Information on Cancer

Cancer, the second leading cause of death in the United States, is a group of conditions of uncontrolled growth of cells originating from almost any tissue in the body.

Cancer may arise in any organ in the body, but tumours of the lung, colon and rectum, breast, skin, and prostate occur most frequently, and are variably associated with dietary factors.

The relationship between diet and cancer has been a topic of considerable controversy in research as well as in public policy. It has been estimated that as many as 35% of all cancer deaths in the United States are attributable to diet. In 1984, the American Cancer Society published a set of dietary guidelines that recommended reducing fat intake to lower the risk of some types of cancer. This recommendation has been supported by the National Cancer Institute and the Surgeon General's Report on Nutrition and Health.

The National Cancer Institute initiated a low-fat dietary intervention program (The Women's Health Trial), to study the effects of a low-fat diet on the incidence of breast cancer in women at elevated risk for the disease.

Women in the intervention group reduced their total fat intake to approximately 20% of total calories over a 12 month period, mainly by decreasing their fat intake from milk products, red meats, and fats/oils. In addition the overall quality of the diets improved.

The intervention produced a number of beneficial dietary changes beyond its primary objective to reduce total fat intake. These dietary changes are consistent with the dietary guidelines for reducing cancer risk, developed by the American Cancer Society and the National Cancer Institute, and included: eating more complex carbohydrates from fruits and vegetables, eating more foods high in vitamin A and C, weight loss, drinking less alcohol, and eating less salt-cured, smoked, and nitrate-cured foods (bacon, baked ham, pork sausages and hot dogs).

Current dietary guidelines recommend that individuals reduce their fat intake, not only for the prevention of cancer but also to reduce the risks of other chronic diseases such as coronary heart disease, hypertension, obesity, and diabetes. In this study the participants successfully decreased their fat intake to 20% of total calories while maintaining nutritional adequacy in their diets and without major changes in the types of foods they were consuming. [Journal of the American Dietetic Association]

It appears that a high vegetable, low-fat, low-calorie diet protects against rectal cancer. Risk decreases with an increased intake of carotenoids, vitamin C, and dietary fibre fromvegetables. [Freudenheim, et al] Records from insurance companies suggested that overweight people were at higher risk for cancer than normal or underweight people.

Tumours of the upper aerodigestive tract (laryngeal, pharyngeal, oral, and oesophageal cancers) are alcohol related, and there is increasing evidence linking alcohol and breast cancer in women. For oral and oesophageal cancers, one cohort study documented a quadrupled mortality rate for persons who drink six or more alcoholic beverages a day, compared with nondrinkers. [Editorial: The Lancet]



Table 2.16

National Cancer Institute Dietary Guidelines.

  1. Reduce fat intake to 30 percent or less of calories.
  2. Increase fibre intake to 20 to 30 grams per day, with an upper intake of 35 grams.
  3. Include a variety of vegetable and fruits in the daily diet.
  4. Avoid obesity.
  5. Consume alcoholic beverages in moderation, if at all.
  6. Minimize consumption of salt-cured, salt-pickled, and smoked foods.

Several mechanisms have been proposed to account for observed associations between diet, digestive processes, and cancer. These include:

  • Carcinogens in food that are present naturally, that are inadvertent contaminants, or that form as products of cooking or preservation.
  • Diet-induced metabolic activation or deactivation of carcinogens. For example, formation of oxygen radicals and lipid perioxidation products can be retarded or blocked by normal enzymatic processes or by the selenium or beta-carotene present in foods.
  • Biological formation of carcinogens, as with conversion of bile acids to tumour-promoting chemicals by normal intestinal bacteria. The bacteria that accomplish this conversion may be affected by diet.
  • Enhancement (eg. by fats) or inhibition (eg. by vitamin A) of promotion.
  • Nutrient imbalance may impair immunity and thus may influence early rejection of malignant cells or the ability of cells to repair damaged DNA.

Role of Vitamin A and Carotenoids in Cancer

A large body of evidence suggests that foods high in Vitamin A and carotenoids are protective against a variety of cancers. The strongest evidence for the role of vitamin A in the prevention of human cancer comes from epidemiologic studies that correlate consumption of carotenoid-containing vegetables or foods with a high vitamin A index to protection against cancer of the lung.

An important issue, related to these studies is whether the protective effects attributed to vitamin A activity, are truly attributable to vitamin A, or whether they are due to some other factor that may be present in the foods. For example, a study of lung cancer among New Jersey white males showed a protective effect for fruits and vegetables that was greatest for dark yellow-orange and green vegetables, but no statistically significant effect for retinol, carotenoids, or vitamin A activity. [Ziegler et al]

Because retinoids are required for normal cell differentiation, their deficiency leads to improper differentiation of stem cells in epithelial tissue. In animals, retinoids may inhibit initiation and promotion stages of carcinogeneses. Retinoids may also have a role in reversing cancerous changes.

Antioxidant chemicals are thought to protect against certain promoters of carcinogeneses. Foods containing vitamin A have been shown to protect against the formation of oxygen radicals and lipid peroxidation, and beta-carotene is a very efficient neutralizer of oxygen radicals.

Large amounts of retinoids in the blood or tissues, can be toxic and may cause birth defects and adverse effects on the skin, liver, and neurologic tissue. Excessive intake of preformed vitamin A or retinoid supplements should be avoided, especially by pregnant women. However, increased intake of carotenoids from food alone is unlikely to have any adverse effects, other than skin discolouration at very large intakes.

Role of Other Dietary Constituents in Cancer

Foods contain both nutritive and nonnutritive components. Most of the later are present naturally, but some are added during formulation, processing, and cooking. Studies have shown that some specific nonnutritive substances can promote tumour development in animals. For example, aflatoxin, a potent carcinogen derived from mold on grains, legumes, or nuts is a naturally occurring toxin in these foods.

Experimental and epidemiological data suggest an association between alcohol consumption and human cancer that is strongest for certain head and neck cancers. Alcohol intake and smoking act synergistically to increase the risk for cancer of the mouth, larynx, and oesophagus.

Although alcohol has an effect independent of smoking in increasing cancer risk, it remains uncertain whether the responsible agent is alcohol itself or any of the more than 400 other chemicals identified in alcoholic beverages. The nutrient deficiencies produced in alcoholics could be associated with impaired immune function, permitting increased carcinogenesis. A slightly greater risk for breast cancer in women has been associated with an average of one drink per day in a cohort study of 89,538 American women. [Willett et al]



Vitamin C functions as a chemical-reducing agent and antioxidant. Human studies have shown a protective association between foods that contain vitamin C and cancers of the oesophagus, stomach, and cervix. Vitamin C blocks the formation of carcinogenic nitrosamines from nitrates and prevents oxidation of certain other chemicals to active carcinogenic forms.

An association between protein consumption, especially animal protein, and the incidence of certain cancers has been observed in several human epidemiologic studies. Smoked and charred foods acquire polycyclic aromatic hydrocarbons, some of which are known to be carcinogenic in animals. These and other potential carcinogenic agents may be formed within foods during cooking in amounts that may be related to temperature and duration of cooking at very high temperatures.

International epidemiologic evidence suggests that populations consuming diets high in salt-cured, salt-pickled, and smoked foods have a higher incidence of stomach and oesophageal cancers. oesophageal and stomach cancers are also associated with poor nutrition. For decades sodium nitrate has been added to cured meats at levels of about 200 parts per million to prevent botulism. Nitrate can react with secondary amines to form carcinogenic nitrosamines. Bacteria in the mouth or intestine, however, reduce nitrate to nitrite in appreciable amounts.

Clearly, a nutritious diet providing adequate amounts of all nutrients and proper calorie content to achieve desirable weight is important for general health and for vigourous defence mechanisms against cancer as well as other diseases.

Nutrition Programs and Services

Food Labels:
Evidence related to the role of dietary factors in cancer suggests that food manufacturers should include on package labelsinformation about nutritional content of the food, especially for fat and carbohydrate components (including fiber).

Food Services:
Evidence related to the role of dietary factors in cancer suggests that the public might benefit from increased availability of foods high in fibre and low in fat.

Food Products:
Evidence related to the role of dietary factors in cancer suggests that foods low or reduced in calories and fat and high in fibre should be made increasingly available by food manufacturers. [The Surgeon General]

  • Journal of the American Dietetic Association: Research, Page 802 - 809, June 1990.
  • Freudenheim, J.L., Graham, S., Marshall, J.R., Haughey, B.P., and Wilkinson, G., A case study of diet and rectal cancer in western New York , American Journal of Epidemiology, 131:612, 1990.
  • Editorial: Alcohol & cancer, The Lancet, 335:634, 1990.
  • Ziegler, R.G., Mason, T.J., Stemhagen, A., Hoover, R., Schoenberg, J.B., Gridley, G., Virgo, P.W., & Fraumeni, J.F., Carotenoid intake, vegetables, and the risk of lung cancer among white men in New Jersey , American Journal of Epidemiology 123:1080, 1986.
  • Willett, W.C., and MacMahon, B., Diet and Cancer; an overview , New England Journal of Medicine 310:697, 1984.
  • The Surgeon General's Report on Nutrition & Health, 1988.