Can Diet & Lifestyle Choices Lower the Risk?

The first time I casually crossed my arms across my chest and felt the small lump just outside my right armpit, I shrugged it off. We were packing up to go camping for my 36th birthday, and I also had some last-minute race prep to do for a big four-day bike race the following weekend. In other words, I was too busy—and, I thought, too healthy and too young—to worry about the pea-size bump neatly bisected by the seam of my sports bra.

Six weeks later, I was diagnosed with early-onset breast cancer. I kept racing my bike as my oncologists mapped out my treatment plan—a lumpectomy, followed by four rounds of chemo and six weeks of radiation, plus 10 years of endocrine therapy—until the stitches from surgeries and biopsies made racing impossible. I kept riding, though, seeking to hold tight to the version of myself I knew best: strong, active, capable and, most of all, healthy—even as my oncologists gently explained that, due to my relatively young age and the fact that a tiny bit of cancer had spread to one of my lymph nodes, treatment would be aggressive and I would probably be pretty sick for at least a few months. 

I listened, but rebelled against the advice to “stay active by taking a short walk each day,” as recommended by all of the older women wearing pink and looking hopeful in the brochures my doctors shared with me. Instead, inspired by gold medal-winning Olympian Kikkan Randall, a professional Nordic skier who was diagnosed with breast cancer a few months before I was, I kept working out. I skied, hiked, played pond hockey, did yoga, lifted weights and went running, even as my hair fell out and the treatment sapped my usual energy. But my favorite flex on my diagnosis was to show up via bike to the cancer center in Vermont, where I did my treatment, taking joy in bringing the mud and vitality generated by my two-wheeled commute into the sterile environment of the hospital. 

Back in 2019, I always appeared to be the youngest person in the room. But just last month, four out of the five women with me in the high-risk diagnostic mammography waiting room were my peers—or possibly younger. The data corroborates my observation: The rates of women under 40 being diagnosed with breast cancer have risen by 16% since the 1990s.  

The same is true for other types of early-onset cancers, including prostate, endometrial, colorectal and cervical. According to a study published last summer in The Lancet Public Health, cancer rates are rising significantly in younger people in the U.S., with 17 out of 34 types of cancer showing a noticeable uptick in incidence for people falling into the Gen X or millennial generations. A 2024 report published by the American Cancer Society found an overall increase in new cancer diagnoses (from 1.9 million in 2022 to over 2 million in 2023), with younger adults making up the majority of new cases. 

Clearly, we have a problem. Some of the increase is due to better and earlier routine cancer screenings. (Annual mammograms are now recommended starting at age 40 rather than 45, for example.) But for people like me—diagnosed young, at the peak of good health and with no diagnosable genetic component (I tested negative for breast cancer susceptibility genes, or BRCA, which is the most common inherited cause of breast cancer), a cancer diagnosis is a mystery. Yet breast cancer is a through-line connecting my great-grandmother, my great-aunt, my grandmother, my mom and me, all of us BRCA-negative breast cancer survivors, and all born and raised within a 10-mile radius.

I can’t change my family history or the environment I was raised in. But with cancer diagnoses on the rise among young people, I have to wonder: are there risk factors that we can control? I decided to dig into the latest science and talk with oncology nutrition experts to understand what risk factors might be contributing to these troubling statistics—and what we can do about it. They all pointed to these big four: smoking, drinking, exercise and diet.

The Connection Between Smoking, Drinking, Obesity and Cancer

Tobacco is responsible for up to 40% of all cancer deaths in the U.S. This isn’t a surprise; we’ve known since the ’60s that smoking causes cancer. But more recently, alcohol officially earned its own place on the list of cancer-causing substances after researchers found it increased your risk of developing seven different types of cancer, including mouth, breast and colon. Just last month, the U.S. Surgeon General called on Congress to require health warning labels on alcohol—yes, just like the health warnings you see on packs of cigarettes. While moderation with alcohol intake has been encouraged for some time, newer research has shown that any amount of alcohol may increase your cancer risk. That’s a bummer for anyone who enjoys a good IPA or a glass of wine. But for people with high-risk genetic profiles, finally knowing that alcohol does increase your risk for some cancers may help them make more informed decisions—or at least provide a bit of insight, should they get diagnosed down the road.

But there’s a third major risk factor for some types of cancer that isn’t talked about often enough, and that’s having a higher body weight in either the overweight or obese BMI category. Researchers estimate that about 18% of cancer cases and 16% of cancer deaths in the U.S. can be linked to the combined effects of alcohol, physical inactivity, a diet low in nutrient-dense foods (lacking in fruits, vegetables, whole grains and beans) and a diagnosis of overweight or obesity.

A specific diagnosis of obesity is convincingly associated with an increased risk for 13 cancers, mostly digestive-system cancers (stomach, esophageal, liver, gallbladder and pancreatic), as well as kidney, endometrial and ovarian cancer. Together, these cancers make up 40% of all cancers diagnosed in the U.S. each year, with the rate of new cancers associated with obesity growing each year. And new research published in JAMA Network Open found that people diagnosed with obesity when they received their first cancer diagnosis were more likely to develop a second primary cancer, particularly an obesity-related type of cancer like the ones listed above.

Women carry a higher burden of risk for cancers where a diagnosis of obesity is a risk factor. The Centers for Disease Control and Prevention estimates that of the 693,000 obesity-associated cancers diagnosed in the U.S. each year, 69% are in women. It’s also worth acknowledging—loudly—that lower socioeconomic status is closely linked to structural barriers that often culminate in a diagnosis of obesity. If you don’t have access to fresh foods, the luxury of time and a safe space to exercise, or the resources to pursue healthier habits, maintaining a healthy weight may feel out of reach.

Is There an Anticancer Diet?

So, what can we do to lower our risks of developing cancer? Not smoke or drink, for one. Increase our levels of physical activity, for two, by striving to meet the goal set down in the Physical Activity Guidelines for Americans: getting at least 150 minutes of moderate-intensity activity per week. We can wear sunscreen. And finally, we can follow a healthy diet, which may decrease our risk of developing cancer by as much as 40%.

But is there such a thing as an “anticancer diet”? Well, yes—and no. You can talk about “superfoods” until you’re blue in the face, but there is no single food—or even food group—that can prevent cancer. 

Yet, what you eat (or don’t eat) can significantly impact your risk. For that reason, when we talk about an anticancer diet, we’re really talking about the bigger picture: how your diet affects your overall health. 

This might feel like a letdown if you were hoping to thwart cancer by eating nothing but cruciferous vegetables and antioxidant-rich berries for the rest of your life. And while there are foods that may have cancer-protective effects, preventing cancer through food is a little more nuanced than that.

Hannah Dalpiaz, RD, LDN, a senior oncology dietitian at Dana-Farber Cancer Institute, is an expert at transforming vague statements like “eat a healthy diet” into nutrition plans for people affected by cancer. She works with people in active treatment and recovery and with people like me who have genetic predispositions toward getting cancer. 

I challenged her to come up with some recommendations for “pre-cancer Lindsay”—young and healthy but under the shadow of a cancer-filled family history. Dalpiaz pointed me toward the American Institute for Cancer Research’s 10 Recommendations for Cancer Prevention. 

Some of these guidelines aren’t surprising. They encourage you to make healthy lifestyle choices—eating a diet rich in whole grains, vegetables, fruits and beans; exercising; and maintaining a healthy weight all make the list. Yet, they also include a few specific callouts of what not to eat.

Some advice, like limiting the consumption of “fast food” or other processed foods or drinks that are high in saturated fat, starches or added sugar, is directly associated with lower levels of visceral body fat. It’s not that all fat, starches and sugar are bad, but that consuming too much of these can not only lead to weight gain but also increase the risk of chronic diseases. Other guidance includes avoiding alcohol and eating no more than 12 to 18 ounces of red meat per week. One recommendation in particular—eating little, if any, processed meat—is directly related to reducing the risk of colorectal cancer.

There’s some wiggle room within those recommendations, Dalpiaz notes. For example, while eating more than 18 ounces of red meat a week may statistically increase your risk, even a moderate reduction—as little as 2 ounces—can make a difference. “It’s not all or nothing, and in small amounts, eating red meat can be OK,” she says.

The same is not true of processed meats, though, which Dalpiaz equates to alcohol consumption: There is not necessarily a safe amount. Yet, she says, it’s important to consider your risks based on all the factors at play before deciding whether to scale back or add something in. 

“It’s not always reductive,” Dalpiaz says. “Sometimes we look to add or enhance rather than eliminate. So maybe the focus is on eating more vegetables, having fruit as a snack, or trying to eat more fiber, which most Americans don’t get enough of.”

And that’s likely why the guidelines recommend the New American Plate, which suggests filling two-thirds of your plate with vegetables, fruits, whole grains and beans, and one-third or less with a serving of animal protein.

“Eating more fruits, vegetables and whole grains is my most frequent recommendation,” Dalpiaz says. “There is never one single food that is inferior or superior. Sometimes people say, ‘Oh, this is the food you have to eat if you don’t want to get cancer,’ and while foods do have different properties and unique phytocompounds that work in tandem, there’s no one food that is the food for preventing cancer.”

Foods That Help Reduce Your Cancer Risk

Even if an anticancer diet doesn’t exist, there are some foods you can add that may help reduce your overall risk.

Cruciferous & Dark Green Leafy Vegetables

Cruciferous and dark green leafy vegetables—like broccoli, cabbage, bok choy, arugula, radishes, turnips and kale, among others—are good sources of sulforaphane, a naturally occurring plant compound in the isothiocyanates family that has anti-inflammatory and antioxidant properties. According to a study published last year, sulforaphane works in two ways: by protecting your cells against oxidative damage, the type of damage that can lead to cancer development, and by actually causing the death of tumor cells, called apoptosis. So, incorporating these vegetables into your diet may help prevent cancer—and if you happen to be diagnosed, cruciferous vegetables may also be a powerful ally in your treatment plan. 

Berries

In general, people who eat more fruits have a lower risk of a wide range of cancer types, likely as part of a combined protection you get from the nutrients they contain, such as vitamin C, ellagitannins, urolithins, flavonoids and fiber. And berries, in particular, are high on the list when it comes to these nutrients. Berries are not only delicious, but studies suggest that the phytochemicals (active compounds) they contain may play a powerful role in delaying cancer development and progression. While human research is ongoing, one study shows that the phytochemicals in berries could help aid cancer immune therapies by improving your T-cells’ (part of your immune system) ability to recognize—and potentially destroy—tumor cells. This mechanism may also provide protective effects against cancer.

Dark Red, Purple & Blue Produce

Dark red, purple and blue produce—like grapes, apples, eggplant, red onions, plums, red and purple cabbage, as well as several types of berries—are rich in anthocyanins, or flavonoids, two types of antioxidants that may have protective effects against cancer. Flavonoids help defend plants against pathogens and UV radiation, and research has shown that they may help prevent cell damage, reduce inflammation, inhibit cancer cell growth, and even cause cancer cells to die off.

Yellow, Orange & Red Fruits & Vegetables

Similarly, mangoes, cantaloupes, oranges, sweet potatoes, carrots and other bright yellow, red and orange fruits and vegetables—are high in carotenoids, which are potent antioxidants with protective qualities. One study from 2008 showed that higher levels of carotenoids in the blood might be linked to lower risks for prostate, breast, lung, colorectal, endometrial, ovarian, cervical, pancreatic, stomach and neck cancers. However, more up-to-date research is needed to confirm this claim. Carotenoids may also be particularly impactful for people at higher risk for breast cancer. According to a review, higher concentrations of carotenoids were strongly associated with a lower risk of breast cancer, particularly for women who didn’t smoke and didn’t have a diagnosis of obesity.

Legumes

Legumes—beans, peas, lentils and more—are budget-friendly, highly versatile and very nutritious. Additionally, some research has shown that eating them regularly may reduce your risk of certain types of cancer, particularly colorectal cancer. In a study published last year, researchers found that people who ate at least one serving of legumes per week were 26% less likely to develop colorectal cancer in the future. And in this case, more is more, as each additional serving of legumes you eat per week is associated with a 15% decrease in colorectal cancer risk. To reap the health benefits of legumes, also known as pulses, the Dietary Guidelines for Americans recommend eating at least 1.5 cups of beans and lentils per week.

Related: Are Beans Good For You?

Nuts

Tree nuts and peanuts are mostly known for their plant-based protein and healthy fat content. But they provide more than that. Nuts are packed with phytochemicals and various vitamins and minerals, which have anti-inflammatory, antioxidant and anticarcinogenic properties. In fact, research shows that nuts may not only help reduce your risk of getting cancer but also your risk of dying from it. Eating 28 grams of nuts (about ¼ cup) daily has been associated with a 21% reduced rate of cancer mortality. Additionally, there’s some evidence that frequently eating nuts might improve survival outcomes among people with certain types of cancer, such as colorectal, breast and prostate. But more studies are needed.

Fermented Foods

Fermented foods such as sauerkraut, kimchi and strained (Greek-style) yogurt can help to build up your gut microbiome. This gut microbiome is made up of microorganisms that play an important role in almost every system of your body, from supporting your brain and digestive health to improving your immune function. And research has shown that these beneficial microbes may help prevent cancer, support your treatment and reduce the likelihood of recurrence.

How Lifestyle Impacts Cancer Risk

There’s no way to know—or to control—all of the factors that go into a cancer diagnosis. But the evidence for pursuing a cancer-preventive lifestyle is compelling.

The American Cancer Society’s 2024 Facts and Figures document perhaps says it best: “Aside from avoiding tobacco use, maintaining a healthy body weight, being physically active, consuming a healthy diet, and avoiding or limiting alcohol intake are the most effective strategies for reducing cancer risk.”  

The mounting evidence has been so strong that, in 2020, the American Cancer Society released new diet and activity guidelines for reducing cancer risk. According to follow-up research, people following those recommendations, which are aligned with the AICR’s, may be 10% to 20% less likely to be diagnosed with cancer and 25% less likely to die from it. And if you’re diagnosed with cancer, don’t stop exercising if it is already part of your routine. If you haven’t been active, try to incorporate any type of movement you enjoy into your day. However, it’s always best to ask your doctor to make sure that incorporating some sort of physical activity is right for you. Staying active can help keep you strong, reduce anxiety and fatigue, and improve sleep and quality of life—all important factors that help make your diagnosis and treatment more bearable.

The Bottom Line

There is no one food that will cause, cure or prevent cancer on its own. But certain habits, such as eating a colorful diet rich in fruits, vegetables, nuts and legumes, avoiding smoking and alcohol, staying active and maintaining a healthy weight, can help reduce your risk. And remember that small changes can yield significant benefits—it’s never too late to start! 

Start by topping a salad with crunchy oven-roasted chickpeas instead of bacon bits, for example, or enjoy a fancy mocktail instead of a gin and tonic. Go for a walk or a run, even if it’s only for 10 to 15 minutes. Make it a goal to eat more fermented foods to help reduce your cancer risk. That promise is enough to make me reach for strained (Greek-style) yogurt instead of cereal with milk in the morning, and to top my eggs with kimchi instead of hot sauce.

And for cancer survivors like me—and for all of you out there who I’m rooting for—that’s really the goal: reducing risks where I can and bolstering my overall health by making good daily lifestyle choices. I’m almost six years out from the day I rode my bike to the hospital for my final radiation session, and so far, so good. My nurses and oncologists cheered as I rang the bell, signifying the end of my active cancer treatment that day in early May of 2019, then waved me off as I swung a leg over the saddle and pedaled home.

I suspect that until they can map the gene that’s responsible for my family’s cancer legacy, my diagnosis at age 36 will remain a mystery. But by focusing on the factors I can manage—both for me and for our 2-year-old daughter—I’m doing everything I can. And if that means more chickpeas and fewer steaks or opting for a mocktail over a margarita, I’m all in. And if I’m on a bike, you’d better believe I’m taking the long way home.