The Cancer Research
The link between cruciferous vegetables and cancer prevention is relatively well-studied.
Lab studies showed several ways that sulforaphane, formed from glucosinolates in broccoli, could thwart the development and progression of prostate cancer. Limited human intervention trials support this potential, however, population studies that followed men for 9 to 22 years showed no link with total – or any form – of prostate cancer so far.
Interpreting the data
After a systematic review of the global scientific literature, AICR/WCRF analyzed how vegetables and their nutrients affect the risk of developing cancer.
“Convincing” or “probable” evidence means there is strong research showing a causal relationship to cancer—either decreasing or increasing the risk. The research must include quality human studies that meet specific criteria and biological explanations for the findings.
A convincing or probable judgement is strong enough to justify recommendations.
- There is probable evidence that foods containing dietary fiber DECREASE the risk of:
- Colorectal cancer
- Weight gain, overweight and obesity*
*This is important, because there is strong evidence that excess body fat increases the risk of at least 12 different cancers.
- There is probable evidence that non-starchy vegetables and fruit combined DECREASE the risk of:
- Aerodigestive cancers overall (such as mouth, pharynx and larynx; esophageal; lung; stomach and colorectal cancers)
“Limited suggestive” evidence means results are generally consistent in overall conclusions, but it’s rarely strong enough to justify recommendations to reduce risk of cancer.
- Limited evidence suggests that foods containing carotenoids may DECREASE the risk of:
- Lung and estrogen receptor-negative (ER-) breast cancers
- Limited evidence suggests that foods containing beta-carotene may DECREASE the risk of:
- Lung cancer
- Limited evidence suggests that foods containing vitamin C may DECREASE the risk of:
- Lung cancer (in people who smoke) and colon cancer
- Limited evidence suggests that non-starchy vegetables may DECREASE the risk of:
- Estrogen receptor-negative (ER-) breast cancer
- Limited evidence suggests that non-starchy vegetables and fruits combined may DECREASE the risk of:
- Bladder cancer
Ongoing Areas of Investigation
- Laboratory Research
Carotenoids act as antioxidants themselves and stimulate the body’s own antioxidant defenses, decreasing free radical damage to DNA that can lead to cancer. Very high levels in cell studies, however, can have an opposite effect, promoting damage from oxidation.
- Beta-carotene and lutein promote cell-to-cell communication that helps control cell growth. These carotenoids also increase carcinogen-metabolizing enzymes and stimulate self-destruction of abnormal cells. The body uses beta-carotene to form vitamin A, which helps protect against cancer through the immune system and expression of genes that regulate cell growth.
- Lutein and zeaxanthin are antioxidants that are especially concentrated in the eyes, brain and skin. Limited animal studies suggest that they may help protect against skin cancer related to sun exposure.
Vitamin C is a powerful antioxidant. In lab studies, it protects cells’ DNA by trapping free radicals, and it helps renew the antioxidant ability of Vitamin E. In cell studies, vitamin C also inhibits the formation of carcinogens and supports the immune system.
Glucosinolates in vegetables are broken down into isothiocyanates (such as sulforaphane) and indoles. In laboratory studies, these compounds decrease inflammation that could cause cell damage leading to cancer. They also inhibit enzymes that activate carcinogens and stimulate enzymes that de-activate carcinogens. These compounds turn on tumor suppressor genes, slow abnormal cell growth and stimulate self-destruction of abnormal cells.
- Indole compounds decrease development of breast cancer in cell and animal studies. In some studies, indoles shift the active form of estrogen into a weaker form. (High amounts of estrogen are a risk factor for certain hormone-linked cancers).
Folate helps maintain healthy DNA and keeps cancer-promoting genes “turned off”. Animal studies, however, suggest that exceptionally high amounts or intervention after cancer cells have formed might promote development of cancer.
Flavonols like kaempferol and quercetin influence gene expression and cell signaling in ways that increase antioxidant, anti-inflammatory and carcinogen-deactivating enzymes in cell and animal studies. They inhibit cancer cells’ growth and ability to spread, and activate signaling that leads to self-destruction of abnormal cells.20,24
They dial down the expression of oncogenes (genes that have the potential to cause increased cell growth that can lead to cancer) and increase expression of tumor suppressor genes.20
- Human Studies
People who eat more vegetables and fruits have lower risk of a wide range of cancers. This probably reflects combined protection from many different nutrients and compounds they contain.
Analysis from two large cohorts combined that was published after the AICR/WCRF Third Expert Report showed a lower risk of breast cancer with more than 5.5 servings/day total vegetable and fruit intake versus 2.5 or fewer servings (RR 0.89, CI 0.83-0.96).
Carotenoids: In population studies, higher blood levels of total carotenoids and beta-carotene are linked with a lower risk of overall cancer. Blood levels may more accurately reflect the consumption of carotenoid-rich foods than diet questionnaires, and they include differences in how much is absorbed from food. However, it may be that the lower cancer risk is seen because blood levels of these compounds are recognized as signals of greater overall vegetable and fruit consumption.
- Lung cancer: Population studies link higher dietary and blood levels of beta-carotene or total carotenoids with a lower risk of lung cancer. Larger studies now show protection less clearly than earlier studies, and the AICR/WCRF Third Expert Report categorizes this link as Limited Suggestive. Additional research is needed. Despite these findings, beta-carotene in high-dose supplements increases lung cancer risk when taken by people who smoke or used to smoke tobacco, according to evidence rated convincing in the AICR/WCRF Third Expert Report.
- Breast cancer: Some population studies also link higher blood levels of carotenoids (including beta-carotene) to lower risk of breast cancer, mainly for estrogen receptor-negative (ER-) forms. The AICR/WCRF Third Expert Report categorized this link as Limited Suggestive. It is possible that an effect of carotenoids on ER-positive (ER+) tumors is simply masked by the hormonal influences that dominate risk of ER+ breast cancer.
Vitamin C: Population studies comparing people with higher and lower levels of vitamin C in their diets, and especially levels circulating in their blood, link higher amounts with lower overall risk of cancer. This effect is larger comparing people with very low levels to moderately increased levels than comparing people with moderate and much higher levels.
Higher levels of vitamin C from foods are linked with lower risk of lung cancer among people who smoke tobacco, although not in those who used to smoke or who have never smoked. People with more vitamin C in their diet are also less likely to develop colon cancer. That’s even after adjusting for other risk factors for colon cancer, such as alcohol, red meat and tobacco. Evidence for both lung and colon cancer is rated as Limited Suggestive in the AICR/WCRF Third Expert Report, and more research is needed.
Cruciferous vegetables: An analysis that combined several population studies showed an association of cruciferous vegetables with reduced overall cancer risk, although there are inconsistencies between studies. Part of the inconsistent findings may stem from genetic differences that allow isothiocyanate compounds to stay in the body longer in some people than in others. Differences in microbes that make up the gut microbiota can lead also to differences in compounds people absorb. Human studies are also complicated to interpret because people who eat the same amount of cruciferous vegetables may get different amounts of protective nutrients and compounds depending on how the vegetables are prepared.
- Prostate cancer: An analysis of 13 observational population studies reported higher cruciferous vegetable consumption associated with lower prostate cancer incidence. However, when looking only at studies less likely to be affected by bias (prospective cohort studies), no association was seen. In analysis for the AICR/WCRF Continuous Update Project, no significant association was seen for total prostate cancer or for advanced forms specifically.
- Breast cancer: Analysis from two large cohorts combined that was published after the AICR/WCRF report publication found cruciferous vegetables associated with lower risk of breast cancer. This is consistent with the lower risk of post-menopausal breast cancer (but not pre-menopausal cancer) with high cruciferous vegetables in an earlier analysis that included some prospective cohort studies. More research is needed to understand this possible association.
Folate: Research on folate and cancer is challenging to interpret, since effects may differ based on time in the cancer process, amount consumed and individual genetic differences. Levels of folate from food and in the blood that are too low are linked with greater risk of several forms of cancer in some population studies. However, excess folic acid from randomized controlled trials with supplements has increased risk of some cancers. (Folic acid is the form of folate in supplements and fortified foods.) More research is needed to understand the amounts that are high enough to pose risk.
- AICR-Supported Studies
- Tips for Selection, Storage and Preparation
- Choose compact, firm heads heavy for their size with no soft spots and no off-odors.
- Green leaves should be fresh and firm with no yellowing.
- Turnips are sweetest when small.
- Wait to wash until just before use.
- Cook just until tender-crisp, with greens still bright. Overcooking leads to strong odors and a less attractive color.
- Add to soup, or make them the star on their own.
- Broccoli and other cruciferous veggies can also be delicious served raw. Try cauliflower or broccoli dipped in hummus or a spicy peanut butter sauce.
From the Blog
In the News
- Livingstone TL, Beasy G, Mills RD, et al. Plant Bioactives and the Prevention of Prostate Cancer: Evidence from Human Studies. Nutrients. 2019;11(9):2245.
- Petimar J, Wilson KM, Wu K, et al. A Pooled Analysis of 15 Prospective Cohort Studies on the Association between Fruit, Vegetable, and Mature Bean Consumption and Risk of Prostate Cancer. Cancer Epidemiology Biomarkers & Prevention. 2017;26(8):1276-1287.
- Baenas N, Marhuenda J, García-Viguera C, Zafrilla P, Moreno DA. Influence of Cooking Methods on Glucosinolates and Isothiocyanates Content in Novel Cruciferous Foods. Foods (Basel, Switzerland). 2019;8(7):257.
- Nugrahedi PY, Verkerk R, Widianarko B, Dekker M. A Mechanistic Perspective on Process-Induced Changes in Glucosinolate Content in Brassica Vegetables: A Review. Crit Rev Food Sci Nutr. 2015;55(6):823-838.
- Oliviero T, Verkerk R, Dekker M. Isothiocyanates from Brassica Vegetables—Effects of Processing, Cooking, Mastication, and Digestion. Mol Nutr Food Res. 2018;62(18):1701069.
- Soares A, Carrascosa C, Raposo A. Influence of Different Cooking Methods on the Concentration of Glucosinolates and Vitamin C in Broccoli. Food and Bioprocess Technology. 2017;10(8):1387-1411.
- World Cancer Research Fund / American Institute for Cancer Research. Continuous Update Project Expert Report 2018. Wholegrains, vegetables and fruit and the risk of cancer. Available at: dietandcancerreport.org.
- Bohn T. Carotenoids, Chronic Disease Prevention and Dietary Recommendations. International Journal for Vitamin and Nutrition Research. 2017;87(3-4):121-130.
- Kaulmann A, Bohn T. Carotenoids, inflammation, and oxidative stress–implications of cellular signaling pathways and relation to chronic disease prevention. Nutr Res. 2014;34(11):907-929.
- Bouayed J, Bohn T. Exogenous antioxidants – Double-edged swords in cellular redox state: Health beneficial effects at physiologic doses versus deleterious effects at high doses. Oxid Med Cell Longev. 2010;3(4):228-237.
- Buscemi S, Corleo D, Di Pace F, Petroni ML, Satriano A, Marchesini G. The Effect of Lutein on Eye and Extra-Eye Health. Nutrients. 2018;10(9):1321.
- Thomas SE, Johnson EJ. Xanthophylls. Advances in Nutrition. 2018;9(2):160-162.
- Moran NE, Mohn ES, Hason N, Erdman JW, Jr, Johnson EJ. Intrinsic and Extrinsic Factors Impacting Absorption, Metabolism, and Health Effects of Dietary Carotenoids. Advances in Nutrition. 2018;9(4):465-492.
- Balic A, Mokos M. Do We Utilize Our Knowledge of the Skin Protective Effects of Carotenoids Enough? Antioxidants (Basel). 2019;8(8):259.
- Institute of Medicine. Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids. Washington, D.C. : National Academies Press;2000.
- Lu JM, Lin PH, Yao Q, Chen C. Chemical and molecular mechanisms of antioxidants: experimental approaches and model systems. Journal of cellular and molecular medicine. 2010;14(4):840–860.
- Lachance JC, Radhakrishnan S, Madiwale G, Guerrier S, Vanamala JKP. Targeting hallmarks of cancer with a food-system–based approach. Nutrition. 2020;69:110563.
- Li W, Guo Y, Zhang C, et al. Dietary Phytochemicals and Cancer Chemoprevention: A Perspective on Oxidative Stress, Inflammation, and Epigenetics. Chem Res Toxicol. 2016;29(12):2071-2095.
- Gupta P, Kim B, Kim SH, Srivastava SK. Molecular targets of isothiocyanates in cancer: recent advances. Mol Nutr Food Res. 2014;58(8):1685-1707.
- Montgomery M, Srinivasan A. Epigenetic Gene Regulation by Dietary Compounds in Cancer Prevention. Advances in Nutrition. 2019;10(6):1012-1028.
- Bishop KS, Ferguson LR. The interaction between epigenetics, nutrition and the development of cancer. Nutrients. 2015;7(2):922-947.
- Thomson CA, Ho E, Strom MB. Chemopreventive properties of 3,3′-diindolylmethane in breast cancer: evidence from experimental and human studies. Nutr Rev. 2016;74(7):432-443.
- Pieroth R, Paver S, Day S, Lammersfeld C. Folate and Its Impact on Cancer Risk. Current Nutrition Reports. 2018;7(3):70-84.
- Gibellini L, Pinti M, Nasi M, et al. Quercetin and cancer chemoprevention. Evid Based Complement Alternat Med. 2011;2011:591356.
- Aune D. Plant Foods, Antioxidant Biomarkers, and the Risk of Cardiovascular Disease, Cancer, and Mortality: A Review of the Evidence. Advances in Nutrition. 2019;10(Supplement_4):S404-S421.
- Farvid MS, Chen WY, Rosner BA, Tamimi RM, Willett WC, Eliassen AH. Fruit and vegetable consumption and breast cancer incidence: Repeated measures over 30 years of follow-up. International Journal of Cancer. 2019;144:1496-1510.
- Aune D, Keum N, Giovannucci E, et al. Dietary intake and blood concentrations of antioxidants and the risk of cardiovascular disease, total cancer, and all-cause mortality: a systematic review and dose-response meta-analysis of prospective studies. Am J Clin Nutr. 2018;108(5):1069-1091.
- World Cancer Research Fund/American Institute of Cancer Research. Continuous Update Project Expert Report 2018. Other dietary exposures and the risk of cancer. (Including Systematic Literature Reviews) Available Available at dietandcancerreport.com.
- Aune D, Giovannucci E, Boffetta P, et al. Fruit and vegetable intake and the risk of cardiovascular disease, total cancer and all-cause mortality—a systematic review and dose-response meta-analysis of prospective studies. Int J Epidemiol. 2017;46(3):1029-1056.
- Gerhauser C. Impact of dietary gut microbial metabolites on the epigenome. Philosophical Transactions of the Royal Society B: Biological Sciences. 2018;373(1748):20170359.
- Liu B, Mao Q, Cao M, Xie L. Cruciferous vegetables intake and risk of prostate cancer: A meta-analysis. International Journal of Urology. 2012;19(2):134-141.
- Norat T, Vieira AR, Chan D, et al. The Associations Between Food, Nutrition and Physical Activity and the Risk of Prostate Cancer. WCRF/AICR Systematic Literature Review Continuous Update Project Report. London: World Cancer Research Fund / American Institute for Cancer Research;2014.
- Liu X, Lv K. Cruciferous vegetables intake is inversely associated with risk of breast cancer: A meta-analysis. The Breast. 2013;22(3):309-313.
- Kim Y-I. Folate and cancer: a tale of Dr. Jekyll and Mr. Hyde? Am J Clin Nutr. 2018;107(2):139-142.
- Folate: Fact Sheet for Health Professionals. Office of Dietary Supplements, National Institutes of Health Available at: https://ods.od.nih.gov/factsheets/Folate-HealthProfessional/Updated July 19, 2019. Accessed December 9, 2019.