. Thus, an antioxidant mixture has been identified that does not have potentially adverse estrogenic activity.

Phytoœstrogènes chez la femme ménopausée

Many women seek alternatives to hormone replacement therapy (HRT). Phytoestrogens are nonsteroidal compounds with estrogenic or antiestrogenic properties. Six of the 16 clinical trials suggest a significant reduction in alleviating symptoms but to a lesser degree than HRT. A meta-analysis showed that phytoestrogens improve lipid profile. The 14 recent clinical trials led, however, to divergent findings. Small clinical trials suggested a protective effect of phytoestrogens on bone metabolism. High concentration of phytoestrogens was associated with a reduction in breast cancer risk in case-control studies.

Composition, Efficacy, and Safety of Spinach Extracts

Spinach leaves, containing several active components, including flavonoids, exhibit antioxidative, antiproliferative, and antiinflammatory properties in biological systems. Spinach extracts have been demonstrated to exert numerous beneficial effects, such as chemo- and central nervous system protection and anticancer and antiaging functions. In this review article, we present a compilation of data generated in our laboratories and those of other investigators describing the chemical composition of spinach, its beneficial effects, relative safety information, and its recommended inclusion in the human diet. A powerful, water-soluble, natural antioxidant mixture (NAO), which specifically inhibits the lipoxygenase enzyme, was isolated from spinach leaves. The antioxidative activity of NAO has been compared to that of other known antioxidants and found to be superior in vitro and in vivo to that of green tea, N-acetylcysteine (NAC), butylated hydroxytoluene (BHT), and vitamin E. NAO has been tested for safety and is well tolerated in several species, such as mouse, rat, and rabbit. NAO has been found to be nonmutagenic and has shown promising anticarcinogenic effects in a few experimental models, such as skin and prostate cancer; it has not shown any target-organ toxicity or side effects. The current review provides epidemiological and preclinical data supporting the efficacy of extracts of spinach and the safety of its consumption.

Dietary and reproductive factors associated with benign breast disease in Mexican women

Benign breast disease (BBD) is common in women in the reproductive age group. The results of epidemiological studies that have examined the relationship between diet and BBD are controversial and scarce. The aim of the present study was to identify and evaluate the impact of dietary and reproductive risk factors in the development of BBD in Mexican women. Between 1994 and 1996, 121 women with BBD and 121 age-matched (+/- 3 yr) clinical controls with non-breast-related diseases were identified. The study population was directly interviewed about their reproductive history, and a semiquantitative food frequency questionnaire was used to obtain dietary information. The population was originally identified as part of a hospital-based case-control study examining exposure to 1,1-bis(p-chlorophenyl)-2,2,2-trichloroethane and breast cancer. A significant reduction in the risk of BBD was observed when comparing the upper with the lower tertiles of consumption of citrus fruit [odds ratio (OR) = 0.43, 95% confidence interval (CI) = 0.21-0.88], non-citrus fruit (OR = 0.35, 95% CI = 0.16-0.76), diary products (OR = 0.36, 95% CI = 0.18-0.75), and food sources of lignans (OR = 0.48, 95% CI = 0.24-0.98). A marginally significant reduction in the risk of BBD associated with the consumption of vitamin B-12 (OR = 0.48, 95% CI = 0.23-1.02) was also observed. Our results add new information about the role of diet in the etiology of BBD.

Phytoestrogen and breast cancer prevention

The incidence rate of breast cancer varies worldwide, with the rate of Japanese and other Asian women only being a third to a half of that for Caucasian women. Recent research has suggested that consumption of phytoestrogen-rich foods may reduce breast-cancer risk. Most epidemiologic studies have involved Asian populations and some studies have shown a substantial reduction in breast-cancer risk (17-73%) in these populations. These results were also observed in countries where the level of consumption of traditional soy foods is low.

Phytoestrogens as modulators of steroid action in target cells

Although numerous reports exist on the potential beneficial role of nutritional phytoestrogens in human health, their molecular mechanism in target cells is still not completely understood. Phytoestrogens promote estrogen and antiestrogen effects by interacting with numerous molecules, carrier proteins, enzymes and membrane and nuclear receptors, directly or indirectly involved in the transfer of estrogen signals. The hypothesis that the ER beta subtype plays a key role in antiproliferative effect of phytoestrogens, especially in breast cancer, is examined here. This review focus on the effects of phytoestrogens in developmental processes such as those linked to reproductive function, tumorigenesis and angiogenesis.

Liquid chromatographic-photodiode array mass spectrometric analysis of dietary phytoestrogens from human urine and blood

Dietary phytoestrogens have been implicated in the prevention of chronic diseases. However, it is uncertain whether the phytoestrogens or the foods associated with phytoestrogens account for the observed effects. We report here a new liquid chromatography photodiode array mass spectrometry (LC-PDA-MS) assay for the determination of nanomolar amounts of the most prominent dietary phytoestrogens (genistein, dihydrogenistein, daidzein, dihydrodaidzein, glycitein, O-desmethylangolensin, hesperetin, naringenin, quercetin, enterodiol, enterolactone) in human plasma or serum and urine. This assay was found to be suitable for the assessment of quercetin exposure in an onion intervention study by measuring urinary quercetin levels. Other successful applications of this assay in clinical and epidemiologic studies validated the developed method and confirmed previous results on the negative association between urinary isoflavone excretion and breast cancer risk.