Well-done Red Meat and Breast Cancer Risk
Abstract & Commentary
Synopsis: Exposure to heterocyclic amines (or other compounds) formed during high-temperature meat cooking may play an important role in the risk of breast cancer.
Source: Zheng W, et al. J Natl Cancer Inst 1998;90: 1724-1729.
Heterocyclic amines, mutagens formed in meats cooked at high temperatures, have been demonstrated as mammary carcinogens in animals. A nested, case-control study among 41,386 cohort members of the Iowa Women’s Health Study evaluated the potential role of heterocyclic amines and intake of well-done meat in the risk for human breast cancer.
A questionnaire was mailed to individuals who had breast cancer diagnosed during the period from 1992 through 1994 and a random sample of cancer-free cohort members to obtain information on usual intake of meats and on meat preparation practices. Color photographs showing various doneness levels of hamburger, beef steak, and bacon were included. Multivariate analysis was performed on data from 273 case subjects and 657 control subjects who completed the survey.
A dose-response relationship was found between doneness of meat consumed and breast cancer risk. The adjusted odds ratios (ORs) for very well-done meat vs. rare or medium-done meat were 1.54 (95% confidence interval CI 0.96-2.47) for hamburger; 2.21 (95% CI 1.30-3.77) for beef steak; and 1.64 (95% CI 0.92-2.93) for bacon. Women who consumed these three meats consistently very well-done had a 4.62 times higher risk (95% CI 1.36-15.70) than that of women who consumed the meats rare or medium. Risk of breast cancer was also elevated with increasing intake of well-done to very well-done meat.
Consumption of well-done meats, and thus, exposure to heterocyclic amines (or other compounds) formed during high temperature meat cooking, may play an important role in the risk of breast cancer.
Comment by John La Puma, MD, facp
Put another brat on the fire! Here in Chicago, you can hear the backyard grillmeister next door man the tongs, shift the coals, and swear at the cat nearly every weekend and most weeknights. The grill is the one part of the kitchen in which most men feel truly at home, as it is usually not in the kitchen, but on the deck, in the backyard, by the shore, at the beach.
But what to do about the well-done crust, where evil lies? In this study, although frying, grilling, and barbecuing were only weakly correlated with the risk of breast cancer, well-doneness was highly correlated. And well-doneness can come from any of these cooking methods—plus roasting, deep frying, even sautéing.
This is strong, comprehensive, epidemiological case-control data. More than 41,000 Iowa women, aged 55-69, have been assessed for cancer risk and prevalence since they returned a mailed questionnaire in January 1986. No information was collected then about meat or its usual doneness, so the investigators performed a case-control study from 1995-1996. The investigators, from the Universities of Minnesota and Iowa and the National Cancer Institute, included chicken and fish with the definition of meat, but the correlation was with red meat.
Tell your patients who want to reduce their risk for breast cancer to cook or order their burgers and steak medium or rare, and to send them back or do it over if overdone. This is even more important than reducing red meat intake. If patients or the grillmeister want a good crust, use cracked spices (e.g., peppercorns or cumin seeds) and whole seeds (e.g., sesame or pumpkin) pressed into the meat. These will add extra flavor, so much so that you won’t miss the nearly burned char. (Dr. La Puma is Professor of Nutrition, Kendall College, Director, C.H.E.F. Clinic, C.H.E.F. Skills Research, Alexian Brothers Medical Center, Elk Grove Village, Ill.)
Which of the following is true regarding the correlation between doneness of meat and breast cancer?
a. No strong relationship was found.
b. A dose-response relationship was found.
c. A relationship was found with barbecuing but not frying.
d. A stronger relationship was found with beef than with pork.