Written by Helen Chu, MS RDN, US Registered Dietitian

From 2012-2018, World Cancer Research Fund (WCRF) /American Cancer Institute (AICR) and The American Cancer Society (ACS) issued evidence-based guidelines on Nutrition and Physical Activity.   These guidelines will be useful to anyone interested in lifestyle choices to reduce the risk of cancer or to live well after a diagnosis.
The following are major recommendations from ACS and WCRF/AICR

Maintain Healthy Weight – body mass index (BMI) 18.5-23

According to the World Cancer Research Fund, there is strong evidence that overweight (BMI >23) or Obesity (BMI >25) is at greater risk of breast cancer come-back. The higher risk is partially due to the fact that fat cells produce more estrogen. With more estrogen in the body, there is a higher chance for breast cancer to be developed.  Studies also suggest that women with greater fat tissues in the stomach area, abdominal fat (central obesity), will have greater chance of breast cancer.  Central obesity is defined as waist circumference >32 in for female. However, research about the value of intentional weight loss to improve outcome is still not clear.


Keep weight within healthy range BMI 18.5-23; avoid weight gain:
  • Exercise constraint over food with added sugar and saturated fat  
  • Watch the size of portion size, even healthy food choices, as calories can add up
  • Always minimize the intake of red meat (beef, lamb, pork); avoid processed food –bacon, ham, sausage, hot dog
  • Limit consumption of sugar-sweetened drinks

Physical Activity          

Regular physical activity reduces body fatness, prevents weight gain, thus has a beneficial effect on prevention of cancer risk. Several observational studies find that exercise even at the moderate level, such as brisk walking, can lower the odds of cancer recurrence.   Regular exercise together with resistance training helps to keep or rebuild lean muscle mass.

  • Be physically active
  • Cut  down periods of inactivity: sitting down at the computer watching TV or other electronic media                     
  • WHO (world health organization) advises:
  • 150 minutes moderate activity or 75 minutes vigorous intense aerobic activity per week
  • Moderate activity: ballroom /line dancing, bicycling, walking briskly, water aerobics, yoga
  • Vigorous activity:  aerobic dance, Zumba, running, hiking uphill, fast swimming
  • Exercise plan should be based on individual needs and physical abilities.


Both WCRF & ACS indicates there is evidence to support alcohol intake is the cause of breast cancer. Alcohol intake can increase the level of estrogens in the blood.  This can increase the risk of recurrence of estrogen receptor positive breast cancer.

Regardless of type, all alcoholic drinks have the same impact on cancer risk, the important factor is the amount and frequency of alcohol consumed.


For prevention, it is best not to drink, or keep it to the special occasion.  If drink, limit to no more than 1 drink (4-5 oz) for women per day.

Healthy eating - more fruits and vegetable

Antioxidants such as vitamin C, E and carotenoids help protect the cell from damage caused by free radical.  These damages play a role in cancer development.  A recent study from Harvard T. H. Chan School of Public health (published in July 2018 International Journal of cancer), found that women who ate > than 5.5 serving of fruits and vegetables daily had a 11% lower risk of breast cancer than those who ate less than 2.5 servings. 

  • Fruits and vegetables - at least 5 servings daily
  • Choose more often these fruits and vegetables rich in carotenoids, antioxidants
  • Dark green leafy vegetables - Kale, spinach mustard greens, broccoli, bok choy
  • Red and orange vegetables - tomatoes, carrot, sweet potato, red pepper, yellow winter squash
  • Fruits- berries, watermelon, apple cantaloupe


So far, there is no consistent scientific evidence to support the use of high dose of antioxidant single vitamin, mineral as a preventive measure for recurrence. One should consult the physician or Registered Dietitian to evaluate the need and safety of specific supplement. Best is to meet nutrient needs through food.       

Bottom line:  Healthy lifestyle: Nutrition + Exercise = Health

A healthy lifestyle includes regular physical activity and a healthy eating pattern.  Both are important. Together will help one to maintain a healthy weight and a general overall health.
Engage in physical activity as part of daily life, walk more, sit less. The daily meal plan should include more fruits and vegetables, lean meat - fish and poultry, less red meat (beef pork, lamb), and whole grains, legumes, less refined carbohydrates.
  • American Cancer Society 2012 guidelines on Nutrition and physical activity for cancer survivor
  • “Diet, Nutrition, Physical Activity and Cancer:  a global perspective”. 2018 Third Expert report 
  • World cancer research Fund/American Institute for Cancer research