It’s not revelatory to say that cancer treatment is hard, but you don’t realise quite how brutal it is until you go through it.
My breast cancer treatment involved 16 cycles of chemotherapy, followed by a 10-hour operation and a week in hospital for mastectomy with reconstruction and lymph node clearance. Then 15 rounds of radiotherapy and, finally, six months of adjuvant chemo. It was the worst 18 months of my life.
Happily, I’m now cancer-free, and prepared to do anything to avoid being back in that chemo chair. So I’ve interviewed doctors, scientists, dieticians and immunologists for a new book to identify the anti-cancer steps that work.
I’m not here to make false promises. We all know heavy-drinking chain-smokers who live for a long time, and sadly many of us have known healthy young people with cancer.
Sometimes there is no rhyme or reason to it. Yet, data from the World Cancer Research Fund (WCRF) found that, of the 387,000 people diagnosed with cancer in the UK between 2019 and 2020, 40 per cent could have been avoided with lifestyle changes.
People avoid talking about this out of fear of “blaming” cancer patients. I get it. When I was diagnosed, I became obsessed with behaviours of which I’d been “guilty”. I drank too much in my 20s; I had a sedentary job and didn’t exercise; I ate ultra-processed foods and too much sugar; I got too stressed… It took months to drag myself out of this cycle of blame.
Think of this not as a stick with which to beat yourself, but as an opportunity to seize the reins.
Consistent small actions are way more powerful than sweeping lifestyle changes that can be overwhelming and end up abandoned. But you can reduce your risk of the disease by choosing to be an active participant in your own wellbeing, rather than a passive victim.
Here’s where to start:
Take regular exercise – it doesn’t have to be for long
Strengthening your body is the most powerful anti-cancer thing you can do. A series of large-scale studies in the past few years have clearly shown a causal effect between a sedentary lifestyle and breast cancer, with regular movement reducing your risk by an astounding 40-60 per cent. That’s worth repeating: trials of hundreds of thousands of patients have shown that exercise halves the risk of recurrence. If these benefits were the result of a new drug, it would make headlines as an enormous breakthrough in cancer treatment.
So what exactly should we be doing? Sarah Newman is founder of Get Me Back, an online community for women getting fit after cancer. She says the World Health Organisation’s (WHO)recommendations are 150 minutes of moderate aerobic activity each week, so around five 30-minute sessions. “It could be gardening, cleaning, brisk walking, chasing after the kids or going for a jog,” she says. “Then try making half of that time more vigorous cardio, where you’re out of breath, such as running at a faster pace or playing sport.”
On top of this, the WHO suggests two strength or resistance sessions a week. Sarah has an introduction to strength training on her YouTube channel @getmebackuk, as well as resistance band workouts (a cheap and easy alternative to weights) for beginners.
If this sounds overwhelming, there will be something out there that you enjoy doing, whether that’s cycling, walking, dancing – even housework and DIY count. It’s easy to get caught up in whether or not you’re doing the right kind of exercise, but the truth is the best kind of exercise is the one that you will actually do. So stop overthinking it and just get moving.
There is much misinformation out there, so let’s look at what we know for sure. The WCRF and the American Institute for Cancer Research created guidelines produced by scientists reviewing thousands of scientific papers, now endorsed by the WHO with the caveat that people should treat them as a package, rather than picking one or two.
They are: keep your weight within the healthy range, and avoid weight gain; be physically active every day; walk more and sit less. Then: eat whole grains, vegetables, fruit and beans as part of your usual diet; limit fast foods and other processed foods high in saturated fat or sugar, as well as cutting down on red meat and eating little, if any, processed meat. Finally: drink water and limit your intake of both sugar-sweetened drinks and alcohol. Note: the WHO recommends meeting your nutritional needs through diet, rather than supplements.
These are all sensible points, although I’d argue that a “healthy range” of weight is vague. If someone tells you that smoking or drinking increases your risk, then it’s pretty clear what you need to do. Citing “obesity” as a risk factor is complicated. Many things contribute to the size and shape of a person’s body, including genetics, hormones and environment, so telling someone that they ought to lose weight is too simplistic.
The strongest evidence is around ultra-processed foods, particularly processed meat. And the way that food is cooked also has an effect: fried or roasted foods are not as good for you.
People demonise sugar, but the real issue is the metabolic effects of dramatic blood sugar spikes. This happens LESS with naturally occurring sugars in fruit and veg because the sugar is tempered by the plant fibre. So added refined sugars are the thing to avoid.
The simplest thing is to focus on “eating the rainbow”, which simply means a variety of different-coloured plant foods. They’re full of phytonutrients: compounds that affect your cellular structure and help prevent disease. Add tomatoes, carrots, beetroot, blueberries and any green veg to your shopping order, and that’s a rainbow.
When it comes to supplements, I agree with the WCRF that it’s better to get nutrients from food, but there are some instances when we need a little extra help. For example, omega-3 if you don’t eat fish, or a B vitamin complex if you’re vegan. And everyone should be taking vitamin D in the winter, particularly if you have darker skin.
While supplements have their place, remember that food is about so much more than nutrients. It’s about love, enjoyment and connection; you can’t get that in a pill.
Cut down on alcohol
Here, the correlation is unequivocal. According to Cancer Research UK, alcohol causes seven different types of cancer, with the evidence linking it to breast cancer particularly robust. “Alcohol is a carcinogen,” says Dr Liz O’Riordan, a breast surgeon who has had breast cancer herself. “We know it can cause cancer by itself, but also alcohol has no nutritional value – it’s only metabolised to fat. And the more fat you have, the more oestrogen you make after the menopause, which increases your risk of breast cancer.”
The WHO guidance says: “There is no safe level of alcohol consumption. The risk of breast cancer increases with each unit of alcohol consumed per day.” So no matter your starting point, the more you cut down, the more you can reduce your risk.
Nurture your immune system
“We’re realising that the immune system is highly important, particularly for triple negative tumours,” says Dr Nina Fuller-Shavel, a scientist and integrative medicine doctor. “That’s why we’re now treating people up front with immunotherapy. Optimising the immune system is important for reducing the risk of recurrence.” This is because we all have cancer cells floating around in our bodies and, generally, our immune system picks them off like a sniper. Impaired immunity means those cells are more likely to form a tumour.
Here are several ways to support your immune system.
For starters, look after your gut. Eat more slowly and include probiotics (like live yoghurt) and prebiotics (like fibre-packed whole plant foods).
Keeping your blood sugar balanced, by minimising refined sugars and staying active, is also key – fasting for 13 hours overnight with an earlier dinner and no evening snacking gives your system time to repair, and calm inflammation. As does avoiding ultra-processed foods and refined sugars. Move your body and eat anti-inflammatory foods such as garlic, berries, broccoli and leafy green veg.
Eat seasonally: the less the food has to travel, the fresher it will be, and more nutritious.
It’s also vital to manage stress: repeated activation of your body’s stress response impacts everything from your immunity to your hormones.
Prioritise sleep. The WHO now lists night-shift work as a probable carcinogen. If you have trouble sleeping, limit caffeine and stick to a regular routine.
‘Reconstruction: How to Rebuild Your Body, Mind and Life After a Breast Cancer Diagnosis’, by Rosamund Dean, is out now (£16.99, HarperCollins)