Women's Intervention Nutrition Study (WINS): Randomized Study to Determine the Efficacy of Dietary Fat Reduction in Addition to Conventional Systemic Adjuvant Therapy in Postmenopausal Women Surgically Treated for Primary Invasive Breast Cancer. Note: The information about this trial has not been updated by the sponsor/principal investigator/lead organization. Cancer.gov cannot verify the accuracy of the information.

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Alternate Title

Nutrition Intervention in Treating Women With Breast Cancer. Note: The information about this trial has not been updated by the sponsor/principal investigator/lead organization. Cancer.gov cannot verify the accuracy of the information.

Basic Trial Information

PhaseTypeStatusAgeSponsorProtocol IDs
Phase IIITreatmentClosed48 to 78OtherAHF-WINS
MRMC-CTCA-9604, WINS-1, NCI-H94-0001, NCT00002564


I.  Determine whether dietary fat reduction will effectively prolong 
disease-free and overall survival in women surgically treated for early stage 
breast cancer who are receiving adjuvant therapy with or without either 
tamoxifen, cyclophosphamide, methotrexate, fluorouracil (CMF), doxorubicin, 
cyclophosphamide (AC), fluorouracil, doxorubicin, cyclophosphamide (FAC, CAF), 
or AC followed by paclitaxel. 

II.  Evaluate whether differences in the lipid profile are associated with 
dietary group assignment and dietary fat.

Entry Criteria

Disease Characteristics:

Histologically proven, invasive, localized carcinoma of the breast

Stage I/II/IIIA disease, i.e.:
 Tumor confined to breast on clinical examination
 Overlying skin movable with respect to tumor
 Tumor movable in relation to underlying muscle and chest wall
 Bone scan and/or x-ray required to rule out bone metastases in cases of
  skeletal pain

Tumor size requirements:
 No greater than 5 cm if lymph nodes are positive
 Greater than 1 cm if lymph nodes are negative

Tumor definitively treated by one of the following procedures:
 Total mastectomy with axillary node dissection
 Segmental mastectomy with or without axillary node dissection and/or sentinel 
  node biopsy followed by breast irradiation, provided:
   Surgical margins are histologically free of invasive or noninvasive tumor
 One additional resection allowed to obtain clear margins
  Total mastectomy required if clear margins are not obtained at second
The following conditions exclude:
 Bilateral malignancy or any mass in the contralateral breast unless proven
  nonmalignant by biopsy
 Palpable lymph nodes in the contralateral axilla or probable supraclavicular
  or infraclavicular nodal involvement unless proven nonmalignant by biopsy
 10 or more positive lymph nodes
 Inflammatory breast cancer
 Ulceration or erythema
 Infiltration of the skin or peau d'orange
  Tethering or dimpling of the skin or nipple inversion should not be
   considered skin infiltration
 Satellite breast nodules
 Parasternal nodules
 Edema of the arm

Hormone receptor status:
 Any estrogen receptor (ER) or progesterone receptor (PR) status allowed
  ER assessment required
  PR assessment recommended
Less than 365 days between definitive surgery and randomization

Prior/Concurrent Therapy:

No concurrent participation in another adjuvant breast cancer trial that has
disease-free or overall survival as a study endpoint (e.g., a major
cooperative group trial)

Biologic therapy:
 Not specified

 Concurrent adjuvant cyclophosphamide, methotrexate, fluorouracil (CMF), 
  doxorubicin, cyclophosphamide (AC), AC followed by paclitaxel, or
  fluorouracil/doxorubicin/cyclophosphamide (FAC, CAF) allowed
 If ER negative, approved chemotherapy regimen and/or tamoxifen required
 No more than 120 days between definitive surgery and initiation of
  adjuvant systemic chemotherapy

Endocrine therapy:
 Concurrent adjuvant tamoxifen required if ER positive (if ER negative,
  tamoxifen and/or an approved chemotherapy regimen required)
 No more than 180 days between definitive surgery and initiation of
  tamoxifen (if receiving tamoxifen alone)
 If receiving adjuvant CMF, AC, or FAC, CAF, or AC, paclitaxel, tamoxifen 
  begins after completion of adjuvant therapy

 Radiotherapy required within 56 days following segmental mastectomy

 Definitive surgery required
 Prior oophorectomy for reasons other than malignancy allowed

Patient Characteristics:

 48 to 78


Menopausal status:

Performance status:
 Not specified

Life expectancy:
 At least 10 years (excluding breast cancer)

 WBC at least 3,000/mm3
 Platelet count at least 100,000/mm3

 Bilirubin no greater than 1.5 mg/dL
 AST no greater than 60 IU/mL (or within 2 times normal)

 Creatinine no greater than 1.5 mg/dL

 No active cardiac disease that would preclude doxorubicin in patients
  assigned to adjuvant chemotherapy with doxorubicin

 Baseline caloric intake at least 20% fat
 Accessible for follow-up and by telephone
 Sufficient memory required to provide food recall data
 Must speak and read English
 Medically and nutritionally eligible for either dietary intervention arm
 No prior or concomitant malignancy except curatively treated nonmelanoma skin 
 cancer or carcinoma in situ of the cervix

Expected Enrollment


Approximately 2,500 women will be accrued for this study.


This is a randomized, multicenter study.  Patients are stratified by center, 
nodal status, ER status, and type of adjuvant chemotherapy.

The first group receives intensive dietary intervention for reduction of total 
fat intake to 15% of calories, with repeated individual and group counseling 

The second group receives USDA/DHHS dietary guidelines and minimal 

All patients who are estrogen receptor positive receive concurrent therapy 
with tamoxifen; cyclophosphamide, methotrexate, fluorouracil (CMF) followed by 
tamoxifen; doxorubicin, cyclophosphamide (AC) followed by tamoxifen; 
fluorouracil, doxorubicin, cyclophosphamide (FAC, CAF) followed by tamoxifen; 
or AC, paclitaxel followed by tamoxifen.

Patients are followed annually throughout the study.

Published Results

Hoy MK, Winters BL, Chlebowski RT, et al.: Implementing a low-fat eating plan in the Women's Intervention Nutrition Study. J Am Diet Assoc 109 (4): 688-96, 2009.[PUBMED Abstract]

Chlebowski RT, Blackburn GL, Thomson CA, et al.: Dietary fat reduction and breast cancer outcome: interim efficacy results from the Women's Intervention Nutrition Study. J Natl Cancer Inst 98 (24): 1767-76, 2006.[PUBMED Abstract]

Chlebowski RT, Blackburn GL, Elashoff RE, et al.: Dietary fat reduction in postmenopausal women with primary breast cancer: phase III Women’s Intervention Nutrition Study (WINS). [Abstract] J Clin Oncol 23 (Suppl 16): A-10, 3s, 2005.

Trial Contact Information

Trial Lead Organizations

Institute for Cancer Prevention

Daniel Nixon, MD, Protocol chair
Ph: 843-792-5336; 800-424-3828
Email: nixond@musc.edu

Registry Information

Trial Start Date1994-04-01
Registered in ClinicalTrials.govNCT00002564
Date Submitted to PDQ1994-04-01
Information Last Verified2010-02-11
NCI Grant/Contract NumberCA17613, CA45504

Note: The purpose of most clinical trials listed in this database is to test new cancer treatments, or new methods of diagnosing, screening, or preventing cancer. Because all potentially harmful side effects are not known before a trial is conducted, dose and schedule modifications may be required for participants if they develop side effects from the treatment or test. The therapy or test described in this clinical trial is intended for use by clinical oncologists in carefully structured settings, and may not prove to be more effective than standard treatment. A responsible investigator associated with this clinical trial should be consulted before using this protocol.