Diet, nutrition, and avoidable cancer.

In a 1981 review, Doll and Peto estimated that approximately 35% of cancer deaths in the United States were potentially avoidable by the modification of diet but that this percentage might be as low as 10% or as high as 70%. Since that time, the epidemiologic literature on diet and cancer has grown greatly, as has understanding of the mechanisms of carcinogenesis. In general, this expanded literature has not provided reason to alter the Doll and Peto estimate substantially. For colon cancer, evidence has accumulated that some of the international differences that were attributed to diet are probably due to physical activity. For breast cancer, the concept that fat intake per se is the primary reason for differences in rates among countries has not been supported by prospective studies. Although several lines of evidence suggest that caloric restriction and slow growth rates may contribute importantly to the low rates of breast cancer found outside Western countries, this may not translate directly to practical means of prevention. In contrast to breast cancer, more recent data have supported a causative role for red meat in the development of colon and prostate cancers, although perhaps not entirely due to its fat content. Whereas earlier thinking about nutrition and cancer emphasized the adverse effects of fat and other components in the diet, the most compelling evidence of the last decade has indicated the importance of protective factors, largely unidentified, in fruits and vegetables. Considering the more recent evidence, it is roughly estimated that about 32% of cancer may be avoidable by changes in diet; however, it now seems unlikely that less than 20% or more than 42% of cancer deaths would be avoidable by dietary change.