Dairy Consumption and the Prevalence of

Reproductive Cancers
Kristen Ellis
November 11, 2014

Abstract
Humans have been consuming dairy milk for generations. Lactase persistence, the
ability to break down lactose, is a trait that very few mammals have. Recent studies indicate
that consuming dairy milk may have adverse affects on human health. Specifically, research
has found a correlation between dairy milk consumption and reproductive cancers, such as
prostate and ovarian cancers. In a study done by Chan et al. found a strong correlation
between risk of prostate cancer and consumption of dairy calcium. Men in the highest
categories of dairy and calcium intakes had a 30% greater risk of prostate cancer that those
who had the lowest consumption. For each 500mg increase of dairy calcium, there was a
16% increased risk in prostate cancer. The researchers also found a significant positive
correlation between prostate cancer and consumption of skim milk. Calcium was
significantly inversely associated with the concentration of 1,25-dihydroxyvitaminD3. This
compound is thought to protect the prostate against cancer. Cramer assessed the
connection between lactase persistence and milk consumption as a determinant of ovarian
cancer risk. There was a significant positive correlation (p = .004) between cumulative
incidence of ovarian cancer and the per capita supply of milk. Cramer discovered that for
each 100g increase in daily per capita supply of fluid milk, there is a net increase of .14% in
the incidence of ovarian cancer. An even stronger correlation was noted between ovarian
cancer and lactase persistence (p= .0002). Larsson et al. evaluated the connection between
milk and lactose intakes and ovarian cancer risk in the Swedish mammography cohort.
Women who consumed 4 servings/d of dairy had a significantly higher risk (p=.02) of
ovarian cancer than women who consumed 2 servings/d. Intakes of lactose and dairy
products were positively associated with the risk of serous ovarian cancer. Moreover, women
who consumed glass of milk a day had double the risk of serous ovarian cancer compared

to women who never or seldom drank milk. These three studies support the hypothesis that
diary consumption is associated with a higher risk of prostate and ovarian cancers.

Introduction
Humans have been consuming dairy for thousands of years. The USDA
recommends that people consume 3 cups of low-fat or fat free dairy a day to promote strong
bones and teeth through consumption of calcium. Calcium is a necessary part of bone
health, though findings suggest that there is no benefit to receiving more that 600mg of
calcium per day; an amount easily found in non-dairy products [3]. A recent study on stress
fractures in adolescent girls found that consumption of dairy products and calcium did not
prevent stress fractures. Alternative ways of receiving calcium other than dairy products may
be beneficial since links between some cancers and consumption of dairy have been found,
especially those of the reproductive system. Reasons for this are uncertain, but there are
speculations that it could be insulin-like growth factor in the milk, lactose, or calcium
specifically from dairy that could cause these complications.
Strong arguments against dairy consumption include the fact that lactose intolerance
is prevalent among humans. 95% of Asian-Americans, 74% of Native Americans, 70% of
African-Americans, 53% of Mexican-Americans, and 15% of Caucasians are lactose
intolerant [3]. Most nursing infants have the ability to break down lactose, but lose it as they
age [8]. Humans are the only mammals that consume milk from other mammals. So, why
would we consume dairy? Dairy is a good source of calcium, magnesium, and phosphorus,
which is believed to strengthen bones and teeth [4]. Some studies suggest dairy consumption
could be linked to lower blood pressure, and a reduced risk of cardiovascular disease. High

amounts of calcium may reduce bad cholesterol, type II diabetes and even some cancers,
although research is still unclear.
Review of Research Studies
Chan, J. M., Stampfer, M. J., Ma, J., Gann, P. H., Gaziano, J. M., & Giovannucci, E.
L. (2001). Dairy products, calcium, and prostate cancer risk in the Physicians' Health
Study. The American journal of clinical nutrition, 74(4), 549-554.
The purpose of this study was to examine the connection between dairy and calcium
consumption and the risk of prostate cancer. Specifically, if the consumption of dairy
negatively affects the production of 1,25-dihydroxyvitaminD3; a vitamin thought to protect
against prostate cancer. The Physicians Health Study began in 1982, where they considered
aspirin and -carotene intake among 22,071 U.S. male physicians. There were annual
follow-up questionnaires through December of 1995. For the intentions of studying dairy
products and prostate cancer risk, only 20,885 men were used. At 18 weeks and 24 months,
men reported on cold breakfast cereal, whole milk and skim milk consumption. At 12
months, they reported on cheese and ice cream intake. After considering those five main
foods, a dietary score was created to represent servings of dairy products per day.
The results of the study found that men in the highest categories of dairy and
calcium intakes had a statistically significant increase by 30% in the risk of prostate cancer
than those in the lowest consumption group. For each 500mg increase in the intake of dairy
calcium showed a 16% increase in the risk of prostate cancer (p= 0.03). Skim milk, which
accounted for 48% of total dairy consumption, was associated with a significant, positive
correlation to prostate cancer risk; possibly, because skim milk contains more calcium than
any other dairy item.

Figure 1: Men who consumed greater than 2.5 servings of dairy a day had a
significantly higher risk of prostate cancer (p=.04). Likewise, men who consumed
more than 600mg of dairy calcium also had a significantly higher risk for prostate
cancer (p=0.02).

Calcium specifically from dairy was significantly, inversely associated with concentrations of
1,25-dihydroxyvitaminD3. For each 300mg increase in total dairy calcium consumption,
concentrations of 1,25-dihydroxyvitaminD3 decreased by 2pmol/L. Decrease in 1,25dihydroxyvitaminD3 was stronger when the dairy consumed was skim milk.
These results were consistent with results from other studies supporting the
hypothesis that intake of dairy products and dairy calcium are positively associated with an
increased risk of prostate cancer and a decrease in serum 1,25-dihydroxyvitaminD3. This
positive association for dairy calcium remained even after an adjustment of the total food
score.

This study were that it used a very large sample size of 20,885 men. Confounding
variables, such as age, were removed so the results could be clear and unbiased. The food
intake questionnaire was also very comprehensive for intake of dairy, even including
consumption of dairy products for cold cereal. Unfortunately, the questionnaires were not
comprehensive for total energy intake, so they could not adjust for total energy directly.
Although, this became less pertinent when they discovered that it would not affect the
results. Overall, the questionnaire did not provide information on total fat or protein intake
as potential confounding variables. The results could have also included graphs to have a
visual representation of the results.
CRAMER, D. W. (1989). Lactase persistence and milk consumption as determinants
of ovarian cancer risk. American journal of epidemiology, 130(5), 904-910.
The purpose of this study was to compare the incidence of ovarian cancer related to
per capita milk consumption and estimates of lactase persistence, which is the ability to
digest lactose after infancy. Researchers collected already existing data on ovarian cancer
incidence, percent of lactase-persistent adults and per capita milk consumption and animal
fat (from nondairy sources). Lactase persistence was evaluated through jejunal biopsies, on
hospitalized patients, and serial blood galactose or glucose determinations after an oral
lactose load for non-hospitalized participants. Food consumption was determined from food
balance sheets published by the United Nations.
Results of the study show a significant positive correlation between cumulative
incidence of ovarian cancer, per capita supply of milk, and percentage of population with
lactase persistence (Figure 2). In Figure 2, Senegal and New Zealand appear to be outliers.
Senegal shows a 65% lactase persistence, but only a .38% incidence of ovarian cancer. New
Zealand inversely shows a only a 36% lactase persistence but a 1.37% incidence of ovarian

cancer. When lactase persistence and ovarian cancer are graphed, these two countries are no
longer outliers. This suggests that a multiple regression model for ovarian cancer incidence
with lactase persistence and milk consumption would be necessary to explain this
relationship. A significant positive correlation between cumulative incidence of ovarian
cancer and the per capita supply of milk (p=.004). Each 100g increase in the dairy per capita
supply of fluid milk resulted in a .14% increase in the cumulative incidence of ovarian cancer
(Figure 3).

Figure 2: Cumulative incidence of ovarian cancer, per capita supply of milk, and
percentage of population with lactase persistence in 32 countries. Almost all countries
showed positive correlations between cumulative incidence of ovarian cancer, per
capita milk supply and percentage with lactase persistence.

Figure 3: Per capita milk supply and risk of ovarian cancer were
significantly positively correlated (p=.004).

An even stronger correlation was noted between cumulative incidence of ovarian cancer and
lactase persistence (p=.0002).

Figure 4: Percent lactase persistence and lifetime risk of ovarian cancer

had a positive correlation (p= .0002).

This study used a large, overarching sample from many countries throughout the world,
reducing bias. The results also included a lot of graphs, which made the large amounts of
data very clear. Still, there are possible inaccuracies in data since they are using many
different sources, and may contain unknown confounding variables. Lactase persistence was
found though many different techniques, which could alter results. There was also no direct

link of consumption of dairy and incidence of ovarian cancer. The study looked at overall
dairy consumption and overall incidence of ovarian cancer. This means that we do not know
if the people who were consuming the most dairy were the ones with the highest incidence
of ovarian cancer.
Larsson, S. C., Bergkvist, L., & Wolk, A. (2004). Milk and lactose intakes and
ovarian cancer risk in the Swedish Mammography Cohort. The American journal of
clinical nutrition, 80(5), 1353-1357.
This study examined the association between consumption of dairy products and
lactose and risk of epithelial ovarian caners. They hypothesized that consumption of milk,
and other dairy products, may increase incidence and mortality of ovarian cancers. 61,084
women age 38-76 years old were used for the study. The women filled out a food-frequency
questionnaire of 67 different food items, that included 8 specific diary items/ These items
were: low-fat, medium-fat, and whole milk, low-fat and regular (3%) yogurt, cheese, ice
cream, and butter. Women were divided into groups based on diary and lactose
consumption. The groups were <2 servings/d, 2-<3 servings/d, 3-<4 servings/d, and 4
servings/d. Women who consumed 4 servings/d of dairy had a significantly higher risk
(p=.02) of ovarian cancer than women who consumed 2servings/d (Figure 5). Results
were not significantly altered by family history of breast cancer, reproductive factors or
postmenopausal hormone use.

Figure 5: Invasive epithelial ovarian cancer in relation to consumption of dairy products.

Milk consumption showed the strongest positive association to serous ovarian cancer
risk than any other dairy products. One glass of milk a day (low-fat and whole) corresponded
to increased risk of serous ovarian cancer. Yogurt also showed a positive correlation to
serous ovarian cancer, but results were nonsignificant. Cheese, butter, and ice cream were
not associated with risk of any type of ovarian cancer.
Lactose intake also showed a positive, linear association to the risk of serous ovarian
cancer (p=.006), presented in Figure 6. Each 10g/d increase in lactose consumption (roughly
1 glass of milk) was associated with a 20% greater risk of serous ovarian cancer. Women
who consumed >15g/d of lactose (~1-2 glasses of milk) were more than twice as likely to
develop serous ovarian caner than women who consumed <2.5g/d (3-4 tbsp.) of milk.
Observed positive association between total milk consumption and the risk of serous
ovarian cancer was mostly related to lactose intake.

Figure 6: Multivariate rate ratios for invasive serous epithelial ovarian caner and
lactose intake. Values were adjusted for age (5-y categories), BMI, education level,
number of children, oral contraceptive use and fruit, vegetable and energy intakes.
Median lactose intake for reference group (diamonds) was 20g/d which is ~2 glasses
milk/d

Intakes of lactose and dairy products, especially milk, were significantly, positively
associated with the risk of serous ovarian cancer. Women who consumed 1 glass of milk/d
had double the risk of serous ovarian cancer compared to women who never to seldom
drank milk.
This study included a large population of women (N=61,084) and addressed the
different types of ovarian cancer. The food frequency questionnaire was very inclusive for
dairy products, and the researchers adjusted for confounding factors such as age, family
history, oral contraceptive use, etc. Although there were unaccounted for variables that were
not measured, potential dietary and lifestyle confounding factors did not affect the results.
One of the problems with this study was that it was an observational study, meaning it
cannot account for unknown confounding factors that were not measured in the

questionnaire. The study also only included women from Sweden, which could possibly have
genetic factors that would affect the incidence of ovarian cancer rates.

Conclusion
Study #1 studied the relationship between milk consumption and prostate cancer,
looking specifically at dairy calcium consumption and its affect on 1,25-dihydroxyvitaminD3.
The results showed men who consumed the most dairy had the highest risk of prostate
cancer. Study #2 looked at lactase persistence and ovarian cancer, showing a strong
correlation between milk supply per capita and incidence of ovarian cancer; stronger
correlations were documented for lactase persistence and ovarian cancer incidence. Study #3
found a positive association between intake of milk and lactose and the risk of serous
ovarian cancer. All three of these studies support my hypothesis that diary consumption is
linked to reproductive cancers.

Further Research
There is much more research that needs to be done to determine what the
connection between dairy consumption and reproductive cancers exactly is. One idea would
be to look at high consumption of calcium and the incidence of ovarian cancer. The first
study looked at dairy calcium consumption and prostate cancer, but did not consider the
effects on ovaries. There was also no mention of the differing effects of raw milk vs.
pasteurized milk for incidence of reproductive cancers. Connecting to the second study, is it
simply being lactase persistent that leads to a higher incidence of ovarian cancer or are those
people simply consuming more dairy? Lastly, is there an effect of whole milk vs. skim milk
on incidence of cancers? Findings in these studies suggest that skim milk was connected to
the highest incidences of reproductive cancers, but there are other studies which suggest that

consumption of whole milk after diagnosis of prostate cancer is related to a higher mortality
[9]

. If there is a link between mortality and high fat dairy milk consumption after a diagnosis,

is there a correlation before diagnosis?

References
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L. (2001). Dairy products, calcium, and prostate cancer risk in the Physicians' Health
Study. The American journal of clinical nutrition, 74(4), 549-554.
2. Cramer, D. W. (1989). Lactase persistence and milk consumption as determinants of
ovarian cancer risk. American journal of epidemiology, 130(5), 904-910.
3. Health Concerns about Dairy Products. (n.d.). Retrieved October 30, 2014, from
http://www.pcrm.org/health/diets/vegdiets/health-concerns-about-dairy-products
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http://www.milk.co.uk/page.aspx?intPageID=73
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cancer risk in the Swedish Mammography Cohort. The American journal of clinical
nutrition, 80(5), 1353-1357.
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9. Song, Y., Chavarro, J. E., Cao, Y., Qiu, W., Mucci, L., Sesso, H. D., ... & Ma, J.
(2013). Whole milk intake is associated with prostate cancer-specific mortality among
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