Takeaways
- Higher ultra-processed food intake before diagnosis was associated with worse survival among Black women with breast cancer, including increased breast cancer–specific and all-cause mortality.
- Total caloric intake appears to partially mediate the association, suggesting excess energy consumption is an important pathway, though not the sole explanation.
- Processed meats emerged as the strongest individual contributor to increased mortality risk, offering a more targeted and actionable dietary focus for survivorship counseling.
A new population-based cohort study suggests that higher consumption of ultra-processed foods (UPFs) before diagnosis is associated with worse survival outcomes among Black women with breast cancer, a population that already experiences disproportionately high mortality from the disease. The findings, published in eClinicalMedicine, represent the first study to specifically examine the relationship between UPF intake and mortality in Black breast cancer survivors.1,2
The analysis followed 1,733 Black women diagnosed with primary breast cancer in New Jersey between 2005 and 2019 who participated in the Women’s Circle of Health Study and the Women’s Circle of Health Follow-Up Study. Participants completed detailed, validated food frequency questionnaires covering the year prior to diagnosis during in-home interviews conducted approximately 10 months after diagnosis. Mortality outcomes were ascertained through linkage with the New Jersey State Cancer Registry, with a median follow-up of 9.3 years.
“Black women have the highest mortality rate from breast cancer compared with other racial or ethnic groups in the U.S.,” said Tengteng Wang, PhD, lead author of the study and a member of the Cancer Prevention and Control Program at Rutgers Cancer Institute. “That’s why we wanted to see what factors might contribute to these differences.”
Ultra-processed food intake and mortality risk
Ultra-processed foods were defined as industrial formulations that typically contain additives, preservatives, and ingredients not commonly used in home cooking. The category includes sugar-sweetened beverages, processed meats, packaged snacks, sweets and desserts, and pre-prepared mixed dishes. In the study cohort, women in the highest tertile of UPF intake consumed a median of more than eight servings per day, compared with fewer than three servings per day among women in the lowest tertile.
During follow-up, 394 deaths were identified, including 206 breast cancer–specific deaths. After adjustment for sociodemographic factors, women in the highest UPF intake group had a 40% higher risk of breast cancer–specific mortality and a 36% higher risk of all-cause mortality compared with those in the lowest intake group. These associations were attenuated after additional adjustment for total energy intake but remained directionally consistent.
“The total energy intake may be one of the mechanisms, but it’s not the only one because a positive association existed even after adjusting for caloric intake,” Wang said.
Dose-response analyses demonstrated a nonlinear relationship between UPF consumption and mortality, with risk increasing at higher levels of intake. Associations were generally consistent across clinical subgroups, although stronger effects were observed among women living in socioeconomically disadvantaged neighborhoods.
Potential biological pathways
Ultra-processed foods tend to be energy-dense and nutrient-poor, characteristics that may promote excess calorie intake, weight gain, and metabolic dysfunction. Consistent with this, adjustment for total energy intake substantially weakened the observed associations, suggesting that caloric excess may partially mediate the relationship between UPF intake and mortality.
“The average consumption is very similar to the U.K. population and also other U.S.-based studies like the Nurses’ Health Study,” Wang said. “I’d like to see more studies conducted among cancer survivors to confirm this, but the current evidence looks biologically reasonable now, particularly considering we have some ideas about the underlying biological mechanisms.”
The research team is conducting additional analyses to explore other potential pathways, including inflammation and insulin resistance. Planned studies will examine whether UPF consumption is associated with activation of the mammalian target of rapamycin signaling pathway in breast tumor tissue, as well as circulating inflammatory markers such as C-reactive protein and interleukin-6.
Processed meats emerge as a key contributor
When individual UPF subgroups were analyzed, processed meats showed the strongest association with adverse outcomes. Higher processed meat intake was associated with increased all-cause mortality, aligning with prior evidence linking processed meat consumption to cancer risk and poorer prognosis.
“Maybe it’s too complicated for breast cancer patients to think about how to reduce consumption of ultra-processed foods in general,” Wang said. “But we find processed meat is the top worst contributor among all UPF subgroups. So maybe a more detailed takeaway is to avoid this one thing.”
Clinical and public health implications
The findings are consistent with prior research suggesting an association between ultra-processed food intake and cancer-related mortality in other populations, indicating that underlying biological mechanisms may not be race-specific. However, this study uniquely highlights diet as a potentially modifiable factor in survivorship among Black women, an understudied and medically underserved population.
“Going back to cooking traditional meals can potentially save money and is generally better for your health,” said Elisa Bandera, professor and chief of the Department of Medicine at Rutgers Robert Wood Johnson Medical School and leader of the Women’s Circle of Health Follow-Up Study.
Although the observational design limits causal inference, the authors note that dietary patterns represent an actionable area for future survivorship interventions. Further studies in racially and ethnically diverse populations will be needed to confirm these findings and clarify how dietary guidance can be integrated into breast cancer survivorship care.
References
- Rutgers University-New Brunswick. For Black Women with Breast Cancer, Ultra-Processed Foods May Worsen Health Outcomes. Newswise. December 18, 2025. Accessed December 19, 2025. https://www.newswise.com/articles/for-black-women-with-breast-cancer-ultra-processed-foods-may-worsen-health-outcomes/?sc=mwhr&xy=10069075
- Wang T, Bandera EV, Perlstein M, et al. Ultra-processed foods consumption and subsequent mortality in a cohort of Black breast cancer survivors. eClinicalMedicine. 2025;91:103700. doi:https://doi.org/10.1016/j.eclinm.2025.103700
