A limited but growing body of evidence shows that nutritional interventions for cancer survivors reduce the risk of recurrence (Chlebowski et al., 2005). It is therefore reasonable to recommend that cancer survivors follow dietary guidelines established for primary prevention of cancer as well as other diseases (e.g., cardiovascular disease, osteoporosis, and diabetes). Cancer survivors can obtain information and guidance on nutrition and diet from the ACS and the American Institute for Cancer Research (AICR) (Brown et al., 2003; AICR, 2004; ACS, 2004a). In general, these guidelines for cancer survivors are similar to general recommendations for the primary prevention of cancer. The rationale for this guidance for cancer survivors is that the same factors that increase cancer incidence might also be important in promoting cancer recurrence after treatment. Data are most compelling for breast cancer, where the risk of recurrence might be increased by obesity and perhaps by diets high in fat and low in fruits and vegetables (Holmes and Kroenke, 2004; Chlebowski et al., 2005).³⁸ Prostate cancer recurrence might also be increased by a high saturated fat intake, with increased intakes of meat and dairy products associated with more aggressive cancers (Brown et al., 2003). Adherence to these dietary guidelines may also be the most effective method for preventing the growth of second primary cancers and to improve overall health. AICR’s dietary recommendations for cancer survivors are shown in Box 3-15.

Most cancer survivors make at least some dietary changes following their diagnosis. In one survey of a general survivorship population, 51 percent of survivors said they had reduced their fat intake, 44 percent increased their fiber intake, and 43 percent reduced their red meat intake. More than one-quarter (28 percent) indicated their physician recommended that they reduce their fat intake, and 15 percent reported that their physician suggested they increase their fiber intake (Blanchard et al., 2003a). Findings from a survey of breast and prostate cancer survivors were similar, with 29 percent reporting that their doctor recommended that they reduce fat intake and 16 percent reporting a recommendation to increase their fruit and vegetable intake (Demark-Wahnefried et al., 2000).

There is convincing evidence that obesity is associated with an increased risk of several cancers, including cancers of the colon, breast, and