The Cancer Research
One of the top fruit choices in the U.S., and the most popular citrus fruit, oranges may provide antioxidant and other forms of protection against cancer. One thing unique about oranges is that far more are consumed as juice than as fresh whole fruit. More research is needed to clarify how any differences in nutrient, phytocompound and fiber content could influence the cancer protection you get.
Interpreting the data
After a systematic review of the global scientific literature, AICR/WCRF analyzed how fruits 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
- 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 fruit may DECREASE the risk of:
- Lung cancer (in people who smoke or used to smoke tobacco) and squamous cell esophageal cancer
- Limited evidence suggests that citrus fruits may DECREASE the risk of:
- Stomach cancer (cardia type only)
- 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 and fruit combined may DECREASE the risk of:
- Bladder cancer
Ongoing Areas of Investigation
- Laboratory Research
Oranges contain a variety of nutrients and phytocompounds that show potential to protect against cancer in laboratory studies.
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 formation of carcinogens and supports the immune system.1,2
Flavanones (such as oranges’ hesperidin) 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.3,4 In these laboratory studies, flavanones dial down expression of oncogenes (genes that have potential to cause increased cell growth that can lead to cancer) and increase expression of tumor suppressor genes.3,5
Terpenes function as antioxidants in cell studies. They also decrease growth and reproduction of isolated cancer cells.6 These terpenes, mainly limonene, lie in oranges’ essential oils, which are found in tiny sacs in the flavedo (the outer colored portion of the peel). It’s possible that cold-pressed juice from juice extractors would provide some amount of these terpene compounds, but it’s not clear how the amount would compare to amounts effective in laboratory studies, and eating the fruit (without the peel) would not provide these compounds.
- Human Studies
Human studies related to oranges and cancer risk compare groups of people who consume relatively high and low amounts of total fruit, citrus fruit, or nutrients found in oranges.
People who eat more fruits have lower risk of a wide range of cancers.7,8 This probably reflects combined protection from many different nutrients and compounds they contain.
Citrus fruit: Limited evidence ties citrus fruit specifically to lower risk of stomach cancer, according to the AICR/WCRF Third Expert Report.7 Analysis for the report also links citrus fruit consumption and lower risk of lung cancer, but relatively large variation in results of different studies (heterogeneity) means that further research is needed.9
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.8,10 This effect is greater comparing people with very low levels to moderately increased levels than comparing people with moderate to 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.7 People with more vitamin C in their diet are also associated with less likely to develop colon cancer.7 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.
Dietary Fiber: Observational population studies link high dietary fiber consumption with reduced risk of colorectal cancer.16,17 Analyses combining 16 to 20 prospective cohort studies also link dietary fiber with lower risk of breast cancer.18-20 However, analysis for the AICR/WCRF Third Expert Report evaluated potential for an association of dietary fiber with this and several other cancers, and found the evidence too limited to support a conclusion.19,21
- Viscous fiber is a type of soluble dietary fiber that forms a gel in the digestive tract, slowing action of digestive enzymes and thus slowing the rise in blood sugar after eating.22-26 By helping to reduce insulin resistance and elevated levels of insulin, this could potentially help reduce cancer risk. Viscous fiber’s actions in the gut may also contribute to reducing circulating estrogen levels.27 Such effects could help explain why some studies link greater soluble dietary fiber and lower breast cancer risk.18,19
- Foods containing dietary fiber probably reduce risk of weight gain, overweight and obesity.28 Some studies suggest that viscous fiber like that in flaxseed may contribute to this effect by increasing feeling of fullness.28 By supporting a healthy weight, foods rich in fiber indirectly contribute to lower risk of the 12 or more cancers related to excess body fat.
- Common Questions
Q: Does orange juice provide the same nutrients and phytocompounds as eating an orange, or are healthful components lost in processing?
A: Consuming most of your fruit consumption as solid, whole fruit instead of juice is recommended — but headline hype suggesting that even 100% orange juice is nothing but sugar is untrue.
Fiber and Phytocompounds: Solid fruit provides dietary fiber – important for reducing cancer risk – that is missing from juice. But contrary to common belief, eating the solid fruit does not necessarily provide you with more of the fruit’s phytocompounds. Many phytocompounds found in oranges are especially concentrated in the peel. Commercial production of orange juice includes the peel in the juicing process, and these compounds are present in 100% juice.11 Although some processing methods may decrease phytocompound content, limited evidence suggests that we may absorb these compounds out of the gut better from juice.12 These laboratory studies that mimic human digestion need to be interpreted with caution, but the evidence available today supports 100% juice as a good source of the protective compounds.
Weight management: Evidence is not clear about the common question of whether whole fruit is more helpful than juice for managing a healthy weight. Each cup (8 fluid ounces) of orange juice contains about 110 calories. Food labels identify that as one serving of juice, but you’d need to squeeze several oranges to get that much juice. The juice from one medium orange – a smaller portion than many people would drink – contains only 60 calories. But if you compare equal amounts of orange sections and 100% orange juice (fresh or reconstituted from frozen), although calorie and sugar content on average is slightly higher in juice, there’s likely a greater difference between individual oranges. On the other hand, the fiber you get from eating an orange can help fill you up, and it also takes longer to eat a whole orange. Slower eating often leads people to consume fewer calories. Nonetheless, human studies don’t show a clear link between fruit juice consumption and weight gain.13,14
Bottom Line: As you cut down on soft drinks and other sugar-sweetened drinks, it’s best to replace them with water rather than large amounts of even 100% fruit juice. But there’s no reason for most people to avoid juice, since studies show that it often helps to meet recommendations for fruit in a healthy diet, including for people with limited budgets or medical circumstances that make eating solid fruit difficult. If you enjoy juice, keep it to one moderate size portion and work to increase total fruit consumption by adding more solid fruit to your habits.
- Tips for Selection, Storage and Preparation
- Choose oranges with firm, fine-textured skins that are heavy for their size.
- Avoid oranges that are soft or spongy, but don’t worry if the rind has traces of green color – that’s chlorophyll that the fruit produces as it grows. It has nothing to do with an orange’s safety, ripeness or flavor.
- Store oranges at room temperature 1-2 days. Or store them up to 2-3 weeks in the refrigerator.
- After refrigeration, return to room temperature before serving for best flavor and juiciness.
- Jazz up the color and flavor of a lettuce or spinach salad with orange slices. Add avocado slices or berries, too, for even more color and flavor. Or combine orange slices with a green salad and top with walnuts, almonds or other nuts for crunch.
- Take a different turn when making salsa. Combine black beans, tomatoes and cilantro (or parsley, if you prefer), and instead of lime as the citrus flavor, add oranges.
- Include oranges or a sprinkle of orange juice to complement the flavors of vegetables like broccoli, spinach, green beans and beets.
- Top poultry or fish with orange slices for color and delightful flavor.
- Sprinkle grated orange zest onto salads, cooked whole grains (like brown rice, farro and quinoa), green vegetables and seafood.
- 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.
- Casey SC, Amedei A, Aquilano K, et al. Cancer prevention and therapy through the modulation of the tumor microenvironment. Semin Cancer Biol. 2015;35:S199-S223.
- Tripoli E, Guardia ML, Giammanco S, Majo DD, Giammanco M. Citrus flavonoids: Molecular structure, biological activity and nutritional properties: A review. Food Chemistry. 2007;104(2):466-479.
- George VC, Dellaire G, Rupasinghe HPV. Plant flavonoids in cancer chemoprevention: role in genome stability. J Nutr Biochem. 2017;45:1-14.
- Deng W, Liu K, Cao S, Sun J, Zhong B, Chun J. Chemical Composition, Antimicrobial, Antioxidant, and Antiproliferative Properties of Grapefruit Essential Oil Prepared by Molecular Distillation. Molecules. 2020;25(1):217.
- 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.
- 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.
- Norat T, Vieira AR, Abar L, Navarro D, Vingeliene S, Chan D. The Associations Between Food, Nutrition and Physical Activity and the Risk of Lung Cancer. WCRF/AICR Systematic Literature Review Continuous Update Project Report. London: World Cancer Research Fund / American Institute for Cancer Research;December 20, 2016.
- 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.
- Ho KKHY, Ferruzzi MG, Wightman JD. Potential health benefits of (poly)phenols derived from fruit and 100% fruit juice. Nutr Rev. 2019;78(2):145-174.
- Aschoff JK, Kaufmann S, Kalkan O, Neidhart S, Carle R, Schweiggert RM. In Vitro Bioaccessibility of Carotenoids, Flavonoids, and Vitamin C from Differently Processed Oranges and Orange Juices [Citrus sinensis (L.) Osbeck]. J Agric Food Chem. 2015;63(2):578-587.
- World Cancer Research Fund/American Institute of Cancer Research. Continuous Update Project Expert Report 2018. Diet, nutrition and physical activity: Energy balance and body fatness. Available at dietandcancerreport.org.
- Pan A, Malik VS, Hao T, Willett WC, Mozaffarian D, Hu FB. Changes in water and beverage intake and long-term weight changes: results from three prospective cohort studies. Int J Obes (Lond). 2013;37(10):1378-1385.