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Drs. Trichopoulou and Lagiou make a valid and interesting point. Our focus on secular changes in total fat consumption as a possible cause of the recently observed decrease in U.S. cancer mortality rates actually refers to a population (North America) in which olive oil plays a relatively minor role in the diet. Clearly, a unique feature of the Mediterranean diet is its reliance on olive oil, and there is mounting epidemiologic and experimental evidence that olive oil may provide some reduction in the risk of a variety of chronic diseases including heart disease, cancer, diabetes, and perhaps osteoporosis. It should be noted, however, that there are other components of the Mediterranean diet that may also confer protection, such as high consumption of tomatoes, grains, nuts, fruit, and yogurt, as well as a lower consumption of animal fats and vegetable oils, rendering it difficult to single out the effects of olive oil per se. Nonetheless, Drs. Trichopoulou and Lagiou are correct in pointing out that our emphasis on secular changes in total fat consumption as the possible cause of the recent drop in U.S. cancer mortality rates may not be generalizable to other countries, particularly those such as Greece and Spain in which olive oil plays a central role in the diet.

Re: Relationship Between Lifetime Ovulatory Cycles and Overexpression of Mutant p53 in Epithelial Ovarian Cancer