Literature Review

Cancer is a major disease burden worldwide. On an annual basis, approximately 10 million

people are diagnosed with cancer, which is fatal in more than 6 million individuals. Currently
there are more than 22 million cancer patients worldwide (Ferlay et al., 2001 IARC cancer
bases no 5), the most common occurrences are lung (12.3% of all cases), breast (10.4%) and
colorectal (9.4%). Studies show there is marked global variation in cancer occurrence, for
example almost a quarter of cancer incidences in developing countries are associated with
prevalence of chronic infections like hepatitis B or human papillomaviruses; whilst a higher
incidence of cancers of the colon, lung, breast and prostate in affluent populations has been
observed, which has been attributed to the Western lifestyle (IARC 2007).

North America, Northern and Western Europe, Australia and New Zealand are regions
described as having a Western lifestyle; typically a diet high in saturated fat, refined
carbohydrates and animal protein, low in fruit and vegetable consumption and inadequate
levels of physical activity. In other less affluent regions of the world such as sub-Sahara
Africa, Western Asia and South Central Asia, the typical lifestyle consists of a low fat, high
vegetable diet, combined with more physical activity. Unsurprisingly, colorectal cancer (CRC)
is the second most common cancer, in terms of incidence and mortality, in developed
countries, accounting for almost 500,000 deaths per year. Epidemiological studies
undertaken with migrant populations from less to more affluent populations show the risk of
developing CRC rapidly increases to the same high level of the adopted country. Given this
evidence, together with research that has shown that the majority of cases of colorectal
cancer (95%) occur sporadically, diet has been implicated as the most important factor in the
etiology of colorectal cancer. As a result of this finding suggestions have been made that up
to 70% of cases of CRC could feasibly be prevented by modification to dietary habits.

It is widely accepted that there is a relationship between consumption of a diet high in fruit
and vegetables and a reduced risk of developing certain types of chronic diseases, including
cancer. Something about different types of epithelial cancer and links to dietary
intervention – Block et al 1992?
One possible explanation for this relationship is that fruit and vegetables contain potential
cytoprotectants including vitamins, minerals, fibre and numerous phytochemicals. Soft fruit,
namely berries, are a good source of these non-nutrient phytochemicals, which have been
proposed to reduce cancer risk (Duthie et al., 2000 Plant polyp in cancer).