Is diet linked to cancer?

Cancer is one of the leading causes of death worldwide. Growing evidence points to the impact of dietary habits on cancer risk. The good news is that simple lifestyle changes, such as following a healthy diet, could prevent 30–50% of all cancers.1,2, 3

Did you know?


Diet-related chronic conditions are among the leading causes of death and disability in Australia.


In 2017-18, just over half (51.3%) of all adult Australians met the guidelines for the recommended daily serves of fruit (2 or more serves), while one in thirteen (7.5%) met the guidelines for serves of vegetables (at least 5-6 serves for men and 5 or more for women). Only one in twenty (5.4%) adults met both guidelines.4  


Cancer is a leading cause of illness in Australia, with over one million Australians currently living with or having survived cancer.5
 


While cancer survival rates have improved, cancer still accounts for about 30% of all deaths in Australia.5


In 2019, an average of 136 people per day were expected to die from cancer in Australia.5  

The Facts:


Fruits and vegetables

  • Regularly eating fruits and vegetables is linked with a reduced risk of cancers at various sites.
  • An analysis of the Pooling Project of Prospective Studies of Diet and Cancer, found that higher total fruit and vegetable intake was related to a lower incidence of estrogen-receptor-negative breast cancer. Vegetable intake alone was associated with an 18 percent lower risk when comparing those who ate the most vegetables with those who ate the least.30

Soy products

  • Studies have found lower rates of breast cancer in Asian countries. Results suggest that the earlier in life people start consuming soy, the lower the risk of breast cancer, with a 25-60% reduction of risk. This effect remains even if soy intake is later reduced.20 This may explain why the Oxford-EPIC study found no association between breast cancer and soy isoflavones, as many subjects began consuming soy in adulthood.20
  • Studies show that soy protein and isoflavones protect against breast cancer and are safe for breast cancer survivors.20, 31
  • Soy is also safe for those receiving breast cancer treatment and may even enhance the medication’s effect.32
  • Consuming soy leads to better prognosis and survival rates, with greatest benefits seen when more soy is eaten.33
  • Consuming soy also reduces the reoccurrence of breast cancer.20
  • The American Cancer Society and the American Institute for Cancer Research concur that consumption of soy products are safe for women with breast cancer.20
  • The World Cancer Research Fund concluded that consuming soy foods may improve the prognosis of women diagnosed with breast cancer.20
  • A meta-analysis found that Chinese women with the highest soy intake had a decreased risk of lung cancer.30 

Dietary patterns

  • "Western" diet:
    • The Western diet, typically comprising processed and red meats, refined grains, soft drinks and sweets is linked to a higher colorectal cancer risk, whereas a diet high in fruits, vegetables, fish, poultry and whole-grain products is associated with a lower risk.34
    • In another cohort study, diets high in ultra-processed foods (mass-produced packaged breads, packaged snacks, soft drinks, reconstituted meat products with nitrite preservatives, instant soups, frozen meals, etc.) were associated with greater than 10% increases in the risk of overall cancer and breast cancer.35
  • Mediterranean diet:
    • The Mediterranean diet, typically high in fruits, vegetables, nuts, legumes, whole wheat bread, fish and olive oil, is abundant in antioxidants, anti-inflammatory nutrients and protective phytonutrients that fight degeneration of normal cells into cancer cells, their proliferation if they develop and angiogenesis that feeds their development.36
  • Vegetarian diets:
    • In a study of cancer risk and mortality37, all-cause mortality was 17% lower for a vegetarian diet than for non-vegetarians.
    • Vegetarian and vegan diets are associated with a lower risk of developing or dying from cancer.38, 39
    • A systematic review and meta-analysis of vegetarians and vegans showed a lower risk of cancer by 8% and 15%, respectively.39
    • Vegetarians and vegans typically eat more vegetables, fruits, soy and whole grains, and less processed and overcooked foods which have been linked to increased risk.40, 41

Specific dietary elements as well as overall dietary patterns have been studied in relation to the risk of cancer.


Excess calories

  • Studies have consistently shown that excess calories, from any source, lead not only to weight gain, but also to increased cancer risk.6, 7
  • After smoking and infection, obesity is the most significant risk factor for cancer globally.8 In fact, it is estimated that 20% of all cancers are caused by obesity.9

Red meat

  • Red meat refers to the muscles of mammals, including lamb, mutton, pork, goat, veal, beef, and horse.10
  • A high intake of red meat has been associated with increased risk of colon cancer. A working group of the International Agency for Research on Cancer (IARC) found a 17% higher risk of colon cancer for each 100 grams of red meat eaten daily.10
  • Eating red meat has also been associated with an increase in cancer-specific mortality.11

Processed meat

  • Processed meat refers to meat that has been treated to preserve and increase flavour by undergoing fermentation, salting, curing, smoking, adding chemical preservatives, etc. Examples include hot dogs, ham, bacon, salami, beef jerky and some deli meats.
  • The IARC Working Group reported an increased colon cancer risk of 18% for each 50 grams of processed meat eaten daily.10
  • The World Health Organization has also declared that processed meats are a Group 1 carcinogen – the same category as cigarette smoking, alcohol, asbestos and air pollution.12

Dairy products

  • Breast cancer:
    • A recent study of North American women initially free of cancer found an association between intake of dairy milk and a greater risk of breast cancer when adjusted for soy intake. As little as ¼ to 1/3 cup of dairy milk per day increased risk of breast cancer by 30%, 1 cup increased risk by 50% and 2-3 cups of dairy milk per day increased risk by 70-80%. No important associations were noted with cheese and yoghurt.13
  • Prostate cancer:
    • Several studies have indicated that high dairy consumption may increase the risk of prostate cancer.
    • Daily milk consumption in adolescence (but not later) may increase the risk more than threefold.19
    • A systematic review and meta-analysis showed higher intake of total dairy, total milk, low-fat milk and cheese increased risk of prostate cancer by 3-9%, while whole milk reduced this effect. No association was found with skim milk, ice-cream and butter.14  
    • The Physicians Health Study followed more than 21,000 participants for 28 years and found that those who consumed more than 2.5 serves of dairy a day had a 12% higher risk.15
    • In overweight and obese men, the consumption of whole milk increased the likelihood of prostate cancer returning. In fact, an intake of four serves of whole milk per day increased their risk of reoccurrence by 73%.16
    • Dairy may increase the risk of death from prostate cancer,with a risk of 141% for men consuming 3 or more serves a day.17
    • A recent study which followed almost 50,000 men for 11 years did not find an increased risk of developing prostate cancer from total and individual dairy products. However, regular-fat dairy products were associated with a 37% greater risk of end-stage prostate cancer while 2%-fat milk was associated with a 14% increased risk.18
    • Another study of almost 4,000 men with prostate cancer found that consuming large amounts of whole milk increased likelihood of cancer progression and death.19
    • Observational studies show lower rates of prostate and breast cancers in Asian countries.20
    • In long-term trials, soy isoflavones did not affect the recurrence of cancer after prostate gland removal, nor the progression of the neoplasia to malignant cancer.21
    • A recent study of almost 45,000 Japanese men and spanning 20 years, found that high intake of soy products and isoflavones may increase the risk of mortality from prostate cancer.22

Refined carbohydrates

  • Processed foods that are high in sugar and low in fibre and nutrients have been linked to a higher risk of colorectal cancer.23
  • A diet high in sugar and refined carbohydrates raises blood glucose and insulin levels – both risk factors for cancer – and may increase the risk of stomach, breast and colorectal cancers.24, 25
  • A Mediterranean study found that a diet containing refined (high GI) carbohydrates that strongly raised blood glucose and insulin levels may increase colorectal cancer risk by 45%, whereas complex carbohydrates (low GI foods) reduced the risk by 27%.26

Omega-3 fatty acids

  • A meta-analysis of randomised controlled trials showed that taking omega-3-fatty acid supplements did not affect the incidence of cancer.27
  • Preliminary results from intervention trials show high intake of marine omega-3-fatty acids may improve outcomes in breast cancer diagnosis, reduce reoccurrence and improve survival.28
  • A critical review of the effect of cancer patients taking omega-3 fatty acid supplements to treat secondary complications such as pain, depression, cachexia-anorexia and paraneoplstic syndrome shows promise due to their anti-inflammatory nature, but this needs further research.29

What can we do about it?


Maintain a healthy weight


Avoid processed meat


Limit or avoid red meat


Follow a plant-based dietary pattern, rich in fruits, vegetables, whole grains, legumes, nuts and seeds. Find out more details here 1.


Include soy products, such as tofu, miso, tempeh, etc.


References:
 
1.         Vineis P, Wild CP. Global cancer patterns: causes and prevention. Lancet. 2014 Feb 8;383(9916):549-57.
2.         Donaldson MS. Nutrition and cancer: a review of the evidence for an anti-cancer diet. Nutr J. 2004 Oct 20;3:19.
3.         Wilson LF, Antonsson A, Green AC, Jordan SJ, Kendall BJ, Nagle CM, et al. How many cancer cases and deaths are potentially preventable? Estimates for Australia in 2013. Int J Cancer. 2018 Feb 15;142(4):691-701.
4.         Australian Bureau of Statistics. National Health Survey: First results. 2018. [cited 2020 Mar 6]. Available from: https://www.abs.gov.au/ausstats/abs@.nsf/mf/4364.0.55.001.
5.         Australian Institute of Health and Welfare. Cancer in Australia 2019. Canberra: AIHW; 2019. [cited 2020 Mar 6]. Available from: https://www.aihw.gov.au/reports/cancer/cancer-in-australia-2019.
6.         Longo VD, Fontana L. Calorie restriction and cancer prevention: metabolic and molecular mechanisms. Trends Pharmacol Sci. 2010 Feb;31(2):89-98.
7.         World Cancer Research Fund - American Institute for Cancer Research. Diet, Nutrition, Physical Activity and Cancer: a Global Perspective. . Internet. London: World Cancer Research Fund - American Institute for Cancer Research; 2008. [cited Jan 06 2021]. Available from: https://www.wcrf.org/dietandcancer/contents.
8.         Renehan AG, Soerjomataram I. Obesity as an Avoidable Cause of Cancer (Attributable Risks). Recent Results Cancer Res. 2016;208:243-56.
9.         Wolin KY, Carson K, Colditz GA. Obesity and cancer. Oncologist. 2010;15(6):556-65.
10.       Bouvard V, Loomis D, Guyton KZ, Grosse Y, Ghissassi FE, Benbrahim-Tallaa L, et al. Carcinogenicity of consumption of red and processed meat. Lancet Oncol. 2015 Dec;16(16):1599-600.
11.       Pan A, Sun Q, Bernstein AM, Schulze MB, Manson JE, Stampfer MJ, et al. Red meat consumption and mortality: results from 2 prospective cohort studies. Arch Intern Med. 2012 Apr 9;172(7):555-63.
12.       World Health Organization. Q&A on the carcinogenicity of the consumption of red meat and processed meat. 2015.  [cited 2020 Mar 6]. Available from: https://www.who.int/news-room/q-a-detail/q-a-on-the-carcinogenicity-of-the-consumption-of-red-meat-and-processed-meat.
13.       Fraser GE, Jaceldo-Siegl K, Orlich M, Mashchak A, Sirirat R, Knutsen S. Dairy, soy, and risk of breast cancer: those confounded milks. Int J Epidemiol. 2020 Feb 25:1-12.
14.       Aune D, Navarro Rosenblatt DA, Chan DS, Vieira AR, Vieira R, Greenwood DC, et al. Dairy products, calcium, and prostate cancer risk: a systematic review and meta-analysis of cohort studies. Am J Clin Nutr. 2015 Jan;101(1):87-117.
15.       Song Y, Chavarro JE, Cao Y, Qiu W, Mucci L, Sesso HD, et al. Whole milk intake is associated with prostate cancer-specific mortality among U.S. male physicians. J Nutr. 2013 Feb;143(2):189-96.
16.       Tat D, Kenfield SA, Cowan JE, Broering JM, Carroll PR, Van Blarigan EL, et al. Milk and other dairy foods in relation to prostate cancer recurrence: Data from the cancer of the prostate strategic urologic research endeavor (CaPSURE™). Prostate. 2018 Jan;78(1):32-9.
17.       Yang M, Kenfield SA, Van Blarigan EL, Wilson KM, Batista JL, Sesso HD, et al. Dairy intake after prostate cancer diagnosis in relation to disease-specific and total mortality. International journal of cancer. 2015;137(10):2462-9.
18.       Preble I, Zhang Z, Kopp R, Garzotto M, Bobe G, Shannon J, et al. Dairy Product Consumption and Prostate Cancer Risk in the United States. Nutrients. 2019;11(7):1615.
19.       Pettersson A, Kasperzyk JL, Kenfield SA, Richman EL, Chan JM, Willett WC, et al. Milk and dairy consumption among men with prostate cancer and risk of metastases and prostate cancer death. Cancer Epidemiol Biomarkers Prev. 2012 Mar;21(3):428-36.
20.       Messina M. Soy and Health Update: Evaluation of the Clinical and Epidemiologic Literature. Nutrients. 2016;8(12):754.
21.       Moyad MA, Stanley A Brosman. Prostate Cancer, Nutrition, and Dietary Supplements 2019. [cited Jan 06 2021]. Available from: https://emedicine.medscape.com/article/453191-overview.
22.       Sawada N, Iwasaki M, Yamaji T, Shimazu T, Inoue M, Tsugane S, et al. Soy and isoflavone consumption and subsequent risk of prostate cancer mortality: the Japan Public Health Center-based Prospective Study. International Journal of Epidemiology. 2020;49(5):1553-61.
23.       Michaud DS, Fuchs CS, Liu S, Willett WC, Colditz GA, Giovannucci E. Dietary glycemic load, carbohydrate, sugar, and colorectal cancer risk in men and women. Cancer Epidemiol Biomarkers Prev [Internet]. 2005. [cited 2020 Mar 6]; 14(1):138-147. Available from: https://cebp.aacrjournals.org/content/14/1/138.long.
24.       Nagle CM, Olsen CM, Ibiebele TI, Spurdle AB, Webb PM, Astralian National Endometrial Cancer Study G, et al. Glycemic index, glycemic load and endometrial cancer risk: results from the Australian National Endometrial Cancer study and an updated systematic review and meta-analysis. Eur J Nutr. 2013 Mar;52(2):705-15.
25.       Eslamian G, Jessri M, Hajizadeh B, Ibiebele TI, Rashidkhani B. Higher glycemic index and glycemic load diet is associated with increased risk of esophageal squamous cell carcinoma: a case-control study. Nutr Res. 2013 Sep;33(9):719-25.
26.       Sieri S, Agnoli C, Pala V, Grioni S, Brighenti F, Pellegrini N, et al. Dietary glycemic index, glycemic load, and cancer risk: results from the EPIC-Italy study. Sci Rep. 2017 Aug 29;7(1):9757.
27.       Zhang Y-F, Gao H-F, Hou A-J, Zhou Y-H. Effect of omega-3 fatty acid supplementation on cancer incidence, non-vascular death, and total mortality: a meta-analysis of randomized controlled trials. BMC public health. 2014;14:204.
28.       Fabian CJ, Kimler BF, Hursting SD. Omega-3 fatty acids for breast cancer prevention and survivorship. Breast Cancer Res. 2015 May 4;17(1):62.
29.       Freitas RDS, Campos MM. Protective Effects of Omega-3 Fatty Acids in Cancer-Related Complications. Nutrients. 2019 Apr 26;11(5).
30.       Jung S, Spiegelman D, Baglietto L, Bernstein L, Boggs DA, van den Brandt PA, et al. Fruit and vegetable intake and risk of breast cancer by hormone receptor status. J Natl Cancer Inst. 2013 Feb 6;105(3):219-36.
31.       Setchell KDR. The history and basic science development of soy isoflavones. Menopause. 2017 Dec;24(12):1338-50.
32.       Nechuta SJ, Caan BJ, Chen WY, Lu W, Chen Z, Kwan ML, et al. Soy food intake after diagnosis of breast cancer and survival: an in-depth analysis of combined evidence from cohort studies of US and Chinese women. Am J Clin Nutr. 2012 Jul;96(1):123-32.
33.       Chi F, Wu R, Zeng YC, Xing R, Liu Y, Xu ZG. Post-diagnosis soy food intake and breast cancer survival: a meta-analysis of cohort studies. Asian Pac J Cancer Prev. 2013;14(4):2407-12.
34.       Brennan SF, Cantwell MM, Cardwell CR, Velentzis LS, Woodside JV. Dietary patterns and breast cancer risk: a systematic review and meta-analysis. Am J Clin Nutr. 2010 May;91(5):1294-302.
35.       Fiolet T, Srour B, Sellem L, Kesse-Guyot E, Alles B, Mejean C, et al. Consumption of ultra-processed foods and cancer risk: results from NutriNet-Sante prospective cohort. BMJ. 2018 Feb 14;360:k322.
36.       Mentella MC, Scaldaferri F, Ricci C, Gasbarrini A, Miggiano GAD. Cancer and Mediterranean Diet: A Review. Nutrients. 2019;11(9):2059.
37.       Le LT, Sabate J. Beyond meatless, the health effects of vegan diets: findings from the Adventist cohorts. Nutrients. 2014 May 27;6(6):2131-47.
38.       Appleby PN, Key TJ. The long-term health of vegetarians and vegans. Proc Nutr Soc. 2016 Aug;75(3):287-93.
39.       Dinu M, Abbate R, Gensini GF, Casini A, Sofi F. Vegetarian, vegan diets and multiple health outcomes: A systematic review with meta-analysis of observational studies. Crit Rev Food Sci Nutr. 2017 Nov 22;57(17):3640-9.
40.       Zhang C, Ho SC, Lin F, Cheng S, Fu J, Chen Y. Soy product and isoflavone intake and breast cancer risk defined by hormone receptor status. Cancer Sci. 2010 Feb;101(2):501-7.
41.       Douglas CC, Johnson SA, Arjmandi BH. Soy and its isoflavones: the truth behind the science in breast cancer. Anticancer Agents Med Chem. 2013 Oct;13(8):1178-87.
 

Summary:

Different foods and dietary patterns have been linked to increased or decreased cancer risk. Following a whole-food plant-based diet may offer protection against several types of cancer. REFERENCES: 1. Vineis P, Wild CP. Global cancer patterns: causes and prevention. Lancet. 2014 Feb 8;383(9916):549-57. doi:10.1016/S0140-6736(13)62224-2 2. Donaldson MS. Nutrition and cancer: a review of the evidence for an anti-cancer diet. Nutr J. 2004 Oct 20;3:19. doi:10.1186/1475-2891-3-19 3. Wilson LF, Antonsson A, Green AC, Jordan SJ, Kendall BJ, Nagle CM, et al. How many cancer cases and deaths are potentially preventable? Estimates for Australia in 2013. Int J Cancer. 2018 Feb 15;142(4):691-701. doi:10.1002/ijc.31088 4. Australian Bureau of Statistics. National Health Survey: First results. 2018. [cited 2020 Mar 6]. Available from: https://www.abs.gov.au/ausstats/abs@.nsf/mf/4364.0.55.001. 5. Australian Institute of Health and Welfare. Cancer in Australia 2019. Canberra: AIHW; 2019. [cited 2020 Mar 6]. Available from: https://www.aihw.gov.au/reports/cancer/cancer-in-australia-2019. 6. Longo VD, Fontana L. Calorie restriction and cancer prevention: metabolic and molecular mechanisms. Trends Pharmacol Sci. 2010 Feb;31(2):89-98. doi:10.1016/j.tips.2009.11.004 7. World Cancer Research Fund - American Institute for Cancer Research. Diet, Nutrition, Physical Activity and Cancer: a Global Perspective. . Internet. London: World Cancer Research Fund - American Institute for Cancer Research,; 2008. [cited Jan 06 2021]. Available from: https://www.wcrf.org/dietandcancer/contents. 8. Renehan AG, Soerjomataram I. Obesity as an Avoidable Cause of Cancer (Attributable Risks). Recent Results Cancer Res. 2016;208:243-56. doi:10.1007/978-3-319-42542-9_13 9. Wolin KY, Carson K, Colditz GA. Obesity and cancer. Oncologist. 2010;15(6):556-65. doi:10.1634/theoncologist.2009-0285 10. Bouvard V, Loomis D, Guyton KZ, Grosse Y, Ghissassi FE, Benbrahim-Tallaa L, et al. Carcinogenicity of consumption of red and processed meat. Lancet Oncol. 2015 Dec;16(16):1599-600. doi:10.1016/S1470-2045(15)00444-1 11. Pan A, Sun Q, Bernstein AM, Schulze MB, Manson JE, Stampfer MJ, et al. Red meat consumption and mortality: results from 2 prospective cohort studies. Arch Intern Med. 2012 Apr 9;172(7):555-63. doi:10.1001/archinternmed.2011.2287 12. World Health Organization. Q&A on the carcinogenicity of the consumption of red meat and processed meat. 2015. [cited 2020 Mar 6]. Available from: https://www.who.int/news-room/q-a-detail/q-a-on-the-carcinogenicity-of-the-consumption-of-red-meat-and-processed-meat. 13. Fraser GE, Jaceldo-Siegl K, Orlich M, Mashchak A, Sirirat R, Knutsen S. Dairy, soy, and risk of breast cancer: those confounded milks. Int J Epidemiol. 2020 Feb 25:1-12. doi:10.1093/ije/dyaa007 14. Aune D, Navarro Rosenblatt DA, Chan DS, Vieira AR, Vieira R, Greenwood DC, et al. Dairy products, calcium, and prostate cancer risk: a systematic review and meta-analysis of cohort studies. Am J Clin Nutr. 2015 Jan;101(1):87-117. doi:10.3945/ajcn.113.067157 15. Song Y, Chavarro JE, Cao Y, Qiu W, Mucci L, Sesso HD, et al. Whole milk intake is associated with prostate cancer-specific mortality among U.S. male physicians. J Nutr. 2013 Feb;143(2):189-96. doi:10.3945/jn.112.168484 16. Tat D, Kenfield SA, Cowan JE, Broering JM, Carroll PR, Van Blarigan EL, et al. Milk and other dairy foods in relation to prostate cancer recurrence: Data from the cancer of the prostate strategic urologic research endeavor (CaPSURE™). Prostate. 2018 Jan;78(1):32-9. doi:10.1002/pros.23441 17. Yang M, Kenfield SA, Van Blarigan EL, Wilson KM, Batista JL, Sesso HD, et al. Dairy intake after prostate cancer diagnosis in relation to disease-specific and total mortality. International journal of cancer. 2015;137(10):2462-9. doi:10.1002/ijc.29608 18. Preble I, Zhang Z, Kopp R, Garzotto M, Bobe G, Shannon J, et al. Dairy Product Consumption and Prostate Cancer Risk in the United States. Nutrients. 2019;11(7):1615. doi:10.3390/nu11071615 19. Pettersson A, Kasperzyk JL, Kenfield SA, Richman EL, Chan JM, Willett WC, et al. Milk and dairy consumption among men with prostate cancer and risk of metastases and prostate cancer death. Cancer Epidemiol Biomarkers Prev. 2012 Mar;21(3):428-36. doi:10.1158/1055-9965.EPI-11-1004 20. Messina M. Soy and Health Update: Evaluation of the Clinical and Epidemiologic Literature. Nutrients. 2016;8(12):754. doi:10.3390/nu8120754 21. Moyad MA, Stanley A Brosman. Prostate Cancer, Nutrition, and Dietary Supplements2019. [cited Jan 06 2021]. Available from: https://emedicine.medscape.com/article/453191-overview. 22. Sawada N, Iwasaki M, Yamaji T, Shimazu T, Inoue M, Tsugane S, et al. Soy and isoflavone consumption and subsequent risk of prostate cancer mortality: the Japan Public Health Center-based Prospective Study. International Journal of Epidemiology. 2020;49(5):1553-61. doi:10.1093/ije/dyaa177 23. Michaud DS, Fuchs CS, Liu S, Willett WC, Colditz GA, Giovannucci E. Dietary glycemic load, carbohydrate, sugar, and colorectal cancer risk in men and women. Cancer Epidemiol Biomarkers Prev [Internet]. 2005. [cited 2020 Mar 6]; 14(1):[138-47 pp.]. Available from: https://cebp.aacrjournals.org/content/14/1/138.long. 24. Nagle CM, Olsen CM, Ibiebele TI, Spurdle AB, Webb PM, Astralian National Endometrial Cancer Study G, et al. Glycemic index, glycemic load and endometrial cancer risk: results from the Australian National Endometrial Cancer study and an updated systematic review and meta-analysis. Eur J Nutr. 2013 Mar;52(2):705-15. doi:10.1007/s00394-012-0376-7 25. Eslamian G, Jessri M, Hajizadeh B, Ibiebele TI, Rashidkhani B. Higher glycemic index and glycemic load diet is associated with increased risk of esophageal squamous cell carcinoma: a case-control study. Nutr Res. 2013 Sep;33(9):719-25. doi:10.1016/j.nutres.2013.06.002 26. Sieri S, Agnoli C, Pala V, Grioni S, Brighenti F, Pellegrini N, et al. Dietary glycemic index, glycemic load, and cancer risk: results from the EPIC-Italy study. Sci Rep. 2017 Aug 29;7(1):9757. doi:10.1038/s41598-017-09498-2 27. Zhang Y-F, Gao H-F, Hou A-J, Zhou Y-H. Effect of omega-3 fatty acid supplementation on cancer incidence, non-vascular death, and total mortality: a meta-analysis of randomized controlled trials. BMC public health. 2014;14:204-. doi:10.1186/1471-2458-14-204 28. Fabian CJ, Kimler BF, Hursting SD. Omega-3 fatty acids for breast cancer prevention and survivorship. Breast Cancer Res. 2015 May 4;17(1):62. doi:10.1186/s13058-015-0571-6 29. Freitas RDS, Campos MM. Protective Effects of Omega-3 Fatty Acids in Cancer-Related Complications. Nutrients. 2019 Apr 26;11(5). doi:10.3390/nu11050945 30. Jung S, Spiegelman D, Baglietto L, Bernstein L, Boggs DA, van den Brandt PA, et al. Fruit and vegetable intake and risk of breast cancer by hormone receptor status. J Natl Cancer Inst. 2013 Feb 6;105(3):219-36. doi:10.1093/jnci/djs635 31. Setchell KDR. The history and basic science development of soy isoflavones. Menopause. 2017 Dec;24(12):1338-50. doi:10.1097/gme.0000000000001018 32. Nechuta SJ, Caan BJ, Chen WY, Lu W, Chen Z, Kwan ML, et al. Soy food intake after diagnosis of breast cancer and survival: an in-depth analysis of combined evidence from cohort studies of US and Chinese women. Am J Clin Nutr. 2012 Jul;96(1):123-32. doi:10.3945/ajcn.112.035972 33. Chi F, Wu R, Zeng YC, Xing R, Liu Y, Xu ZG. Post-diagnosis soy food intake and breast cancer survival: a meta-analysis of cohort studies. Asian Pac J Cancer Prev. 2013;14(4):2407-12. doi:10.7314/apjcp.2013.14.4.2407 34. Brennan SF, Cantwell MM, Cardwell CR, Velentzis LS, Woodside JV. Dietary patterns and breast cancer risk: a systematic review and meta-analysis. Am J Clin Nutr. 2010 May;91(5):1294-302. doi:10.3945/ajcn.2009.28796 35. Fiolet T, Srour B, Sellem L, Kesse-Guyot E, Alles B, Mejean C, et al. Consumption of ultra-processed foods and cancer risk: results from NutriNet-Sante prospective cohort. BMJ. 2018 Feb 14;360:k322. doi:10.1136/bmj.k322 36. Mentella MC, Scaldaferri F, Ricci C, Gasbarrini A, Miggiano GAD. Cancer and Mediterranean Diet: A Review. Nutrients. 2019;11(9):2059. doi:10.3390/nu11092059 37. Le LT, Sabate J. Beyond meatless, the health effects of vegan diets: findings from the Adventist cohorts. Nutrients. 2014 May 27;6(6):2131-47. doi:10.3390/nu6062131 38. Appleby PN, Key TJ. The long-term health of vegetarians and vegans. Proc Nutr Soc. 2016 Aug;75(3):287-93. doi:10.1017/s0029665115004334 39. Dinu M, Abbate R, Gensini GF, Casini A, Sofi F. Vegetarian, vegan diets and multiple health outcomes: A systematic review with meta-analysis of observational studies. Crit Rev Food Sci Nutr. 2017 Nov 22;57(17):3640-9. doi:10.1080/10408398.2016.1138447 40. Zhang C, Ho SC, Lin F, Cheng S, Fu J, Chen Y. Soy product and isoflavone intake and breast cancer risk defined by hormone receptor status. Cancer Sci. 2010 Feb;101(2):501-7. doi:10.1111/j.1349-7006.2009.01376.x 41. Douglas CC, Johnson SA, Arjmandi BH. Soy and its isoflavones: the truth behind the science in breast cancer. Anticancer Agents Med Chem. 2013 Oct;13(8):1178-87. doi:10.2174/18715206113139990320

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Dr. Luiz Fernando SellaMD, MPH
Author
Medical Doctor at the Federal University of Santa Catarina, Brazil, a Certified Lifestyle Medicine Physician and Health and Wellness Coach.

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