after nearly two decades of follow-up. During the dietary intervention period (median, 8.1 years), it was found that a low-fat dietary pattern led to a lower incidence of death (from all causes) after breast cancer (40 deaths versus 94 in the "normal diet" arm; HR, 0.65; 95% CI, 0.45 to 0.94, P = .02.). After a median 16.1 years of cumulative follow-up (inclusive of the intervention period), further analysis showed that this benefit persisted (234 deaths versus 443 in the "normal diet" arm; HR, 0.82; 95% CI, 0.70 to 0.96 with P = .01). A more recent update, with 19.6 years of cumulative follow-up, reported the persistent reduction of death (from all-causes) after breast cancer continued (359 v 652 deaths; HR, 0.85; 95% CI, 0.74 to 0.96; P = .01) and a statistically significant reduction in deaths as a result of breast cancer (breast cancer followed by death directly attributed to the breast cancer) emerged (132 v 251 deaths; HR, 0.79; 95% CI, 0.64 to 0.97; P = .02). Another recent analysis of Dietary Modification intervention outcomes showed a 30% reduction in coronary heart disease (CHD) risk among women having normal blood pressure (n = 23,248) and partaking in a low-fat dietary pattern (122 versus 256 CHD events; HR, 0.70; 95% CI, 0.56 to 0.87 during the intervention period). Participants with existing cardiovascular disease at baseline (n = 1,656) were at higher risk of developing coronary heart disease, both during the intervention and extended follow-up periods (101 versus 116 CHD events, HR, 1.47; 95% CI, 1.12 to 1.93; and 36 versus 44, HR, 1.61 95% CI 1.02 to 2.55, respectively). The increased among women with prior CVD was likely due to post-randomization confounding, resulting in some difficulty in interpretation. Women in the diet intervention group were more likely to report changes in statin use (either cessation or initiation) post-randomization than women in the comparison group. Secondary analyses concluded that the dietary intervention did not increase risk of diabetes, but instead slowed progression. During the trial, intervention group women had lower rates of initiation of insulin therapy (HR, 0.74; 95% CI, 0.59 to 0.94; P = 0.01) and through cumulative follow-up (HR, 0.88; 95% CI 0.78 to 0.99; P = 0.04). These types of analysis, conducted more than a decade after the halt of the intervention trials, serves further to demonstrate the long-term value and return on investment yielded by the