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The current literature suggests that approximately half to two thirds of those diag- nosed with breast cancer handle it well psychologically (Baker, Marcellus, Zabora, Pol- land, Jodrey, 1997; Spiegel, 1996). In fact, some individuals with a history of cancer report renewed vigor in their approach to life, and stronger interpersonal relationships (Anderson, 1986; Cella & Tross, 1986). For example, Tempelaar and colleagues (1989) found that cancer patients reported more positive and fewer negative social experiences than a comparison group of healthy “normals.” Further, Collins and colleagues (1990) interviewed 55 cancer patients who were within five years of the initial diagnosis or cancer recurrence and found widespread reports of. | Public Health Nutrition 7 1A 187-200 DOI 10.1079 PHN2003588 Diet nutrition and the prevention of cancer Timothy J Key1 Arthur Schatzkin2 Walter C Willett3 Naomi E Allen1 Elizabeth A Spencer1 and Ruth C Travis1 1Cancer Research UK Epidemiology Unit University of Oxford Oxford UK 2Nutritional Epidemiology Branch Division of Cancer Epidemiology and Genetics National Cancer Institute Bethesda USA 3Departments of Epidemiology and Nutrition Harvard School of Public Health Boston USA Abstract Objective To assess the epidemiological evidence on diet and cancer and make public health recommendations. Design Review of published studies concentrating on recent systematic reviews meta-analyses and large prospective studies. Conclusions and recommendations Overweight obesity increases the risk for cancers of the oesophagus adenocarcinoma colorectum breast postmenopausal endometrium and kidney body weight should be maintained in the body mass index range of 18.5-25 kg m2 and weight gain in adulthood avoided. Alcohol causes cancers of the oral cavity pharynx oesophagus and liver and a small increase in the risk for breast cancer if consumed alcohol intake should not exceed 2 units d. Aflatoxin in foods causes liver cancer although its importance in the absence of hepatitis virus infections is not clear exposure to aflatoxin in foods should be minimised. Chinese-style salted fish increases the risk for nasopharyngeal cancer particularly if eaten during childhood and should be eaten only in moderation. Fruits and vegetables probably reduce the risk for cancers of the oral cavity oesophagus stomach and colorectum and diets should include at least 400 g d of total fruits and vegetables. Preserved meat and red meat probably increase the risk for colorectal cancer if eaten consumption of these foods should be moderate. Salt preserved foods and high salt intake probably increase the risk for stomach cancer overall consumption of salt preserved foods and salt should be moderate. Very hot
