Cancer Rates of Vegetarians

By Jack Norris, RD

Contents

• Introduction
• EPIC-Oxford: Cancer Mortality Rates (2016)
• General Cancer
• Specific Cancers
  • Colorectal
  • Prostate
  • Breast
  • Lung
  • Ovarian
  • Uterine
  • Stomach
  • Pancreatic
  • Brain
  • Oral
  • Upper Digestive Tract
  • Cervical
  • Melanoma
  • Endometrial
  • Kidney
  • Bladder
  • Lymphatic & Hematopoietic Tissue
• Bibliography

Introduction

This article will address the subject of cancer rates in vegetarians. Very little data exists for vegans. The tables in this article are extracted from all studies that have looked at vegetarians and show the rates of cancer mortality (how many people died from the disease) or incidence (how many people contracted the disease).

Each table below looks at a different type of cancer and whether there has been a difference in risk between vegetarians and non-vegetarians.

Some things to keep in mind:

• Because the 1999 meta-analysis included participants in the Health Food Shoppers, Adventist Health, Heidelberg Vegetarian, and Oxford Vegetarian studies; and the EPIC-Oxford study includes many of the same people as were in the Oxford Vegetarian study, many of these results are not from completely different populations.
• Although the 2012 paper from Adventist Health Study-2 (Tantamango-Bartley, 2012) found some statistically significant differences between vegetarians and non-vegetarians for some specific cancers, they included semi- and pesco-vegetarians in the “vegetarian” category and thus are not listed below. Individual cancer categories were analyzed among the diet groups and female vegans had a lower risk of “all female cancers” before adjusting for body mass index (BMI). Vegans also had a slightly higher rate of urinary tract cancers after adjusting for BMI.
• There is no data on North American vegetarians who are not also Seventh-day Adventists.

In order for the rate to be statistically significant, the numbers in the confidence interval (in the parentheses) must both either be less than 1.00 or greater than 1.00.

EPIC-Oxford: Cancer Mortality (2016)

EPIC-Oxford (Appleby, 2016) found no difference in all cancer mortality between vegetarians (including vegans) and regular meat-eaters (0.93, 0.82-1.05). Vegetarians had lower rates of death from pancreatic (0.48, 0.28-0.82) and lymphatic (0.50, 0.32-0.79), but not colorectal, lung, breast, or ovary cancers.

After excluding participants who changed diet categories during the study, vegetarians had a lower risk of all cancer (0.82, 0.72-0.94), and similar findings as above for the other cancers.

Vegans suffered from 67 deaths from cancer, with a rate not significantly different from regular meat-eaters (1.14, 0.88-1.47).

General Cancer

Table 1 shows that the 2014 study from EPIC-Oxford is the first to show vegetarians to have a lower cancer rate than non-vegetarians (not including pesco-vegetarians). It took 14.9 years of follow-up before a statistically significant difference developed.

Table 1. Risk for All Cancers Combined
Study	Years	Risk and Confidence Interval	Adjustments	Notes
EPIC-OxfordA	1993-2010	Non-Veg 1.00 Pesco-Veg   .88 (.80, .97) Vegetarians   .88 (.82, .95)	smoking, alcohol, physical activity level, gender, study, recruitment method	Incidence
EPIC-OxfordB	1993-2005	Non-Veg 1.00 Vegetarians   .93 (.71, 1.04)	age, gender, smoking	Incidence
EPIC-OxfordC	1993-2002	Non-Veg 1.00 Vegetarians 1.11 (.82, 1.51)	age, gender, smoking	Mortality
Oxford VegetarianD	1980-2000	Non-Veg 1.00 Vegetarians 1.06 (.85, 1.34)	age, gender, smoking; excluded first 5 years of follow-up	Mortality
Health Food ShoppersD	1973-1997	Non-Veg 1.00 Vegetarians 1.18 (.99, 1.41)	age, gender, smoking; excluded first 5 years of follow-up	Mortality
Heidelberg VegetarianE	1978-1989	Non-Veg 1.00 Vegetarians 1.59 (.87, 2.94)	gender, duration of diet, BMI (smoking did not effect results)	Mortality. Non-vegetarians ate meat “occasionally.”
A. Key, 2014 B. Key, 2009a C. Key, 2003 D. Appleby, 2002 E. Chang-Claude, 1993

Table 2 shows that the most recent reports from both AHS-2 and EPIC-Oxford found a lower cancer rate in vegans compared to non-vegetarians.

Table 2. Risk For All Cancers Combined
Study	Years	Risk and Confidence Interval	Adjustments	Notes
EPIC-OxfordA	1993-2010	Non-Veg 1.00 Pesco   .88 (.80, .97) Lacto-ovo   .89 (.83, .96) Vegan   .81 (.66, .98)	smoking, alcohol, physical activity level, gender, study, recruitment method	Incidence
Adventist Health Study-2B	2002-2006	Non-Veg 1.00 Semi   .98 (.82, 1.17) Pesco   .88 (.77, 1.01) Lacto-ovo   .93 (.85, 1.02) Vegan   .84 (.72, .99)	age, race, family history of cancer, education, smoking, alcohol, age at menarche, pregnancies, breastfeeding, oral contraceptives, hormone replacement therapy, and menopause status. Adjusting for physical activity did not change the results.	Incidence
Adventist Health Study-2B	2002-2006	Non-Veg 1.00 Semi   .98 (.83, 1.18) Pesco   .89 (.77, 1.03) Lacto-ovo   .95 (.86, 1.04) Vegan   .86 (.73, 1.00)	Same as above, plus BMI	Incidence
EPIC-Oxford C	1993-2006	Non-Vega 1.00 Vegetarians   .88 (.81, .96) Pescob   .82 (.73, .93)	age, gender, smoking, alcohol, BMI, physical activity, parity, oral contraceptives, method of recruitment	Incidence
EPIC-OxfordD	1993-2005	Non-Vega 1.00 Vegetarians   .89 (.80, 1.00) Pescob   .83 (.71,   .96)	age, gender, smoking	Incidence
aExcluding those who ate no meat other than fish. bAte no meat other than fish. A. Key, 2014 B. Tantamango-Bartley, 2012 C. Key 2009b D. Key, 2009a

Specific Cancers

The tables below do not include the results of the 2014 EPIC-Oxford (Key, 2014) or 2015 EPIC-Oxford (Appleby, 2016) reports. These reports are starting to contain so many different analyses that maintaining these tables is becoming unwieldy; we are assessing whether to change the format to something much simpler.

Colorectal Cancer

Table 3 shows one study that found a higher risk of colorectal cancer for vegetarians and one study that found a lower risk.

Table 3. Risk For Colorectal Cancer.
Study	Years	Risk and Confidence Interval	Adjustments	Notes
Netherlands Cohort StudyA	1986-2006	Non-Veg 1.00 Vegetarians   .78 (.51, 1.20)	age, gender	Incidence
Netherlands Cohort StudyA	1986-2006	Non-Veg 1.00 Vegetarians   .89 (.58, 1.39)	age, gender, energy, smoking, alcohol, BMI, physical activity, education	Incidence
EPIC-OxfordB	1993-2010	Non-Veg 1.00 Pesco-Veg   .66 (.48, .92) Vegetarians   1.03 (.84, 1.26)	smoking, alcohol, physical activity level, gender, study, recruitment method	Incidence
EPIC-OxfordC	1993-2005	Non-Veg 1.00 Vegetarians 1.49 (1.09, 2.03)	age, gender, smoking	Incidence
Oxford VegetarianD	1980-2000	Non-Veg 1.00 Vegetarians 1.42 (  .76, 2.67)	age, gender, smoking; excluded first 5 years of follow-up	Mortality
Oxford VegetarianE	1980-1999	Non-Veg 1.00 Vegetarians   .85 (  .55, 1.32)	age, sex, alcohol, smoking	Incidence
Meta-AnalysisF	1999	Non-Veg 1.00 Vegetarians   .99 (  .77, 1.27)	age, gender, smoking, and study	Mortality
Health Food ShoppersD	1973-1997	Non-Veg 1.00 Vegetarians   .85 (  .52, 1.39)	age, gender, smoking; excluded first 5 years of follow-up	Mortality
Adventist HealthG	1976-1982	Non-Veg 1.00 Vegetarians   .53 (  .35, .81)	age, gender	Incidence
A. Gilsing, 2015 B. Key, 2014 C. Key, 2009a D. Appleby, 2002 E. Sanjoaquin, 2004 F. Key, 1999 G. Fraser, 1999

Table 4 divides populations into more specific diet groups:

Table 4. Risk For Colorectal Cancer.
Study	Years	Risk and Confidence Interval	Adjustments	Notes
AHS-2A	2002-2014	Non-Veg 1.00 Semi-Veg  .92 (.62, 1.37) Pesco  .57 (.40, .82) Lacto-ovo  .82 (.65, 1.02) Vegan  .84 (.59-1.19)	age, race, gender, education, exercise, smoking, alcohol, family history, peptic ulcers, inflammatory bowel disease, diabetes mellitus, aspirin, statins, prior colonoscopy or flexible sigmoidoscopy, supplemental calcium, supplemental vitamin D, calories, hormone therapy	Incidence
EPIC-OxfordB	1993-2006	Non-Vega 1.00 Vegetarians 1.12 (.87, 1.44) Pescob   .77 (.53, 1.13)	age, gender, smoking, alcohol, BMI, physical activity, parity, oral contraceptives, method of recruitment	Incidence
EPIC-OxfordC	1993-2005	Non-Vega 1.00 Vegetarians 1.39 (1.01, 1.91) Pescob   .64 (   .37, 1.10)	age, gender, smoking	Incidence
aExcluding those who ate no meat other than fish. • bAte no meat other than fish. A. Orlich, 2015 B. Key 2009b C. Key, 2009a

Prostate Cancer

The results for prostate cancer, Table 5 below, are similar to colorectal; only the Adventist Health Study showed a statistically significant difference.

Table 5. Risk For Prostate Cancer.
Study	Years	Risk and Confidence Interval	Adjustments	Notes
EPIC-OxfordA	1993-2005	Non-Veg 1.00 Vegetarians   .90 (.61, 1.33)	age, gender, smoking	Incidence
Oxford VegetarianB	1980-2000	Non-Veg 1.00 Vegetarians   .66 (.27, 1.59)	age, gender, smoking; excluded first 5 years of follow-up	Mortality
Meta-AnalysisC	1999	Non-Veg 1.00 Vegetarians   .91 (.60, 1.39)	age, gender, smoking, and study	Mortality
Health Food ShoppersB	1973-1997	Non-Veg 1.00 Vegetarians 1.29 (.62, 2.68)	age, gender, smoking; excluded first 5 years of follow-up	Mortality
Adventist HealthD	1976-1982	Non-Veg 1.00 Vegetarians   .65 (.44,  .95)	age, gender	Incidence. 6 years of follow up.
A. Key, 2009a B. Appleby, 2002 C. Key, 1999 D. Fraser, 1999

In AHS-2, vegans had a lower risk than regular meat-eaters, even after adjusting for BMI. In EPIC-Oxford, fish-eaters had a statistically significant, lower rate of prostate cancer than regular meat eaters. See Table 6 below.

Table 6. Risk For Prostate Cancer.
Study	Years	Risk and Confidence Interval	Adjustments	Notes
AHS-2A	2002-2013	Non-Vega 1.00 Semi-Vegc 1.18 (.91, 1.54) Pescob 1.07 (.88, 1.31) Lacto-Ovo   .96 (.83, 1.12) Vegan   .66 (.50,   .87)	Age, race, family history, education, screening, caloric intake, BMI	Incidence
EPIC-OxfordB	1993-2006	Non-Vega 1.00 Vegetarians   .87 (.64, 1.18) Pescob   .57 (.33,   .99)	age, gender, smoking, alcohol, BMI, physical activity, parity, oral contraceptives, method of recruitment	Incidence
aExcluding those who ate no meat other than fish. • bAte no meat other than fish. • cAte red meat or poultry ≤1 time/month but all meats combined (including fish) <1 time/wk. A. Tantamango-Bartley, 2015 B. Key 2009b

Breast Cancer

Unfortunately, the one (barely) significant finding was that vegetarians had more breast cancer in the Health Food Shoppers study. See Table 7 below. That study did not adjust for having children which is protective against breast cancer, and vegetarian women tend to have fewer children.

Table 7. Risk For Breast Cancer.
Study	Years	Risk and Confidence Interval	Adjustments	Notes
AHS-2A	2002-2011	Non-Veg 1.00 Semi   .91 (.67, 1.23) Pesco   .91 (.71, 1.17) Lacto-ovo   1.05 (.89, 1.23) Vegan   .78 (.58, 1.05) All Veg   .97 (.84, 1.11)	race, height, physical activity, family history of cancer, mammography, age at menopause, age at menarche, birth control pills, hormone replacement therapy, age at first child, number of children, breastfeeding, educational level, smoking, alcohol	Incidence
EPIC-OxfordB	1993-2005	Non-Veg 1.00 Vegetarians   .94 (.77, 1.13)	age, gender, smoking	Incidence
Oxford VegetarianC	1980-2000	Non-Veg 1.00 Vegetarians 1.23 (.66, 2.31)	age, smoking; excluded first 5 years of follow-up	Mortality
Meta-AnalysisD	1999	Non-Veg 1.00 Vegetarians   .95 (.55, 1.63)	age, smoking, and study	Mortality
South Asian-Born Women Living in UKE	1995-1999	Non-Veg 1.00 Vegetarians   .77 (.50, 1.19)	age, smoking; excluded first 5 years of follow-up	Incidence. Case control.
Health Food ShoppersC	1973-1997	Non-Veg 1.00 Vegetarians 1.62 (1.01, 2.60)	age, smoking; excluded first 5 years of follow-up	Mortality
IndiaF	1980-1984	Non-Veg 1.00 Vegetarians 1.25 (.48, 1.67)	age, region	Incidence. Case control.
Adventist HealthG	1976-1982	Non-Veg 1.00 Vegetarians   .80 (.56, 1.15)	age	Incidence. 6 years of follow up.
A. Penniecook-Sawyers, 2016 B. Key, 2009a C. Appleby, 2002 D. Key, 1999 E. Dos Santos Silva, 2002 F. Rao, 1994a G. Fraser, 1999

Table 8. Rates for Breast Cancer
Study	Years	Risk and Confidence Interval	Adjustments	Notes
EPIC-OxfordA	1993-2006	Non-Vega 1.00 Vegetarians   .91 (.77, 1.08) Pescob 1.05 (.86, 1.28)	age, gender, smoking, alcohol, BMI, physical activity, parity, oral contraceptives, method of recruitment	Incidence
aExcluding those who ate no meat other than fish. • bAte no meat other than fish. A. Key 2009b

Lung Cancer

Table 9. Rates for Lung Cancer
Study	Years	Risk and Confidence Interval	Adjustments	Notes
EPIC-OxfordA	1993-2005	Non-Veg 1.00 Vegetarians 1.23 (.69, 2.17)	age, gender, smoking	Incidence
Oxford VegetarianB	1980-2000	Non-Veg 1.00 Vegetarians 1.27 (.60, 2.68)	age, gender, smoking; excluded first 5 years of follow-up	Mortality
Meta-AnalysisC	1999	Non-Veg 1.00 Vegetarians   .84 (.59, 1.18)	age, gender, smoking, and study	Mortality
Health Food ShoppersB	1973-1997	Non-Veg 1.00 Vegetarians 1.19 (.70, 2.02)	age, gender, smoking; excluded first 5 years of follow-up	Mortality
Adventist HealthD	1976-1982	Non-Veg 1.00 Vegetarians   .86 (.42, 1.79)	age, gender	Incidence. 6 years of follow up.
A. Key, 2009a B. Appleby, 2002 C. Key, 1999 D. Fraser, 1999

Table 10. Rates for Lung Cancer
Study	Years	Risk and Confidence Interval	Adjustments	Notes
EPIC-OxfordA	1993-2006	Non-Vega 1.00 Vegetarians 1.11 (.75, 1.65) Pescob   .59 (.29, 1.23)	age, gender, smoking, alcohol, BMI, physical activity, parity, oral contraceptives, method of recruitment	Incidence
aExcluding those who ate no meat other than fish. • bAte no meat other than fish. A. Key 2009b

Ovarian Cancer

Table 11. Rates for Ovarian Cancer
Study	Years	Risk and Confidence Interval	Adjustments	Notes
EPIC-OxfordA	1993-2005	Non-Veg 1.00 Vegetarians   .85 (.49, 1.46)	age, gender, smoking	Incidence
A. Key, 2009a

Table 12. Rates for Ovarian Cancer
Study	Years	Risk and Confidence Interval	Adjustments	Notes
EPIC-OxfordA	1993-2006	Non-Vega 1.00 Vegetarians   .69 (.45, 1.07) Pescob   .37 (.18,   .77)	age, gender, smoking, alcohol, BMI, physical activity, parity, oral contraceptives, method of recruitment	Incidence
aExcluding those who ate no meat other than fish. • bAte no meat other than fish. A. Key 2009b

Uterine Cancer

Table 13. Rates for Uterine Cancer
Study	Years	Risk and Confidence Interval	Adjustments	Notes
Adventist HealthA	1976-1982	Non-Veg 1.00 Vegetarians   .85 (.58, 1.23)	age, gender	Incidence. 6 years of follow up.
A. Fraser, 1999

Stomach Cancer

Table 14. Risk for Stomach Cancer
Study	Years	Risk and Confidence Interval	Adjustments	Notes
Meta-AnalysisA	1999	Non-Veg 1.00 Vegetarians 1.02 (.64, 1.62)	age, gender, smoking, and study	Mortality
A. Key, 1999

Table 15. Risk for Stomach Cancer
Study	Years	Risk and Confidence Interval	Adjustments	Notes
EPIC-OxfordA	1993-2006	Non-Vega 1.00 Vegetarians   .36 (.16,   .78) Pescob   .29 (.07, 1.20)	age, gender, smoking, alcohol, BMI, physical activity, parity, oral contraceptives, method of recruitment	Incidence
aExcluding those who ate no meat other than fish. • bAte no meat other than fish. A. Key 2009b

Pancreatic Cancer

Table 16 shows that vegetarians had about half the rate of pancreatic cancer compared to people who ate meat more than once
daily. In comparison to all meat eaters, the rates were not significantly different.

Table 16. Risk for Pancreatic Cancer
Study	Years	Risk and Confidence Interval	Adjustments	Notes
Adventist HealthA	1976-1982	Non-Veg 1.00 Vegetarians   .46 (  .06, 1.39) Vegetarians 1.00 Non-Vega 2.18 (1.04, 4.58)	age, sex, smoking, other foods age, gender	Mortality
aAte meat more than once daily. A. Mills, 1988

Table 17. Risk for Pancreatic Cancer
Study	Years	Risk and Confidence Interval	Adjustments	Notes
EPIC-OxfordA	1993-2006	Non-Vega 1.00 Vegetarians   .94 (.52, 1.71) Pescob   .82 (.34, 1.96)	age, gender, smoking, alcohol, BMI, physical activity, parity, oral contraceptives, method of recruitment	Incidence
aExcluding those who ate no meat other than fish • bAte no meat other than fish A. Key 2009b

Brain Cancer

Among people who ate meat more than once daily, there were no cases of meningioma cancer and this finding was statistically significant (see Table 18 below.)

Table 18. Risk for Brain Cancer
Study	Years	Risk and Confidence Interval	Adjustments	Notes
Adventist HealthA	1976-1982	Glioma Cancer Vegetarians 1.00 Non-Vega 1.56 (.52, 5.63) Non-Vegb 1.75 (.34, 8.54) Meningioma Cancer Vegetarians 1.00 Non-Vega   .36 (.09, 1.46) Non-Vegb 0 (P < .05)	age, gender	Incidence. 6 years of follow up.
aAte meat less than once daily. • bAte meat more than once daily. A. Mills, 1989

Table 19. Risk for Brain Cancer
Study	Years	Risk and Confidence Interval	Adjustments	Notes
EPIC-OxfordA	1993-2006	Non-Vega 1.00 Vegetarians 1.25 (.72, 2.16) Pescob 1.39 (.69, 2.80)	age, gender, smoking, alcohol, BMI, physical activity, parity, oral contraceptives, method of recruitment	Incidence
aExcluding those who ate no meat other than fish. • bAte no meat other than fish. A. Key 2009b

Oral Cancer

Vegetarians, as shown in Table 20 below, had significantly lower rates of oral cancer in this study of Indian vegetarians.

Table 20. Risk for Oral Cancer
Study	Years	Risk and Confidence Interval	Adjustments	Notes
IndiaA	1980-1984	Non-Veg 1.00 Vegetarians   .55 (.40, .74)	age, region	Incidence. Case control.
A. Rao, 1994b

Cancer of the Upper Digestive Tract

Table 21. Risk for Cancer of the Upper Digestive Tract
Study	Years	Risk and Confidence Interval	Adjustments	Notes
EPIC-OxfordA	1993-2006	Non-Vega 1.00 Vegetarians   .81 (.45, 1.46) Pescob   .44 (.16, 1.25)	age, gender, smoking, alcohol, BMI, physical activity, parity, oral contraceptives, method of recruitment	Incidence
aExcluding those who ate no meat other than fish. • bAte no meat other than fish. A. Key 2009b

Cervical Cancer

Table 22. Risk for Cervical Cancer
Study	Years	Risk and Confidence Interval	Adjustments	Notes
EPIC-OxfordA	1993-2006	Non-Vega 1.00 Vegetarians 2.08 (1.05, 4.12) Pescob 2.05 (  .91, 4.63)	age, gender, smoking, alcohol, BMI, physical activity, parity, oral contraceptives, method of recruitment	Incidence
aExcluding those who ate no meat other than fish. • bAte no meat other than fish. A. Key 2009b

Melanoma

Table 23. Risk for Melanoma
Study	Years	Risk and Confidence Interval	Adjustments	Notes
EPIC-OxfordA	1993-2006	Non-Vega 1.00 Vegetarians   .89 (.61, 1.29) Pescob   .90 (.55, 1.47)	age, gender, smoking, alcohol, BMI, physical activity, parity, oral contraceptives, method of recruitment	Incidence
aExcluding those who ate no meat other than fish. • bAte no meat other than fish. A. Key 2009b

Endometrial Cancer

Table 24. Risk for Endometrial Cancer
Study	Years	Risk and Confidence Interval	Adjustments	Notes
EPIC-OxfordA	1993-2006	Non-Vega 1.00 Vegetarians   .75 (.45, 1.28) Pescob   .61 (.29, 1.30)	age, gender, smoking, alcohol, BMI, physical activity, parity, oral contraceptives, method of recruitment	Incidence
aExcluding those who ate no meat other than fish. • bAte no meat other than fish. A. Key 2009b

Kidney Cancer

Table 25. Risk for Kidney Cancer
Study	Years	Risk and Confidence Interval	Adjustments	Notes
EPIC-OxfordA	1993-2006	Non-Vega 1.00 Vegetarians   .76 (.36, 1.58) Pescob   .36 (.09, 1.52)	age, gender, smoking, alcohol, BMI, physical activity, parity, oral contraceptives, method of recruitment	Incidence
aExcluding those who ate no meat other than fish. • bAte no meat other than fish. A. Key 2009b

Bladder Cancer

Table 26. Risk for Bladder Cancer
Study	Years	Risk and Confidence Interval	Adjustments	Notes
EPIC-OxfordA	1993-2006	Non-Vega 1.00 Vegetarians   .47 (.25,   .89) Pescob   .81 (.36, 1.81)	age, gender, smoking, alcohol, BMI, physical activity, parity, oral contraceptives, method of recruitment	Incidence
aExcluding those who ate no meat other than fish. • bAte no meat other than fish. A. Key 2009b

Lymphatic & Hematopoietic Tissue Cancer

Table 27. Risk for Lymphatic & Hematopoietic Tissue Cancer.
Study	Years	Risk and Confidence Interval	Adjustments	Notes
EPIC-OxfordA	1993-2006	All Non-Vega 1.00 Vegetarians   .55 (.39,  .78) Pescob   .85 (.56, 1.29) Non-Hodgkin’s Lymphoma Non-Vega 1.00 Vegetarians   .57 (.35,   .95) Pescob   .86 (.47, 1.58) Multiple Myeloma Non-Vega 1.00 Vegetarians   .25 (.08,  .73) Pescob   .72 (.25, 2.10) Leukemia Non-Vega 1.00 Vegetarians   .78 (.43, 1.43) Pescob 1.18 (.58, 2.40)	age, gender, smoking, alcohol, BMI, physical activity, parity, oral contraceptives, method of recruitment	Incidence
aExcluding those who ate no meat other than fish. • bAte no meat other than fish. A. Key 2009b

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Basically same results as reference 13 Key at al. Am J Clin Nutr 2009;89(suppl):1S-7S. Not cited.