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Breast cancer is a complex disease influenced by environmental, genetic, dietary,
and hormonal factors. This underscores the importance of postoperative
nutritional management in supporting recovery, minimizing complications, and
enhancing long-term outcomes. This review synthesizes clinical guidelines,
expert recommendations, and observational studies to provide a comprehensive
overview of dietary interventions for breast cancer patients following surgery.
Post-surgical nutritional care is centered around three primary objectives:
supporting wound healing through high-quality protein intake, maintaining
optimal nutritional status to prevent malnutrition, and promoting healthy
lifestyle habits to reduce the risk of recurrence. To achieve these objectives,
postoperative dietary strategies focus on several key components: ensuring
adequate hydration for metabolic processes and tissue repair, consuming a
balanced diet rich in fresh vegetables and fruits to mitigate oxidative stress,
incorporating whole grains to support overall healing, and maintaining
sufficient intake of high-quality protein from sources such as fish, meat, and
dairy products to aid tissue repair and immune system recovery. Patients are
also advised to avoid alcohol, limit saturated fats, and reduce intake of salty,
sugary, and smoked foods to minimize inflammation. As research progresses, the
implementation of personalized dietary plans remains essential for optimizing
recovery outcomes in breast cancer patients.
Breast cancer represents a significant health burden, with its incidence consistently
rising over the past several decades. In 2021, South Korea reported 28,861 new cases
of breast cancer, which represented 10.4% of all cancer diagnoses and 21.5% of
cancers in women, making it the second most prevalent cancer among women. Although
the rate of increase has slightly declined since 2007, the incidence of breast
cancer continues to rise. This trend is influenced by improvements in diagnostic
techniques and changes in risk factors, including lifestyle alterations and an aging
population. Breast cancer also exhibits a high survival rate, with a 5-year relative
survival rate of 93.8%, due to advances in early detection and treatment methods.
Nonetheless, breast cancer remains a significant cause of cancer-related mortality
among women, accounting for 8.6% of female cancer deaths in 2023 [1].
Breast cancer represents a significant global health challenge, not only in South
Korea but worldwide. According to the World Health Organization, approximately 2.3
million women were diagnosed with breast cancer globally in 2022, resulting in
670,000 deaths. In the same year, breast cancer was the most common cancer among
women in 157 out of 185 countries, underscoring its widespread impact on
women's health [2]. Furthermore, from
1990 to 2019, the number of global breast cancer cases more than doubled, increasing
from 876,990 to 2,002,350, with an average annual percentage increase of 0.33%.
Although the number of deaths has also risen during this period, advancements in
medical care have led to a 0.56% annual decrease in mortality rates worldwide [3]. The high prevalence of breast cancer and its
significant impact on public health underscore the urgent need for comprehensive
management strategies that include prevention, treatment, and recovery support.
Surgery is the cornerstone of breast cancer treatment and serves as the primary
curative intervention. It provides essential local disease control and critical
pathological staging information necessary for treatment planning [4]. Although advancements in surgical techniques
and therapeutic options have significantly improved outcomes over the years, major
surgical complications can still occur. These complications, which include surgical
issues such as bleeding, wound disruption, infection, or foreign body retention, as
well as medical complications like myocardial infarction, pulmonary embolism,
pneumonia, or acute respiratory distress syndrome, have been linked to worse
cancer-specific and overall survival [5].
Additionally, cancer survivors face the risk of accelerated functional decline,
which adversely affects physical functioning, recovery, and overall quality of life
[6]. Therefore, truly successful treatment
must extend beyond the operating room to include a comprehensive recovery process
and long-term survivorship support. Within this framework, perioperative strategies,
including proper nutritional management, are crucial for supporting immediate
recovery. To achieve optimal long-term outcomes, a coordinated multidisciplinary
approach is essential. This approach promotes healthy practices, reduces the risks
of recurrence and secondary malignancies, and minimizes complications from
comorbidities [7]. Nutritional support is a
key component of this multidisciplinary approach.
Preoperative nutritional support has been demonstrated to reduce hospital stays,
complication rates, and cancer recurrence [8].
Protective factors consist of regular consumption of vegetables, fruits, fiber, and
carotenoids, as well as consistent physical activity. Conversely, factors that
increase risk include obesity, alcohol consumption, high meat intake, and diets high
in saturated fats [9]. Addressing these
dietary habits is crucial for prevention.
During the postoperative period, proper nutrition plays a crucial role in healing,
enhances treatment tolerance, and improves rehabilitation outcomes, establishing it
as a fundamental aspect of comprehensive breast cancer management [10]. Given the significant implications, this
review concentrates on evidence-based nutritional management strategies for patients
who have undergone breast cancer surgery.
Ethics statement
As this study is a literature review, it did not require institutional review board
approval or individual consent.
Breast cancer and nutritional factors
Recovery management
Surgical stress induces the upregulation of glucagon, cortisol, and
proinflammatory cytokines, which extensively catabolize hepatic and muscle
glycogen to meet the energy requirements of wound healing. This process also
involves increased gluconeogenesis in the liver, using lactate, amino acids, and
glycerol as the primary substrates. The elevated levels of catabolic hormones
hinder insulin secretion and the clearance of blood glucose, leading to insulin
resistance and hyperglycemia. If not properly managed, these conditions can
impair immune function and heighten the risk of infection. These complex
metabolic alterations, which include changes in protein synthesis, energy
utilization, and nutrient processing, culminate in a hypermetabolic-catabolic
state. To address these challenges, patients need specialized nutritional
interventions during recovery that focus on a balanced diet and lifestyle
modifications [11].
Post-surgical nutritional care is centered around three main objectives. First,
ensuring balanced meals with high-quality protein intake is essential for
supporting surgical wound healing and physical recovery [12,13]. Second,
maintaining optimal nutritional status and preventing malnutrition are key to
facilitating a faster and smoother return to daily activities, as well as
enhancing health-related quality of life [14]. Third, adopting proper lifestyle habits is crucial in
preventing cancer recurrence [7].
To facilitate rapid recovery following breast cancer surgery, a comprehensive
nutritional strategy has been developed (Fig.
1). This strategy aligns with the Korean Dietary Guidelines [15] and underscores the significance of
balanced meals. It advocates for the daily intake of fresh vegetables and
fruits, alongside suitable amounts of grains, fish, meat, and dairy products.
Adequate hydration, achieved through sufficient water consumption, is also
emphasized. Additionally, regular physical activity is crucial for maintaining a
healthy body weight and promoting overall recovery.
Fig. 1.
Food group wheel. The figure illustrates the recommended daily intake
of diverse foods, emphasizing balanced consumption to support recovery
and overall health. It provides guidance on the types of foods to be
consumed and their appropriate portions for each day. Adapted from
Ministry of Health and Welfare and The Korean Nutrition Society [15] with CC-BY.
In the following sections, we will discuss each component of this nutritional
strategy in detail. This includes the rationale behind the recommended food
groups, hydration guidelines, and the role of physical activity in postoperative
recovery.
Nutritional factors
Water and hydration
Water is fundamental to human physiology and plays a crucial role in
maintaining health. It is the primary component of blood and body tissues,
acting as an important carrier for nutrients and waste products.
Additionally, water regulates body temperature and supports various
metabolic processes [16].
For breast cancer patients, maintaining adequate hydration is crucial during
both treatment and recovery phases. Treatments such as chemotherapy,
radiation, and surgery can significantly increase the body's water
requirements and the risk of fluid loss. Dehydration, a frequent side effect
of cancer therapies, can occur due to persistent vomiting, diarrhea,
bleeding, prolonged fever, or excessive sweating. These conditions can
severely impair the body's ability to heal [17].
Proper hydration is essential for these patients, as it promotes wound
healing, alleviates treatment-related side effects, maintains electrolyte
balance, and increases overall physiological resilience during recovery
[1]. Medical guidelines typically
advise adults to drink at least 7 to 8 cups of water per day, although
specific needs may vary based on treatment intensity, physical activity, and
general health [15]. Besides water,
other beneficial beverages include herbal teas, nonfat soymilk, and diluted
fruit juice, which not only aid in hydration but also provide additional
nutrients. Conversely, the consumption of alcohol, coffee, decaffeinated
coffee, black tea, decaffeinated tea, and caffeinated sodas is discouraged.
These beverages may lead to fluid loss, hinder nutrient absorption, or
worsen treatment-related side effects [18].
Protein intake
Protein plays a crucial role in the post-surgical recovery of breast cancer
patients. It aids in various processes including wound healing, muscle
preservation, blood cell production, immune system strengthening, and
overall recuperation [12]. However,
surgical stress significantly increases protein catabolism. The
hypercortisolemia associated with surgery inhibits protein synthesis and
accelerates protein breakdown, leading to a net loss of amino acids from
skeletal muscle [13]. This shift
results in the loss of skeletal muscle, which directly diminishes strength
and functionality, thereby impeding the recovery process. To mitigate these
catabolic effects and enhance recovery, it is essential to maintain adequate
protein intake.
Lean meats are an excellent source of high-quality protein, providing a
balanced profile of amino acids that fulfill human physiological needs. To
minimize health risks, it is recommended that meat consumption be limited to
500 grams per week [19], which
amounts to small portions roughly the size of a ping-pong ball [20]. Patients should opt for lean cuts
such as skinless poultry or those with minimal fat, rather than fattier
options like ribs, pork belly, or chicken skin. Conversely, the consumption
of red meats such as beef, lamb, and pork, along with processed meats like
ham and sausages, has been associated with an increased risk or exacerbation
of cancer outcomes. These meats may contain carcinogenic compounds such as
heterocyclic amines and polycyclic aromatic hydrocarbons, which form during
cooking at high temperatures. Red meat also includes hormone residues and
pro-inflammatory molecules such as N-glycolylneuraminic acid, which may
contribute to chronic inflammation and tumor growth. Additionally, processed
meats often contain nitrites and nitrates that can transform into
carcinogenic nitrosamines [21].
Therefore, red meat consumption should be restricted to one serving per meal
and no more than two servings per week, and processed meats should be
avoided due to their potential health risks [22].
Cooking techniques significantly influence the nutritional value and
potential carcinogenic properties of protein sources. It is advisable to use
indirect cooking methods such as grilling, steaming, baking, or preparing
light stir-fries. These methods help preserve the nutritional integrity of
foods while minimizing health risks by reducing the formation of harmful
compounds like heterocyclic amines and benzopyrene, which are produced when
protein is subjected to high direct heat or charring [23]. To limit the intake of excessive saturated fats,
patients should avoid deep-frying or pan-frying with excessive oil.
Healthier cooking options, such as steaming or braising, are preferable
[24]. It is also beneficial to
incorporate unsaturated fats from sources like blue-backed fish, sesame oil,
perilla oil, and olive oil, which offer nutritional advantages [25]. Furthermore, patients should avoid
reusing cooking oils [26] and
consuming smoked foods [27], as these
practices can lead to the formation of carcinogenic compounds.
Instead of high-fat meats, patients are encouraged to opt for healthier
protein options such as a single fish fillet or dishes made with soy-based
ingredients [20]. Soy products, rich
in isoflavones, function as phytoestrogens and offer hormonal balance as
well as antioxidant and anticancer properties. It is advisable to consume
these in whole food forms, including tofu, edamame, and traditional soy
products, while avoiding concentrated soy supplements that may contain
harmful compounds [28]. For portion
control, about two tablespoons of black beans or one-fifth of a tofu block
per serving is recommended to achieve health benefits [20].
Vegetable and fruit consumption
Consuming a wide variety of colorful fruits and vegetables is crucial for
breast cancer patients because each color represents different
phytochemicals, each with unique health-protective properties. These
phytochemicals are bioactive compounds that plants naturally produce as a
defense mechanism. Beyond their protective role in plants, these compounds
provide numerous health benefits for humans, including anti-inflammatory,
antioxidant, and anticancer effects, and they help prevent chronic
conditions such as heart disease and metabolic disorders [29].
Table 1 highlights key anti-breast
cancer phytochemicals, their dietary sources, and their health benefits.
Flavones, present in red and yellow fruits and vegetables, are linked to
lower risks of coronary heart disease, various cancers, and chronic
inflammation. They also help reduce estrogen levels, potentially inhibiting
the growth of breast tumors. Isoflavones, found in foods such as sour
cherry, tomato, broccoli, and carrot, play a role in cancer prevention by
suppressing metastasis and inducing apoptosis in breast cancer cells.
Prenylated flavonoids, found in Morus alba, Artocarpus
heterophyllus, Glycine max, and Ficus carica,
have been shown to induce apoptosis and reduce cytotoxicity in breast cancer
cells. Lignans, present in potatoes, broccoli, and berries, are associated
with a reduced risk of postmenopausal breast cancer and other chronic
conditions. Lastly, sitosterol, commonly found in fat-rich vegetables like
avocado, has demonstrated significant anticancer and anti-inflammatory
effects by inhibiting the growth of breast cancer cells and inducing
apoptosis.
Table 1.
Major anti-breast cancer phytochemicals, their sources, and the
related benefits
Anticancer phytochemicals
Sources
Benefits
References
Flavones
Red and yellow fruits and
vegetables (watermelons, bell peppers…)
- Reduced risk of coronary heart
diseases, cancers, chronic inflammation, osteoporosis and
other age-related diseases. - Lowering estrogen
levels that can help inhibit breast tumor growth and reduces
the risk of recurrence.
- Inhibition of cancer cell
growth, suppression of metastasis, and induction of
apoptosis. - Inhibits the proliferation of breast
cancer cells by inducing cell cycle arrest.
Morus alba, Artocarpus
heterophyllus, Glycine max, and Ficus
carica
- Anti-cancer, anti-inflammatory,
neuroprotective, anti-diabetic, anti-obesity,
cardioprotective effects, and anti-osteoclastogenic
activities. - Induced apoptosis suppresses
cytotoxicity against human breast cancer cells.
- Reduces immunomodulatory,
antimicrobial, anticancer, anti – inflammatory, and
lipid-lowering effect. - Inhibits breast cancer cell
growth and induces apoptosis
The Mediterranean Diet (MeDi), which emphasizes the daily consumption of
fruits and vegetables, has been shown to provide an optimal intake of
polyphenols (phenolic acids, flavonoids, stilbenes, lignans) and fiber.
These components, abundantly found in these foods, are linked to improved
outcomes in breast cancer survivors [30].
To achieve these benefits, patients should be encouraged to consume
5–9 servings of fruits (approximately 150 g per serving) and
vegetables (approximately 75 g per serving) daily [36]. This can be accomplished by including at least two
plates of diverse vegetables per meal, prepared in various styles such as
namul, salads, or stir-fries, and by consuming
1–2 portions of fruit daily. These fruit portions should be divided
into 1–2 servings, each roughly the size of an apple, to manage sugar
intake [19].
Physical activity and weight management
Maintaining an appropriate body weight is crucial in strategies for breast
cancer recovery and prevention. Being overweight or obese after a breast
cancer diagnosis is associated with an increased risk of cancer recurrence,
mortality, and second primary contralateral breast cancer [37].
Higher weekly energy expenditure through exercise has been shown to
significantly improve physical functioning in survivors. Additionally,
cancer patients have reported positive effects of physical activity on
mental well-being. It helps alleviate common treatment-related side effects,
such as fatigue, and supports overall health, resilience, quality of life,
and physical functioning [38].
Patients are encouraged to engage in physical activity at least five times
per week, with each session lasting 30 minutes or more, while also balancing
their dietary intake. Combining physical activity with a balanced diet
amplifies the benefits of each, enhancing overall health and supporting
weight management. Providing structured programs and tailored guidance can
further enhance patients' motivation and engagement, leading to more
effective outcomes [39].
Dairy products
Dairy products are rich in essential nutrients such as calcium, vitamin D,
butyrate, lactoferrin, and conjugated linoleic acid, all of which have shown
anticarcinogenic properties [40].
These nutrients are vital in reducing the risk of breast cancer as they
support cellular health and inhibit carcinogenic pathways. For breast cancer
patients, particularly postmenopausal women, maintaining adequate calcium
intake is crucial to prevent osteoporosis [41]. It is advisable to consume at least one serving of milk or
dairy products daily, either with a meal or as a snack, to ensure adequate
calcium levels [19]. Additionally,
incorporating a variety of calcium sources, such as dried anchovies and
seaweed, can provide dietary flexibility and balance [42].
Due to the high saturated fat content in dairy products, it is advisable to
choose low-fat or non-fat options [9].
For individuals who experience difficulty digesting milk, alternatives like
lactose-free milk, soy milk, yogurt, or yogurt drinks serve as excellent
substitutes. Yogurt, in particular, provides superior nutritional benefits
compared to milk, including probiotics, protein, calcium, and essential
vitamins such as B6 and B12. Additionally, the probiotic Lactobacillus
acidophilus found in yogurt has shown potential in enhancing the immune
response to breast cancer, underscoring its importance in a balanced
post-surgical diet [43].
Alcohol consumption
Alcohol is metabolized into acetaldehyde, a carcinogenic compound, in the
body. This process increases the secretion of estrogen and androgen, which
in turn promotes the development of breast cancer, irrespective of the type
of alcohol consumed or the age of the individual. Ethanol intensifies this
risk by encouraging tumor growth and the formation of metastases. It also
enhances the effects of estrogens on breast tissue through various pathways
[44]. Additionally, alcohol
impairs the immune system and depletes essential nutrients, including
folate, which is vital for DNA synthesis and repair to maintain genomic
stability. As a folate antagonist, alcohol diminishes the bioavailability of
folate, thereby undermining cellular health and elevating cancer risk [45].
Evidence shows that alcohol consumption, regardless of the type of alcoholic
beverage or menopausal status, is consistently linked to a higher risk of
breast cancer. A dose-response meta-analysis revealed that for every 10
grams of ethanol consumed daily, the risk of breast cancer rises by about 5%
in premenopausal women and 9% in postmenopausal women [46].
Moreover, studies have reported that high alcohol intake, defined as more
than 20 grams per day, is associated with increased breast cancer mortality,
and a dose–response relationship has been observed [47]. Among breast cancer survivors,
consuming more than one drink daily has been found to increase the risk of
late recurrence (i.e., occurring more than 5 years after diagnosis) by 28%
[48]. Therefore, abstinence from
alcohol, regardless of the type, is recommended.
Caffeine
Coffee consumption has not been strongly correlated with cancer recurrence in
breast cancer patients [49]. However,
because caffeine may hinder calcium absorption and impact the prevention of
osteoporosis, it is advisable to limit coffee intake to one or two cups per
day. Including a small amount of milk in coffee may help mitigate the
effects of caffeine on calcium absorption [50].
Conclusion
While no single food can definitively prevent breast cancer or its recurrence,
maintaining a balanced diet, consuming high-quality protein, adopting proper
lifestyle habits, and engaging in regular physical activity can significantly
promote overall health and may offer valuable support in managing cancer.
Authors' contributions
Project administration: not applicable
Conceptualization: Sa J
Methodology & data curation: not applicable
Funding acquisition: not applicable
Writing – original draft: Kim K, Lee M, Sa J
Writing – review & editing : Kim K, Lee M, Sa J
Conflict of interest
Minjeong Kim serves as the editorial board members of the Ewha Medical Journal,
but had no role in the decision to publish this article. No other potential
conflict of interest relevant to this article was reported.
Funding
Not applicable.
Data availability
Not applicable.
Acknowledgments
Not applicable.
Supplementary materials
Not applicable.
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Fig. 1.
Food group wheel. The figure illustrates the recommended daily intake
of diverse foods, emphasizing balanced consumption to support recovery
and overall health. It provides guidance on the types of foods to be
consumed and their appropriate portions for each day. Adapted from
Ministry of Health and Welfare and The Korean Nutrition Society [15] with CC-BY.
Fig. 1.
Nutritional management for breast cancer patients
Major anti-breast cancer phytochemicals, their sources, and the
related benefits
Anticancer phytochemicals
Sources
Benefits
References
Flavones
Red and yellow fruits and
vegetables (watermelons, bell peppers…)
- Reduced risk of coronary heart
diseases, cancers, chronic inflammation, osteoporosis and
other age-related diseases. - Lowering estrogen
levels that can help inhibit breast tumor growth and reduces
the risk of recurrence.
- Inhibition of cancer cell
growth, suppression of metastasis, and induction of
apoptosis. - Inhibits the proliferation of breast
cancer cells by inducing cell cycle arrest.
Morus alba, Artocarpus
heterophyllus, Glycine max, and Ficus
carica
- Anti-cancer, anti-inflammatory,
neuroprotective, anti-diabetic, anti-obesity,
cardioprotective effects, and anti-osteoclastogenic
activities. - Induced apoptosis suppresses
cytotoxicity against human breast cancer cells.
- Reduces immunomodulatory,
antimicrobial, anticancer, anti – inflammatory, and
lipid-lowering effect. - Inhibits breast cancer cell
growth and induces apoptosis
