Breast cancer risk was directly associated with processed meat intake [ hazard ratio ( HR ) Q4vsQ1 = 1.45 ( 0.92-2 .27 ) , Ptrend = 0.03 ] and this association was stronger when excluding cooked ham [ HRQ4vsQ1 = 1.90 ( 1.18-3 .05 ) , Ptrend = 0.005 ] .