Direct answer
Cancer prevention starts with avoiding tobacco, limiting alcohol, healthy weight, physical activity, a nutritious dietary pattern, infection prevention, sun protection and appropriate screening. Supplements do not cure cancer or replace oncology treatment; some prevention supplements have shown harm. During treatment, individualized exercise, nutrition assessment and symptom or palliative care can support function and quality of life. Review every supplement with the oncology team.
- WHO states about 38% of cancers can currently be prevented by avoiding known risk factors and applying evidence-based prevention strategies — meaningful risk reduction, not a guarantee (WHO cancer fact sheet).
- IARC classifies alcoholic beverages and processed meat as carcinogenic to humans, and red meat as probably carcinogenic. Alcohol causes cancers at several sites; the meat classifications rely mainly on colorectal-cancer evidence.
- A BMJ umbrella review found strong evidence linking adiposity measures to 11 cancer sites or subtypes across its main and secondary analyses. The findings used different exposure measures and do not prove that a weight-loss intervention prevents every listed cancer.
- A large randomized trial (VITAL) found vitamin D3 at 2,000 IU/day did not significantly reduce invasive cancer incidence in generally healthy adults, while the cited 2020 review described uncertain secondary cancer-mortality signals.
- The SELECT trial found neither selenium nor vitamin E reduced prostate cancer incidence — and vitamin E was linked to a 17% relative increase in prostate-cancer incidence with 400 IU/day vitamin E alone in follow-up; this result applies to the tested regimen and similar older men.
Cancer prevention is strongest when it targets proven causes: no tobacco, little to no alcohol, healthy body weight, regular physical activity, a mostly plant-forward high-fiber diet, infection prevention, UV protection, and appropriate screening (WHO cancer fact sheet, WCRF Cancer Prevention Recommendations). No supplement cures cancer or replaces oncology care; the best supportive practices during and after treatment are oncology-directed treatment, early diagnosis, symptom control, nutrition support, exercise when safe, smoking cessation, and palliative care when needed (WHO cancer fact sheet, NCI CAM overview, ASCO guideline).
Table of contents
- Evidence summary
- What cancer is and what prevention can realistically do
- The prevention pyramid
- Pillar 1: Do not use tobacco, and get help quitting if you do
- Pillar 2: Avoid or reduce alcohol
- Pillar 3: Build a high-fiber, plant-forward dietary pattern
- Pillar 4: Move regularly and avoid long sedentary stretches
- Pillar 5: Maintain a healthy body weight without crash dieting
- Pillar 6: Use screening and early diagnosis appropriately
- Pillar 7: Prevent infection- and environment-related cancers
- Supportive management during and after cancer treatment
- Supplements and ingredients: evidence grades
- Risks, side effects, and interactions
- What works and what does not
- Independent evidence, funding, and conflict review
- Frequently asked questions
- Sources
Evidence summary
| Claim | Best evidence | Source country / organization | Funding / conflict check | Strength |
|---|---|---|---|---|
| Many cancers are preventable, but prevention is not a guarantee. | WHO states that about 38% of cancers can currently be prevented by avoiding risk factors and implementing evidence-based prevention strategies. | WHO / IARC, global | WHO public-health guidance; fact-sheet-specific financing and every supporting study’s conflicts were not fully traced. | Strong WHO |
| Tobacco avoidance is a major cancer-prevention priority, especially for tobacco users. | WHO lists tobacco use among major cancer risk factors, and IARC’s tobacco-control handbook reviews risk reversal after quitting. | WHO / IARC, global | The original 2007 IARC handbook acknowledges financial support from the French Ministry of Health, Youth and Sports. Its procedures describe interest screening; every underlying study’s finances were not cleared. Original handbook | Strong IARC |
| Alcohol causes cancer; reducing intake reduces exposure to a carcinogen. | IARC classifies alcoholic beverages as carcinogenic to humans, and WHO lists alcohol as a chemical carcinogen and risk factor. | IARC / WHO, global | WHO/IARC public-health sources. The classification and advice are verified; the fact sheet does not establish absence of beverage-industry funding across its supporting literature. | Strong WHO |
| Adiposity is associated with higher risk for several cancer sites or subtypes. | The umbrella review identified strong associations across different adiposity measures and main/secondary analyses involving 11 cancer sites or subtypes. | United Kingdom / international literature | Listed support included Genesis Research Trust/Garfield Weston, Sigrid Jusélius Foundation, WCRF, Ovarian Cancer Action and UK cancer/NIHR infrastructure. Authors declared no conflicts; underlying study finances were not exhaustively traced. | Strong BMJ umbrella review |
| Higher physical activity is associated with lower risk for several cancers; exercise can improve function and fatigue during treatment. | The review found strong prevention associations for bladder, breast, colon, endometrial, esophageal adenocarcinoma, gastric and kidney cancers. Survivor mortality evidence was less certain and vulnerable to reverse causation. | United States / international literature | U.S. HHS supported the committee review; ICF provided contracted review support, and McTiernan reported Breast Cancer Research Foundation salary support. Authors reported no potential conflicts. | Strong Physical activity systematic review |
| Processed meat raises colorectal cancer risk; red meat evidence is weaker but concerning. | IARC classified processed meat as carcinogenic to humans and red meat as probably carcinogenic, mainly for colorectal cancer. | IARC, global | IARC press release reports the working-group classification and process. Complete group disclosures and every underlying study’s financing are not supplied in this release. | Strong for processed meat IARC press release |
| Higher dietary fiber is associated with lower colorectal cancer risk. | Meta-analysis of cohort studies reported inverse associations between dietary fiber intake and colon cancer risk, especially distal colon cancer. | China / international cohorts | Chinese NSFC grant 81372152; authors declared no conflicts and acknowledged Editage editing assistance. The payment terms for editing and all underlying cohorts’ finances were not reported or cleared. | Moderate Fiber meta-analysis |
| Cruciferous vegetables may help, but evidence is observational rather than a supplement-style proof. | Meta-analysis found high cruciferous vegetable intake inversely associated with colorectal and colon cancer risk, with prospective evidence only borderline significant. | China / international observational studies | Listed Chinese national infectious-disease grants and NIH/Fogarty training support; authors declared no conflicts. This remains observational evidence and does not clear every included study’s financial chain. | Moderate to weak Cruciferous vegetable meta-analysis |
| Vitamin D supplementation does not reliably prevent cancer incidence in generally healthy adults. | VITAL found no significant reduction in invasive cancer incidence with vitamin D3 2,000 IU/day. The cited 2020 review discussed uncertain secondary cancer-mortality findings; it does not establish broad prevention or a confirmed advanced-cancer benefit. | United States | NIH-funded trial with donated capsules/placebos and lab support disclosed; positive secondary signals should not be overstated. | Mixed / targeted VITAL |
| Selenium and vitamin E supplements should not be used for prostate-cancer prevention. | SELECT found neither selenium nor vitamin E reduced prostate cancer incidence; vitamin E was associated with a 17% increased prostate-cancer risk in follow-up. | United States / Canada / Puerto Rico | NCI-funded SWOG trial; a negative finding does not establish independence. Complete trial product-supply and author-conflict details are not verified here. (Primary source) | Strong against SELECT review |
| Beta-carotene supplements are unsafe for lung-cancer prevention in smokers and asbestos-exposed people. | Systematic review/meta-analysis found beta-carotene supplementation increased lung-cancer risk, especially in smokers and asbestos workers. | Poland / randomized-trial literature | Medical University of Lodz support; review authors declared no conflicts. The pooled trials’ entire funding and product-supply chains were not traced. | Strong against Beta-carotene meta-analysis |
| Exercise during active cancer treatment can reduce fatigue and improve function for many patients, but it must be individualized. | ASCO guideline reviewed 52 systematic reviews and 23 RCTs and recommends regular aerobic and resistance exercise during active treatment with curative intent when safe. | ASCO, United States / international evidence | ASCO funded guideline administration. Panel disclosures included LabCorp employment, National Cattlemen’s Beef Association research support, pharmaceutical fees/research and digital-health holdings. These ties do not establish influence on the recommendations. Full guideline and disclosures | Strong supportive-care evidence ASCO guideline |
Text version of this infographic
| Evidence tier | Practices | Interpretation |
|---|---|---|
| Strong | No tobacco; HPV/HBV prevention; evidence-based screening; healthy weight; physical activity. | These are the highest-priority practices for population-level cancer risk reduction. |
| Strong to moderate | Avoiding or reducing alcohol; limiting processed meat; sun and UV protection. | These reduce exposure to known or probable carcinogens. |
| Moderate | High-fiber diet; whole grains; legumes; cruciferous vegetables as foods. | Useful dietary pattern components, but food evidence is often observational and should not be marketed like a drug. |
| Targeted | Vitamin D supplementation. | Correct deficiency when present; do not claim broad cancer incidence prevention. |
| Avoid for prevention | Beta-carotene supplements in smokers/asbestos-exposed people; vitamin E and selenium supplements for prostate-cancer prevention. | Randomized evidence shows lack of benefit or possible harm. |
What cancer is and what prevention can realistically do
Cancer is not one disease; WHO defines it as a large group of diseases marked by abnormal cells that grow beyond usual boundaries and can invade nearby tissue or spread to other organs, a process called metastasis (WHO cancer fact sheet). WHO lists three broad categories of external carcinogens: physical agents such as ultraviolet and ionizing radiation, chemical agents such as tobacco smoke, alcohol, asbestos, aflatoxin, and arsenic, and biological agents such as cancer-causing viruses, bacteria, and parasites (WHO cancer fact sheet).
Prevention works by reducing avoidable carcinogen exposure, supporting healthy body weight and physical activity, preventing cancer-causing infections, and finding precancer or early cancer before it becomes harder to treat (WHO cancer fact sheet, NCI prevention overview). It does not eliminate genetic risk, age-related risk, occupational exposure, environmental exposure, or the need for medical diagnosis when symptoms appear (WHO cancer fact sheet).
The prevention pyramid
The practical cancer-prevention pyramid starts with exposures that cause the largest and clearest harm, then adds lifestyle patterns, screening, and supportive care. Supplements sit near the top because their evidence is narrower, weaker, or sometimes harmful compared with the fundamentals (WCRF Cancer Prevention Recommendations, NCCIH cancer and complementary health).
Text version of this infographic
- Foundation: oncology care if cancer is suspected or diagnosed, early diagnosis of symptoms, and appropriate screening.
- Major carcinogen reduction: do not use tobacco, avoid or reduce alcohol, and reduce known environmental and occupational carcinogen exposure.
- Metabolic and dietary pattern: build a plant-forward, high-fiber diet, move regularly, limit sedentary time, and maintain healthy body weight.
- Infection and radiation prevention: prevent HPV and hepatitis B where appropriate, treat cancer-related infections medically, and protect against UV exposure.
- Supplements: use only for deficiency, medically indicated replacement, or clinician-directed supportive care; do not use supplements as cancer cures.
Pillar 1: Do not use tobacco, and get help quitting if you do
Tobacco is a top-priority cancer risk because WHO lists tobacco use among the major behavioral risk factors, and IARC’s tobacco-control handbook specifically evaluates reversal of disease risk after smoking cessation (WHO cancer fact sheet, IARC tobacco cessation handbook). Tobacco smoke exposure is relevant even after diagnosis because an AACR policy statement states that tobacco use in cancer patients is associated with lower treatment efficacy and safety, lower survival, lower quality of life, increased treatment-related toxicity, and higher risk of recurrence and second primary tumors (AACR policy statement).
The practical rule is simple: aim for complete cessation with evidence-based support. People with cancer should be asked about tobacco use repeatedly and offered cessation treatment because oncology settings often under-deliver cessation help despite clear harm from continued smoking (AACR policy statement). AACR/ASCO policy and disclosures
Pillar 2: Avoid or reduce alcohol
Alcohol is not a “heart-healthy exception” in cancer prevention; WHO lists alcohol as a chemical carcinogen and cancer risk factor, and IARC has classified alcoholic beverages as carcinogenic to humans (WHO cancer fact sheet, alcohol and cancer review summarizing IARC). The IARC-based cancer sites include oral cavity, pharynx, larynx, esophagus, colorectum, liver, and female breast in major reviews of alcohol and cancer risk (alcohol and cancer global review).
For prevention, “less is better” is more evidence-aligned than choosing a “healthy” alcoholic beverage. During treatment, alcohol may aggravate oral symptoms or interact with drugs; ask the oncology team whether it is safe in the specific treatment context (ACS survivor guideline PubMed).
Pillar 3: Build a high-fiber, plant-forward dietary pattern
The most defensible cancer-prevention diet is not a detox, alkaline protocol, juice fast, carnivore plan, ketogenic cure, or single-superfood routine. The strongest guideline pattern is a diet rich in vegetables, fruits, legumes, and whole grains; limited in red and processed meat, sugar-sweetened drinks, highly processed foods, and refined grains; and matched to energy needs for healthy body weight (WCRF Cancer Prevention Recommendations, ACS prevention guideline).
Dietary fiber is one of the most credible food components for colorectal-cancer risk reduction. A meta-analysis found that higher fiber intake was inversely associated with colon cancer risk, while WCRF recommends eating whole grains, vegetables, fruit, and beans as major dietary staples (fiber meta-analysis, WCRF Cancer Prevention Recommendations).
Cruciferous vegetables such as broccoli, cabbage, cauliflower, kale, mustard greens, bok choy, and Brussels sprouts are reasonable foods to include, but their evidence should be described accurately. A meta-analysis found inverse associations between cruciferous vegetable intake and colorectal cancer risk, yet the prospective-study signal was borderline, so the right claim is “useful part of a healthy pattern,” not “broccoli cures cancer” (cruciferous vegetable meta-analysis).
Processed meat deserves a stronger warning than most foods because IARC classified processed meat as carcinogenic to humans and red meat as probably carcinogenic to humans, mainly based on colorectal-cancer evidence (IARC processed meat statement). A meta-analysis of prospective studies also supported limiting red and processed meat for colorectal-cancer prevention (red and processed meat meta-analysis).
Text version of this infographic
| Plate area | Foods | Reason |
|---|---|---|
| Vegetables and fruit | Colorful vegetables, leafy greens, whole fruit, and cruciferous vegetables. | Supports micronutrient, phytochemical, and fiber intake as part of a healthy dietary pattern. |
| Whole grains | Oats, brown rice, whole wheat, millet, barley, quinoa, and other intact grains. | Raises dietary fiber and replaces refined grains. |
| Legumes | Beans, lentils, chickpeas, peas, soy foods. | Provides fiber-rich protein and helps replace processed meat. |
| Protein choices | Legumes, fish, eggs, poultry, nuts, seeds, yogurt, and modest unprocessed red meat if consumed. | Prioritizes nutrient density while limiting processed meat exposure. |
| Limit or avoid | Processed meat, alcohol, sugary drinks, highly processed foods, refined grains. | Reduces carcinogen exposure and supports weight management. |
Pillar 4: Move regularly and avoid long sedentary stretches
Physical activity is one of the best-supported lifestyle tools for cancer risk reduction. A systematic review for the Physical Activity Guidelines Advisory Committee found strong evidence linking higher physical activity with lower risk of several cancers, including colon, breast, endometrial, bladder, esophageal adenocarcinoma, gastric, and kidney cancers (physical activity systematic review).
For general prevention, the practical target is regular moderate-to-vigorous activity plus muscle-strengthening, scaled to age, disability, pregnancy status, disease, and baseline fitness. For people in cancer treatment, ASCO recommends regular aerobic and resistance exercise during active treatment with curative intent when safe, while noting that evidence for diet and weight-loss interventions during active treatment is much more limited (ASCO guideline).
Pillar 5: Maintain a healthy body weight without crash dieting
Excess adiposity is linked to multiple cancers, and a BMJ umbrella review found strong evidence for associations between adiposity and 11 cancer sites or subtypes across its main and secondary analyses, including esophageal adenocarcinoma, gastric cardia, colon, rectum, biliary tract, pancreas, postmenopausal breast, endometrium, ovary, kidney, and multiple myeloma; not every result used the same BMI measure or subgroup (BMJ umbrella review). WCRF recommends being a healthy weight and avoiding weight gain in adult life as part of its cancer-prevention recommendations (WCRF Cancer Prevention Recommendations).
Weight management should not become malnutrition. During cancer treatment, unintended weight loss, low appetite, swallowing problems, diarrhea, nausea, mouth sores, taste changes, or muscle loss should trigger oncology dietitian referral rather than aggressive dieting (ACS survivor guideline PubMed).
Pillar 6: Use screening and early diagnosis appropriately
Early diagnosis and screening are different. WHO defines early diagnosis as recognizing symptoms, accessing clinical evaluation, and getting timely referral, while screening aims to find signs of a specific cancer or precancer before symptoms appear (WHO cancer fact sheet, WHO guide to cancer early diagnosis).
Screening can save lives for some cancers, but it is not universally useful for every cancer and can cause false positives, overdiagnosis, anxiety, unnecessary procedures, and complications. WHO states that screening programmes are effective for some but not all cancer types and require quality assurance, while NCI explains that screening tests look for cancer before symptoms and must be weighed against harms (WHO cancer fact sheet, NCI cancer screening overview).
The practical global rule is to ask a clinician which screening is appropriate for personal risk, age, sex, anatomy, family history, prior results, immune status, HPV/HBV/HCV status, and local health-system quality. Common evidence-based screening areas include cervical cancer, breast cancer, colorectal cancer, and lung cancer for selected high-risk people, but the exact test, starting age, interval, and stopping age vary by guideline and country (WHO cancer fact sheet, NCI cancer screening overview).
Text version of this infographic
- Symptoms first: symptoms such as unexplained bleeding, persistent lumps, unusual weight loss, persistent cough, trouble swallowing, non-healing sores, or major bowel changes need diagnostic evaluation rather than routine screening.
- Risk profile: screening decisions depend on age, anatomy, family history, genetic risk, infection history, smoking exposure, prior test results, and health status.
- Eligible test: an appropriate screening test must have a defined target cancer, interval, follow-up pathway, and quality system.
- Follow-up: a positive or abnormal screening test is not a cancer diagnosis; it requires diagnostic follow-up.
Pillar 7: Prevent infection- and environment-related cancers
WHO states that about 10% of cancers diagnosed globally in 2022 were attributed to carcinogenic infections, including Helicobacter pylori, HPV, hepatitis B virus, hepatitis C virus, and Epstein-Barr virus (WHO cancer fact sheet). WHO also states that HPV and hepatitis B vaccination can reduce risk for cervical and liver cancer in groups for whom vaccination is recommended (WHO cancer fact sheet).
Environmental and exposure reduction matters because WHO lists ultraviolet radiation, ionizing radiation, asbestos, aflatoxin, arsenic in drinking water, air pollution, occupational ionizing radiation, and radon as relevant carcinogenic exposures or cancer risk factors (WHO cancer fact sheet). Practical prevention includes sun protection, avoiding tanning devices, safer occupational controls, ventilation and radon attention where relevant, safe medical radiation use, food storage practices that reduce mold/aflatoxin exposure, and testing/treating infections when medically indicated (WHO cancer fact sheet).
Supportive management during and after cancer treatment
Supportive management is not the same as cancer treatment. Cancer treatment requires a correct diagnosis, staging, and cancer-specific therapy such as surgery, radiotherapy, systemic therapy, or combinations, while supportive care aims to preserve function, reduce symptoms, support nutrition, improve quality of life, and help patients complete appropriate treatment (WHO cancer fact sheet).
Exercise during treatment
ASCO recommends regular aerobic and resistance exercise during active treatment with curative intent because evidence shows improvements in cardiorespiratory fitness, strength, fatigue, and other patient-reported outcomes (ASCO guideline). Exercise plans should be modified for anemia, infection risk, bone metastases, neuropathy, fall risk, ostomies, recent surgery, severe fatigue, cardiopulmonary disease, lymphedema risk, and treatment side effects (ASCO guideline, ACSM roundtable).
Nutrition during treatment
The first nutrition goal during treatment is not “maximum cancer starvation”; it is preventing malnutrition, preserving muscle mass, supporting treatment tolerance, and managing side effects that interfere with eating. The ACS survivor guideline recommends nutrition assessment and counseling as soon as possible after diagnosis, especially when nutrition problems, weight loss, or treatment side effects threaten intake (ACS survivor guideline).
Fatigue, mood, and quality of life
Cancer-related fatigue often improves with exercise rather than rest alone. A Cochrane review concluded that aerobic exercise can be beneficial for cancer-related fatigue during and after cancer therapy, particularly in solid tumors, while acknowledging uncertainty about optimal type, intensity, and timing (Cochrane exercise fatigue review).
Palliative care
Palliative care is not “giving up”; WHO describes it as care that relieves symptoms and suffering and improves quality of life for patients and families (WHO cancer fact sheet). WHO states that relief from physical, psychosocial, and spiritual problems through palliative care is possible for more than 90% of patients with advanced-stage cancer (WHO cancer fact sheet).
Supplements and ingredients: evidence grades
Supplements are not a cancer cure, and the clinical evidence reviewed here does not support routine “anticancer stacks.” NCI states that complementary and alternative medicine includes products and practices not part of standard medical care, while NCCIH warns that some complementary approaches can interfere with cancer treatment or be harmful (NCI CAM overview, NCCIH cancer and complementary health).
| Supplement / ingredient | Evidence grade for cancer risk reduction | What the evidence supports | What it does not support | Funding / conflict note |
|---|---|---|---|---|
| Dietary fiber from foods | Moderate | Higher fiber intake is associated with lower colorectal/colon cancer risk in meta-analyses, and fiber-rich foods align with WCRF/ACS patterns (fiber meta-analysis, WCRF recommendations). | Fiber supplements as a stand-alone cancer-prevention treatment. | The cited fiber meta-analysis had a Chinese public grant and declared no conflicts. All supporting cohort finances were not cleared; observational confounding remains. |
| Cruciferous vegetables as foods | Weak to moderate | Useful part of a vegetable-rich pattern; observational meta-analysis suggests inverse colorectal/colon association (cruciferous vegetable meta-analysis). | Broccoli extract, sulforaphane capsules, or cruciferous vegetables as cancer cures. | The cited review disclosed public/training grants and no conflicts. Supporting study finances were not fully traced; these food associations do not establish extract efficacy. |
| Vitamin D | Targeted / mixed | Correcting deficiency supports bone/mineral health; VITAL did not reduce invasive cancer incidence, while the cited 2020 review discusses uncertain secondary cancer-mortality signals rather than confirmed broad prevention (VITAL, VITAL updated analyses, NIH ODS vitamin D). | Routine high-dose vitamin D as an anticancer supplement in people without deficiency. | VITAL was NIH-funded but used donated study capsules/placebos and lab support, so positive secondary claims should be conservative. |
| Calcium | Targeted / not routine | Calcium is essential for bone health and may have some colorectal adenoma/cancer-related evidence, but use should be based on dietary adequacy and medical need rather than anticancer marketing (NIH ODS calcium). | High-dose calcium supplementation for broad cancer prevention. | NIH ODS is a government nutrition source; individual calcium trials vary in funding and design. |
| Folate / folic acid | Do not use high-dose for prevention | Folate is required for DNA synthesis and deficiency correction, but high-dose folic acid is not an oncology prevention strategy (NIH ODS folate). | High-dose folic acid to prevent or treat cancer. | NIH ODS is a government source; cancer effects depend on baseline status, dose, timing, and existing lesions. |
| Selenium | Not recommended | Correct deficiency if medically identified; routine supplementation did not prevent prostate cancer in SELECT (SELECT review, NIH ODS selenium). | Selenium pills for prostate-cancer prevention. | SELECT was primarily NCI-funded. The cited review declared no conflicts, but complete trial product-supply terms and all author relationships remain unverified here. |
| Vitamin E | Not recommended | Vitamin E is an essential nutrient when consumed at adequate levels; SELECT found no prostate-cancer prevention and follow-up associated vitamin E with increased prostate-cancer risk (SELECT review, NIH ODS vitamin E). | High-dose vitamin E as an anticancer antioxidant. | SELECT’s tested vitamin E regimen increased prostate-cancer incidence in similar older men. Public funding and a negative finding do not settle every trial financial relationship. |
| Beta-carotene supplements | Avoid in smokers/asbestos exposure | Food carotenoids are part of healthy diets, but supplemental beta-carotene increased lung-cancer risk in trial meta-analysis, especially in smokers and asbestos workers (beta-carotene meta-analysis). | Beta-carotene pills for lung-cancer prevention. | The review reported Medical University of Lodz support and no conflicts; the entire underlying-trial financial chain was not cleared. |
| High-dose antioxidant stacks during treatment | Avoid unless oncology-approved | Review all supplements with oncology/pharmacy teams because natural products can create pharmacokinetic or pharmacodynamic interactions with cancer treatments (natural-product interaction review, NCCIH cancer and complementary health). | Using antioxidant stacks to make chemotherapy or radiotherapy safer without oncologist approval. | Interaction literature is incomplete, so absence of evidence is not proof of safety. |
Text version of this infographic
- Prefer as foods: fiber-rich foods and cruciferous vegetables fit healthy dietary patterns and have observational evidence for risk reduction.
- Targeted only: vitamin D and calcium should be used for deficiency or adequacy when medically appropriate, not as broad anticancer supplements.
- Do not market for cancer prevention: selenium, vitamin E, beta-carotene pills, and high-dose antioxidant stacks have null, harmful, or interaction-prone evidence.
- During cancer therapy: every supplement, powder, tea, extract, or injection should be reviewed by the oncology team.
Risks, side effects, and interactions
Supplements can be biologically active, and cancer treatment narrows the safety margin. NCCIH warns that some complementary approaches may interfere with standard cancer treatment or be harmful, and a review of natural products and cancer treatments describes clinically important pharmacokinetic and pharmacodynamic interaction mechanisms (NCCIH cancer and complementary health, natural-product interaction review).
| Ingredient / supplement | Common side effects | Rare but serious risks | Interactions and cautions | Who needs extra caution | Source |
|---|---|---|---|---|---|
| Fiber supplements such as psyllium | Stomach pain, nausea or vomiting can occur. Use the prescribed fluid amount. | Difficulty swallowing or breathing requires prompt medical attention. Powder must be mixed with at least 8 oz (240 mL) liquid; tell the clinician about intestinal blockage or swallowing difficulty. | The monograph advises avoiding digoxin, salicylates and nitrofurantoin within 3 hours of psyllium. Ask the oncology pharmacist to review the exact oral medicines and timing; other class-wide interactions are not established by this citation. | Swallowing difficulty, intestinal blockage, rectal bleeding, or relevant medical conditions such as diabetes or kidney disease warrant clinician review. | Psyllium medication and administration advice: MedlinePlus; individualize timing with oncology pharmacy. |
| Cruciferous vegetable foods | Food tolerance varies; the cited vitamin K sheet does not establish a cruciferous-specific adverse-effect frequency. | The cited source does not establish a serious thyroid risk from ordinary cruciferous foods. | Vitamin K-rich greens can affect warfarin dose stability if intake changes abruptly; maintain consistent intake and monitor INR with clinician guidance. | People using warfarin need consistent vitamin K intake. Cancer-related food handling should be individualized; ASCO does not recommend routine neutropenic diets that avoid raw fruit and vegetables to prevent infection. | NIH ODS vitamin K; ASCO food-safety evidence |
| Vitamin D | Vitamin D toxicity can cause nausea, vomiting, weakness, loss of appetite, dehydration, excessive thirst, frequent urination and neuropsychiatric symptoms through hypercalcemia. | Hypercalcemia, kidney stones, kidney injury, soft-tissue calcification, and arrhythmia risk with excessive dosing. | Thiazides with vitamin D can increase hypercalcemia risk, particularly with kidney impairment or hyperparathyroidism. Orlistat can reduce absorption, and systemic steroids can impair vitamin D metabolism. Other medicine combinations need individual pharmacy review. | Kidney impairment, hyperparathyroidism, high calcium intake and thiazide use require individual review. Age and pregnancy change recommended intakes and upper limits. | NIH ODS vitamin D |
| Calcium supplements | Constipation, bloating, gas; calcium carbonate can cause more GI symptoms than some other forms. | Excess calcium can cause hypercalcemia or hypercalciuria and related kidney or cardiac problems. Some studies found increased kidney-stone risk with supplements; others did not. | Calcium can reduce absorption of levothyroxine, dolutegravir and quinolone antibiotics. Follow the exact drug label/pharmacy schedule. Lithium plus calcium can increase hypercalcemia risk; other oncology-drug combinations need individual review. | People with kidney disease, hypercalcemia-related conditions or these interacting medicines need clinician review; count calcium from food, supplements and antacids. | NIH ODS calcium |
| Folate / folic acid | Usually well tolerated at standard dietary/supplement doses. | High folic acid intake can correct the anemia of vitamin B12 deficiency while neurological injury continues. Cancer effects depend on dose, timing and baseline status; high-dose prevention is not established. | Discuss folate with the prescriber when using methotrexate: oncology and low-dose rheumatology regimens differ. Phenytoin, carbamazepine and valproate can affect folate status, and folate can alter drug levels; sulfasalazine impairs absorption. | Methotrexate or these antiepileptics, sulfasalazine, vitamin B12 deficiency risk, and active cancer treatment warrant a regimen-specific prescription plan. Follow oncology-directed vitamin supplementation rather than changing it yourself. | NIH ODS folate |
| Selenium | Garlic breath odor, metallic taste, nausea, diarrhea, brittle hair/nails with excess intake. | Chronic excess causes selenosis with hair/nail loss, rash or nervous-system symptoms. Massive overdoses can cause severe kidney or heart injury. SELECT’s initial nonsignificant diabetes signal did not persist as a confirmed increase with follow-up. | Cisplatin can lower selenium levels, but the clinical importance is uncertain. Evidence is insufficient that selenium reduces chemotherapy toxicity. The cited fact sheet does not establish additive bleeding with anticoagulants or antiplatelets. | People using cisplatin or taking multiple selenium products need individual review; avoid excess total intake and use age-appropriate limits. | NIH ODS selenium; SELECT review |
| Vitamin E supplements | Effects depend on dose and product; the cited fact sheet principally documents bleeding and other high-dose concerns rather than the current broad symptom catalogue. | Bleeding risk and hemorrhagic stroke concern at high doses; SELECT follow-up linked vitamin E supplementation with increased prostate-cancer risk. | High supplemental vitamin E can inhibit platelet aggregation and may increase bleeding with anticoagulants or antiplatelets; the clinically significant threshold is uncertain. Possible chemotherapy/radiotherapy interaction is a concern, but evidence is conflicting, so seek oncology advice. | People on blood thinners, bleeding disorders, planned surgery/procedures, prostate-cancer risk concerns, and anyone receiving cancer therapy. | NIH ODS vitamin E; SELECT review |
| Beta-carotene supplements | The cited meta-analysis addresses lung-cancer incidence, not a complete adverse-effect profile for beta-carotene products. | Increased lung-cancer risk in smokers and asbestos-exposed people in randomized-trial evidence. | Avoid beta-carotene supplements for lung-cancer prevention in smokers or asbestos-exposed people. Trials used specific doses and combinations; the review does not establish identical risk for all antioxidant products or every cancer-treatment regimen. | Smokers and asbestos-exposed people should avoid the tested prevention strategy; other clinical situations require separate evidence and oncology advice. | Beta-carotene meta-analysis |
| High-dose antioxidant stacks | Effects depend on the actual ingredients, dose and formulation; no common-event rate is established for all stacks. | Some natural products can alter anticancer-drug exposure; unsupported cure claims can delay effective care. Risks must be assessed for each product and treatment. | Clinical examples include St John’s wort reducing exposure to irinotecan’s active metabolite, imatinib or docetaxel, and curcumin/piperine altering tamoxifen/endoxifen exposure. These are product-specific findings, not proof that every antioxidant stack interacts with all cancer or supportive medicines. | Anyone receiving cancer treatment should disclose the exact products and medicines for oncology/pharmacy review. | NCCIH; natural-product interaction review |
What works and what does not
| Claimed practice | Verdict | Evidence | Key caveat |
|---|---|---|---|
| Quitting tobacco lowers future risk relative to continued smoking; continued smoking is associated with worse cancer outcomes. | WORKS | WHO/IARC identify tobacco as a major cancer risk, and AACR states continued smoking worsens cancer treatment and outcomes (WHO, AACR policy statement). | Risk relative to continued smoking falls over time; oncology patients need active cessation support, not just advice. |
| Avoiding or reducing alcohol lowers exposure to a known carcinogen. | WORKS | WHO lists alcohol as a chemical carcinogen and cancer risk factor (WHO cancer fact sheet). | No alcoholic beverage is proven “safe” for cancer prevention. |
| High-fiber, plant-forward dietary pattern. | WORKS / MODERATE | WCRF and ACS recommend whole grains, vegetables, fruit, and beans, and fiber meta-analysis supports lower colon cancer risk (WCRF, fiber meta-analysis). | Diet reduces risk; it does not treat established cancer. |
| Cruciferous vegetables. | MIXED BUT REASONABLE | Meta-analysis found inverse associations with colorectal/colon cancer risk but prospective evidence was borderline (cruciferous vegetable meta-analysis). | Prefer foods; do not sell extracts as cancer cures. |
| Regular physical activity. | WORKS | The review supports prevention associations for several specified cancers; ASCO recommends exercise during active treatment with curative intent to improve fitness, fatigue and function. Review; ASCO | Modify for treatment side effects, anemia, bone metastases, fall risk, and infection risk. |
| Adiposity is associated with cancer risk; maintaining healthy weight is recommended. | RECOMMENDED / ASSOCIATIONAL EVIDENCE | Umbrella review supports adiposity links with multiple cancers, and WCRF recommends healthy weight (BMJ umbrella review, WCRF). | During treatment, avoid unintended weight loss and muscle loss; get oncology dietitian support. |
| Screening everyone for every cancer. | DOESN'T | WHO states screening is effective for some but not all cancers and requires quality assurance (WHO cancer fact sheet). | Screening must be risk-based and linked to diagnostic follow-up. |
| Vitamin D for broad cancer prevention. | MIXED / NOT ROUTINE | VITAL did not significantly lower invasive cancer incidence with vitamin D3 2,000 IU/day (VITAL). | Correct deficiency, but do not use megadoses for anticancer claims. |
| Selenium or vitamin E for prostate-cancer prevention. | DOESN'T / POSSIBLE HARM | SELECT found no prevention and vitamin E was linked with increased prostate cancer in follow-up (SELECT review). | Avoid prevention marketing. |
| Beta-carotene pills for smokers. | HARM | Trial meta-analysis found increased lung-cancer risk, especially in smokers and asbestos workers (beta-carotene meta-analysis). | Food carotenoids are different from high-dose pills. |
| Alternative therapy instead of oncology treatment. | DANGEROUS | NCI defines CAM separately from standard medical care, and NCCIH warns that some complementary approaches interfere with cancer treatment (NCI CAM overview, NCCIH). | Delaying diagnosis or treatment can lose the window for cure. |
Text version of this infographic
| Verdict | Practices |
|---|---|
| Works | No tobacco, regular physical activity, healthy body weight, appropriate screening, HPV/HBV prevention, plant-forward high-fiber diet. |
| Mixed or targeted | Vitamin D for deficiency or selected clinician-guided use; cruciferous vegetables as foods; calcium adequacy. |
| Does not work | Screening every cancer in everyone, detoxes, alkaline cures, sugar-starving cures, and supplements replacing oncology treatment. |
| Harm or avoid | Beta-carotene pills in smokers/asbestos-exposed people, vitamin E or selenium for prostate-cancer prevention, and unapproved high-dose antioxidant stacks during treatment. |
Independent evidence, funding, and conflict review
Research funding at a glance
11 disclosure entries. The counts below summarize independence tiers explicitly assigned in this article. They count disclosures, not studies, funding amounts or evidence quality.
Consult this article’s source and funding notes for named funders, countries, relationships and exceptions where available. Institutional backing, researcher interests and trial sponsorship are separate questions. Public funding alone does not establish independence; commercial ties alone do not prove a claim false. This overview is not a new financial audit.
| Source | Country / organization | Evidence type | Funding and conflict trace | Independence rating | Credibility rank | Source role and remaining limits |
|---|---|---|---|---|---|---|
| WHO cancer fact sheet | WHO, global | Public-health fact sheet | WHO public-health fact sheet; page-specific cash funding and individual contributor disclosures were not stated. Every cited study’s financing was not traced. | Public-agency source; financing not fully traced | Very strong | Evidence/guidance role described by the source; individual motivation and every ultimate donor were not independently established. |
| IARC European Code Against Cancer | IARC/WHO, Europe-facing but evidence-based | Prevention code | ECAC5 acknowledges EU4Health grant 101075240. The current code is an IARC-coordinated, Europe-specific prevention resource; complete individual and supporting-study finances were not verified. | Public grant identified; full conflicts not cleared | Strong | Evidence/guidance role described by the source; individual motivation and every ultimate donor were not independently established. |
| WCRF Cancer Prevention Recommendations | World Cancer Research Fund, international nonprofit | Diet/activity recommendations | WCRF is a UK-registered charity/company limited by guarantee. The recommendation page does not list complete donor funding or panel conflicts; all underlying evidence finances were not traced. | Full funding/COI not verified (Primary source) | Strong | Evidence/guidance role described by the source; individual motivation and every ultimate donor were not independently established. |
| ACS prevention guideline | American Cancer Society, United States | Guideline | Full guideline disclosures report ACS staff employment and ACS outside-work donations, sponsorship or partnerships involving nutrition, activity, alcohol and supplement sectors. Some author salary support came from RWJF or CDC. Full guideline disclosures | Disclosed institutional commercial relationships | Strong | Evidence/guidance role described by the source; individual motivation and every ultimate donor were not independently established. |
| ACS survivor guideline | American Cancer Society, United States | Survivorship guideline | ACS paid Howe as an independent contractor. Authors reported NIH support, nonprofit/publisher relationships and, for Meyerhardt, pharmaceutical research/fees and Taiho-funded NCCN panel support. Full guideline disclosures | Disclosed professional and commercial relationships | Strong | Evidence/guidance role described by the source; individual motivation and every ultimate donor were not independently established. |
| ASCO exercise, diet, and weight guideline | ASCO, United States / international evidence | Clinical guideline | ASCO funded administration; disclosed ties include LabCorp employment, beef-industry research, pharmaceutical fees/research and digital-health holdings. Evidence quality for exercise was moderate to low despite the strong recommendation. Full guideline | Disclosed panel commercial relationships | Strong | Evidence/guidance role described by the source; individual motivation and every ultimate donor were not independently established. |
| Physical activity systematic review | United States / international literature | Systematic review | HHS committee support, contracted ICF review assistance, travel/per-diem support and McTiernan’s Breast Cancer Research Foundation salary were reported. Authors reported no potential conflicts. | Review support disclosed; study-level finances incomplete | Strong | Evidence/guidance role described by the source; individual motivation and every ultimate donor were not independently established. |
| BMJ adiposity umbrella review | United Kingdom / international evidence | Umbrella review | Public/charitable and university cancer-research support listed; authors declared no conflicts and stated funders had no influence. Observational confounding and underlying-study financial uncertainty remain. | Review disclosures read; study-level finances incomplete | Strong | Evidence/guidance role described by the source; individual motivation and every ultimate donor were not independently established. |
| VITAL vitamin D trial | United States | Randomized trial | NIH-funded; study capsules/placebos and testing support were donated by companies in VITAL reporting, so product-related support is disclosed and conclusions are interpreted conservatively. | Public funding with commercial material support (Primary source) | Strong | Evidence/guidance role described by the source; individual motivation and every ultimate donor were not independently established. |
| SELECT selenium/vitamin E review | United States public cancer research network | Large RCT review | SELECT was primarily NCI-funded; the review declared no conflicts. Original 2011 methods/results and available author disclosure footnotes were recovered, but complete product-supply terms and every author relationship were not verified. NCI trial summary | Review declares no conflicts; trial-level ties not fully verified (Primary source) | Very strong against supplement claim | Evidence/guidance role described by the source; individual motivation and every ultimate donor were not independently established. |
| NCCIH cancer complementary health | NIH/NCCIH, United States | Government safety summary | NIH/NCCIH public safety summary, with named NCI/NCCIH reviewers. Page-specific cash financing and all supporting trial relationships were not listed or fully traced. | Public-agency source; finances not fully traced | Strong | Evidence/guidance role described by the source; individual motivation and every ultimate donor were not independently established. |
Frequently asked questions
Can cancer be prevented completely?
No. WHO states that about 38% of cancers can currently be prevented by avoiding risk factors and implementing evidence-based prevention strategies, which means prevention can reduce risk but cannot eliminate all cancer (WHO cancer fact sheet). Age, inherited variants, prior exposures, infections, immune status, and chance still matter (WHO cancer fact sheet).
What is the single most important cancer-prevention habit?
Not using tobacco is a major prevention priority, especially for tobacco users because WHO lists tobacco among the major cancer risk factors and IARC has a dedicated cancer-prevention handbook on risk reversal after quitting (WHO cancer fact sheet, IARC tobacco cessation handbook). If tobacco is already present, combine behavioral support with clinician-approved cessation treatment rather than relying on willpower alone.
Do any supplements cure cancer?
No supplement should be presented as a cancer cure or replacement for oncology treatment. NCI separates complementary approaches from standard medical care, and NCCIH warns that some complementary approaches can interfere with cancer treatment or be harmful (NCI CAM overview, NCCIH cancer and complementary health).
Does vitamin D prevent cancer?
Vitamin D is important for bone and mineral health, especially when deficiency is present, but it is not proven as a broad cancer-prevention supplement. VITAL found that vitamin D3 2,000 IU/day did not significantly reduce invasive cancer incidence, while the cited 2020 review discusses uncertain secondary mortality signals. Those findings do not establish a confirmed reduction in advanced cancer or broad prevention (VITAL, VITAL updated analyses, NIH ODS vitamin D).
Are broccoli, cabbage, and other cruciferous vegetables anticancer foods?
They are reasonable foods to include, but they are not cancer treatments. A meta-analysis found high cruciferous vegetable intake was inversely associated with colorectal and colon cancer risk, but the prospective-study evidence was only borderline, so the honest claim is that cruciferous vegetables belong in a healthy plant-forward pattern (cruciferous vegetable meta-analysis).
Should people with cancer exercise during treatment?
Often yes, if the oncology team says it is safe and the plan is adapted. ASCO recommends regular aerobic and resistance exercise during active treatment with curative intent because evidence shows improvements in fitness, strength, fatigue, and patient-reported outcomes (ASCO guideline).
Is screening always good?
No. WHO states that screening is effective for some but not all cancer types and requires quality assurance, while NCI emphasizes weighing benefits and harms before screening (WHO cancer fact sheet, NCI screening overview). Screening should be based on personal risk and should always include a plan for diagnostic follow-up if results are abnormal.
Should cancer patients avoid all sugar?
The guidelines reviewed here do not support a “zero sugar” or sugar-starvation cure as cancer treatment. A healthier goal is to limit sugar-sweetened drinks and highly processed foods while maintaining enough calories, protein, and micronutrients to preserve muscle and tolerate treatment (WCRF Cancer Prevention Recommendations, ACS survivor guideline).
Can fasting, keto, alkaline diets, or detoxes treat cancer?
These approaches should not replace conventional oncology care. ASCO found evidence for specific diets and weight-loss interventions during active cancer treatment to be very limited, while NCI and NCCIH warn that nonstandard approaches can delay or interfere with cancer treatment (ASCO guideline, NCI CAM overview, NCCIH cancer and complementary health).
What should I bring to my oncology visit?
Bring every supplement, herb, powder, tea, extract, injection, over-the-counter medicine, prescription medicine, and “natural” product you use because natural products can interact with cancer therapies through mechanisms such as drug metabolism and transport; the interaction depends on the exact products, dose and cancer treatment (natural-product interaction review). Also bring recent weight changes, appetite changes, pain, fatigue, sleep issues, bowel changes, alcohol/tobacco use, and exercise limits so supportive care can be tailored.
Sources
- World Health Organization. Cancer fact sheet. https://www.who.int/news-room/fact-sheets/detail/cancer
- World Health Organization. Guide to cancer early diagnosis. https://www.who.int/publications-detail-redirect/guide-to-cancer-early-diagnosis
- International Agency for Research on Cancer. European Code Against Cancer. https://cancer-code-europe.iarc.who.int/
- IARC. IARC Monographs evaluate consumption of red meat and processed meat. https://www.iarc.who.int/wp-content/uploads/2018/07/pr240_E.pdf
- IARC Handbooks of Cancer Prevention. Tobacco Control: Reversal of Risk after Quitting Smoking. https://publications.iarc.who.int/Book-And-Report-Series/Iarc-Handbooks-Of-Cancer-Prevention/Tobacco-Control-Reversal-Of-Risk-After-Quitting-Smoking-2007
- World Cancer Research Fund. Cancer Prevention Recommendations. https://www.wcrf.org/preventing-cancer/cancer-prevention/our-cancer-prevention-recommendations/
- National Cancer Institute. Cancer Causes and Prevention. https://www.cancer.gov/about-cancer/causes-prevention
- National Cancer Institute. Cancer Screening. https://www.cancer.gov/about-cancer/screening
- Rock CL, Thomson C, Gansler T, et al. American Cancer Society guideline for diet and physical activity for cancer prevention. https://pubmed.ncbi.nlm.nih.gov/32515498/
- Rock CL, Thomson CA, Sullivan KR, et al. American Cancer Society nutrition and physical activity guideline for cancer survivors. https://pubmed.ncbi.nlm.nih.gov/35294043/
- Ligibel JA, Bohlke K, May AM, et al. Exercise, Diet, and Weight Management During Cancer Treatment: ASCO Guideline. https://pubmed.ncbi.nlm.nih.gov/35576506/
- McTiernan A, Friedenreich CM, Katzmarzyk PT, Powell KE, Macko R, Buchner D, Pescatello LS, Bloodgood B, Tennant B, Vaux-Bjerke A, George SM, Troiano RP, Piercy KL, 2018 PHYSICAL ACTIVITY GUIDELINES ADVISORY COMMITTEE*. Physical Activity in Cancer Prevention and Survival: A Systematic Review. 2019. Research record
- Kyrgiou M, Kalliala I, Markozannes G, et al. Adiposity and cancer at major anatomical sites: umbrella review. https://pmc.ncbi.nlm.nih.gov/articles/PMC5421437/
- Chan DSM, Lau R, Aune D, et al. Red and Processed Meat and Colorectal Cancer Incidence: Meta-Analysis of Prospective Studies. https://pmc.ncbi.nlm.nih.gov/articles/PMC3108955/
- Ma Y, Hu M, Zhou L, et al. Dietary fiber intake and risks of proximal and distal colon cancers. https://pmc.ncbi.nlm.nih.gov/articles/PMC6133424/
- Wu QJ, Yang Y, Wang J, et al. Cruciferous vegetables intake and the risk of colorectal cancer: a meta-analysis. https://pmc.ncbi.nlm.nih.gov/articles/PMC3603442/
- Manson JE, Cook NR, Lee IM, et al. Vitamin D Supplements and Prevention of Cancer and Cardiovascular Disease. https://pubmed.ncbi.nlm.nih.gov/30415629/
- Manson JE, Bassuk SS, Buring JE. Principal Results of VITAL and Updated Meta-Analyses. https://pmc.ncbi.nlm.nih.gov/articles/PMC7089819/
- Nicastro HL, Dunn BK. Selenium and Prostate Cancer Prevention: Insights from SELECT. https://pmc.ncbi.nlm.nih.gov/articles/PMC3705339/
- Kordiak J, Bielec F, Jabłoński S, Pastuszak-Lewandoska D. Role of Beta-Carotene in Lung Cancer Primary Chemoprevention: A Systematic Review with Meta-Analysis and Meta-Regression. 2022. Research record
- NIH Office of Dietary Supplements. Vitamin D Fact Sheet for Health Professionals. https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/
- NIH Office of Dietary Supplements. Calcium Fact Sheet for Health Professionals. https://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/
- NIH Office of Dietary Supplements. Folate Fact Sheet for Health Professionals. https://ods.od.nih.gov/factsheets/Folate-HealthProfessional/
- NIH Office of Dietary Supplements. Selenium Fact Sheet for Health Professionals. https://ods.od.nih.gov/factsheets/Selenium-HealthProfessional/
- NIH Office of Dietary Supplements. Vitamin E Fact Sheet for Health Professionals. https://ods.od.nih.gov/factsheets/VitaminE-HealthProfessional/
- National Cancer Institute. Complementary and Alternative Medicine for Patients. https://www.cancer.gov/about-cancer/treatment/cam/patient
- NCCIH. Cancer and Complementary Health Approaches: What You Need To Know. https://www.nccih.nih.gov/health/cancer-and-complementary-health-approaches-what-you-need-to-know
- Chan WJ, Adiwidjaja J, McLachlan AJ, Boddy AV, Harnett JE. Interactions between natural products and cancer treatments: underlying mechanisms and clinical importance. 2023. Research record
- Cramp F, Byron-Daniel J. Exercise for the management of cancer-related fatigue in adults. https://pmc.ncbi.nlm.nih.gov/articles/PMC8480137/
- Toll BA, Brandon TH, Gritz ER, et al. Assessing Tobacco Use by Cancer Patients and Facilitating Cessation: AACR Policy Statement. https://pmc.ncbi.nlm.nih.gov/articles/PMC5992896/
- Campbell KL, Winters-Stone KM, Wiskemann J, et al. Exercise Guidelines for Cancer Survivors. https://pubmed.ncbi.nlm.nih.gov/31626055/
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