Cancer is a leading cause of death worldwide, accounting for nearly 1 in 6 deaths in 2020, according to the World Health Organization (WHO). Accordingly, substantial attention has been directed towards identifying modifiable risk factors for cancer. Diet represents one such factor; adherence to a healthy, balanced diet is known to reduce cancer risk, partly because it supports the maintenance of healthy body weight. More recently, research interest has expanded beyond the assessment of overall diet quality and caloric intake to examine dietary profiles such as vegetarianism and veganism. In this context, Dunneram and colleagues recently published findings in the British Journal of Cancer illustrating that, across over 1.8 million participants in the UK, US, India and Taiwan, individuals adhering to vegetarian diets have a lower risk of multiple myeloma and kidney, pancreatic, prostate and breast cancer, but a heightened risk of oesophageal cancer.
The study assessed long-term data from over 1.8 million people with relatively healthy eating habits and compared the cancer risks between vegetarians and meat eaters. Dietary patterns were assessed using food frequency questionnaires that assessed the consumption of key food groups, while cancer outcomes were ascertained through linked healthcare records. Participants were followed up for a minimum of six years, but up to 27 years in some cohorts. Importantly, the analysis accounted for a variety of factors which may increase the likelihood of both vegetarianism and cancer, such as sex, educational attainment, and physical activity.
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The study found that when compared to meat eaters, vegetarianism was associated with a 9% reduced risk of breast cancer, a 12% reduced risk of prostate cancer, a 21% reduced risk of pancreatic cancer, a 28% reduced risk of kidney cancer, and a 31% reduced risk of multiple myeloma. However, vegetarians were also found to have a markedly higher risk of developing squamous cell carcinoma of the oesophagus, with a 93% heightened risk when compared to meat eaters. These findings are unusual as they challenge the prevailing narrative that vegetarian diets are uniformly protective against cancer. The observational nature of this study cannot support causal inference on its own, but the strength of the evidence certainly warrants efforts to validate its findings using causal inference methods.
Factors such as the overconsumption of processed foods, such as meats that are smoked and cured (established carcinogenic processing), may represent one important pathway. Simultaneously, deficiencies in some micronutrients typically provided through the consumption of meat, such as riboflavin, may show promise as a modifiable risk factor in cancer development. These findings are particularly important in light of epidemiological projections by GlobalData, which forecast an overall increase in the incident number of multiple myeloma cases across the eight major markets (the US, France, Germany, Italy, Spain, the UK, Japan, and China), from approximately 87,000 in 2026 to 95,000 by 2032. Given the strong evidence presented in this study and the projected increases in cancer incidence, these findings represent an important avenue for future research to build upon.
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