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Emily Sonestedt

Emily Sonestedt

Associate senior lecturer

Emily Sonestedt

Enterolactone is differently associated with estrogen receptor beta-negative and -positive breast cancer in a Swedish nested case-control study


  • Emily Sonestedt
  • Signe Borgquist
  • Ulrika Ericson
  • Bo Gullberg
  • Håkan Olsson
  • Herman Adlercreutz
  • Göran Landberg
  • Elisabet Wirfält

Summary, in English

BACKGROUND: Differences in the estrogen receptor (ER) status of tumors may explain ambiguities in epidemiologic studies between the blood concentrations of enterolactone and breast cancer. To our knowledge, the association between enterolactone and ERbeta-defined breast cancer has previously not been examined.

METHODS: A nested case-control study within the Malmö Diet and Cancer cohort used 366 cases and 733 matched controls to identify the major determinants of plasma enterolactone and to examine the association between enterolactone concentration and breast cancer risk and if this association differs depending on the ERalpha and ERbeta status of tumors. A modified diet history method assessed dietary habits. Time-resolved fluoroimmunoassay determined enterolactone concentrations and immunohistochemistry using tissue microarray determined ER status.

RESULTS: Dietary fiber, as well as fruits and berries, and high-fiber bread showed statistically significant correlations with enterolactone (r, 0.13-0.22). Smoking and obesity were associated with lower enterolactone concentrations. Enterolactone concentrations above the median (16 nmol/L) were associated with reduced breast cancer risk when compared with those below [odds ratio, 0.75; 95% confidence interval (95% CI), 0.58-0.98]. The reduced risk was only observed for ERalpha [positive (+); odds ratio, 0.73; 95% CI, 0.55-0.97] and ERbeta [negative (-)] tumors (odds ratio, 0.60; 95% CI, 0.42-0.84), with significantly different risks for ERbeta (-) and ERbeta (+) tumors (P for heterogeneity = 0.04).

CONCLUSIONS: This study supports the suggestion that enterolactone is a biomarker of a healthy lifestyle. The protective association between enterolactone and breast cancer was significantly different between ERbeta (-) and ERbeta (+) tumors and most evident in tumors that express ERalpha but not ERbeta.


  • Nutrition Epidemiology
  • Diabetes - Cardiovascular Disease
  • Tumor microenvironment
  • Medical oncology
  • Lund Melanoma Study Group
  • Pathology, Malmö

Publishing year







Cancer Epidemiology Biomarkers & Prevention





Document type

Journal article


American Association for Cancer Research


  • Cancer and Oncology


  • 4-Butyrolactone
  • Adult
  • Aged
  • Biomarkers, Tumor
  • Breast Neoplasms
  • Case-Control Studies
  • Diet
  • Estrogen Receptor alpha
  • Estrogen Receptor beta
  • Female
  • Humans
  • Lignans
  • Linear Models
  • Microarray Analysis
  • Middle Aged
  • Obesity
  • Prospective Studies
  • Reproducibility of Results
  • Risk Assessment
  • Smoking
  • Surveys and Questionnaires
  • Sweden



Research group

  • Nutrition Epidemiology
  • Diabetes - Cardiovascular Disease
  • Lund Melanoma Study Group
  • Pathology, Malmö


  • ISSN: 1538-7755