Take-home message:

Introduction

Cancer is a group of diseases characterised by uncontrolled cell growth and spread, forming tumors that can be benign (non-cancerous) or malignant (cancerous). While benign tumors do not spread and are usually not life-threatening, malignant tumors can invade tissues. Cancer cells cannot perform the normal functions of the tissues they replace, disrupting the body's regular processes. Additionally, cancer cells can metastasise (spread to other parts of the body), making cancer particularly dangerous and challenging to treat. Cancer can develop in almost any body part and is classified by its origin, with over 100 types named after the organs or tissues where they form, such as lung cancer starting in the lungs and breast cancer in the breast. Additionally, cancers can be categorised by the type of cell they originate from, including carcinomas (epithelial cells), sarcomas (connective tissues), leukaemia’s (blood-forming tissues) and lymphomas (immune system cells). Cancer is caused by mutations in the DNA within cells, which can be inherited, triggered by environmental factors like tobacco smoke and radiation, or occur randomly during cell division. Cancer symptoms vary based on the type and location of the disease, with common signs including lumps, unexplained weight loss, fatigue and skin changes. Diagnosis involves imaging tests like X-rays and magnetic resonance imaging scans (MRIs), laboratory tests and biopsies. Treatment options depend on the cancer's type, location, stage and the patient's overall health, and include surgery, radiation therapy, chemotherapy, immunotherapy, targeted therapy and hormone therapy to eliminate cancer cells, control their spread or relieve symptoms.

Cancer remains one of the leading causes of morbidity and mortality worldwide, with millions of new cases diagnosed each year. According to the Global Cancer Statistics 2020, there were an estimated 19.3 million new cancer cases and nearly 10 million cancer deaths worldwide in 2020, with breast, lung, colorectal, prostate and stomach cancers being the most common (1). In South Africa, cancer incidence is also a significant health concern, with an estimated 107,467 new cases reported in 2020 (1).

Cancer is largely preventable through lifestyle and environmental modifications (2). Research indicates that up to 40% of cancers can be prevented by adopting healthy behaviours such as maintaining a balanced diet, engaging in regular physical activity, avoiding tobacco and limiting alcohol consumption (2). The World Cancer Research Fund (WCRF) also identifies several key lifestyle factors that can reduce cancer risk: maintaining a healthy weight, eating a diet rich in whole grains, vegetables, fruits and beans, limiting fast foods and other processed foods high in fat, starches or sugars, limiting consumption of red and processed meat and reducing sugar-sweetened drinks (2, 3). Additionally, the WCRF recommends breastfeeding for mothers to reduce breast cancer risk and following guidelines for cancer prevention after a cancer diagnosis. Early detection through screening programs and vaccinations against cancer-causing viruses like human papillomavirus (HPV) and hepatitis B can reduce the risk. By prioritising these preventive measures, individuals can decrease their chances of developing cancer and improve their overall health and well-being.

Here, I am reviewing the evidence for the link between meat consumption, particularly red and processed meat and cancer risk. I explore the relationship between meat consumption and cancer risk revealed by systematic reviews (review of research evidence on a specific topic) and meta-analysis (a statistical technique that combines results from multiple studies to provide a precise estimate of the effect size or association), the genetic link involving N-acetyltransferase 2 (NAT2) variants, preparation methods to reduce carcinogens, the potential of lab-grown meat and guidelines for healthy meat consumption.

The Relationship Between Meat Consumption and Cancer Risk

Red meat refers to the muscle meat of mammals, which is typically red in colour when raw. Red meats do not include chicken or fish but include beef, veal, lamb, mutton, goat and pork, with pork classified as red meat due to its myoglobin content, a protein in muscle tissue that binds oxygen and imparts the characteristic red colour to the meat. Processed meats are meats that have been preserved by smoking, curing, salting, or adding chemical preservatives or other processes to enhance flavour or preservation. Processed meats include products like bacon, sausages, hot dogs, deli meats (salami, ham and pastrami) and biltong. Additionally, lab-grown meat, also called cultured, in vitro, or artificial from animal cells, has emerged as a modern alternative, yet its long-term health impacts are still under study (4).

The consumption of meats has been scrutinised by the WCRF/American Institute of Cancer Research (2, 3) and researchers around the world. Red and processed meats have been associated with an increased risk of various types of cancer, including those of the oesophagus (muscular tube connecting the throat to the stomach), stomach, colorectal (colon and rectal) and pancreatic cancers (see Table below for a summary). Due to compelling evidence some of which are presented here, the International Agency for Research on Cancer (IARC) classifies red meat as Group 2A (probably carcinogenic to humans) and processed meat as Group 1 (carcinogenic to humans) (5).

Table: Summary of Research Studies on Meat Consumption and Cancer Risk

Cancer risks associated with meat consumption are influenced by cooking methods that produce carcinogens like heterocyclic amines and polycyclic aromatic hydrocarbons, as well as inherent meat components such as haeme iron, which promotes the formation of damaging N-nitroso compounds and free radicals. Additionally, the intake of red meat introduces N-Glycolylneuraminic acid (Neu5Gc) into the body, potentially triggering xenosialitis—a chronic inflammatory response that, in combination with other carcinogenic compounds from meat, may exacerbate cancer risks through complex dietary, immune and genetic interactions (16, 17). These processes are complex and multifaceted, involving oxidative stress and possibly the gut microbiome (18). Additionally, animal products contain saturated fat and there is evidence suggesting a relationship between high intake of saturated fat, commonly found in meat, and an increased risk of cancer (19, 20). High consumption of saturated fat can contribute to inflammation and other biological processes that may promote cancer development. Understanding and moderating meat and the concomitant saturated fat consumption, coupled with maintaining a balanced diet, is essential to reduce these cancer risks. Public and personal health decisions should be informed by the cumulative scientific evidence highlighting these associations.

Exploring the Genetic Link: NAT2 Variants and Cancer Risk from Meat Consumption

The NAT2 enzyme plays a crucial role in the metabolism of carcinogenic compounds. Certain individuals have a higher risk of developing cancer from meat consumption due to genetic predispositions, notably those with the 'rapid' variants of NAT2 alleles. These variants are linked to an accelerated metabolism of carcinogenic compounds like heterocyclic amines. While Wang and colleagues (21) demonstrated that Japanese and African American individuals with the NAT2 rapid phenotype experience an increased risk of colorectal cancer with red meat intake, a pooled analysis has reported varying results on the impact of NAT2 enzyme activity on cancer risk (22). This discrepancy highlights the need for continued research to accurately understand and personalise dietary recommendations based on genetic susceptibility and individual responses to meat consumption.

Reducing Carcinogens in Meat Through Preparation Methods

The method of meat preparation impacts associated health risks (23, 24). Techniques such as poaching or boiling at lower temperatures, sous-vide for precise, low-temperature cooking, pressure cooking to avoid high heat, partial cooking in the microwave, trimming excess fat, frequent turning to avoid charring, using acidic marinades, avoiding direct flame exposure, removing charred portions, pairing meat with antioxidant-rich vegetable, and utilising air frying at temperatures at or below 180˚C are healthier alternatives to traditional methods like stewing, oven-baking, griddle-grilling, barbecuing, and braaiing. These methods help reduce the formation of harmful compounds and promote a healthier diet, thereby lowering the risk of colorectal cancer. Marinating meat in herbs or antioxidant-rich oils before cooking or grilling can inhibit the formation of heterocyclic amines (25). Additionally, allowing adequate oxygen flow and maintaining lower cooking temperatures can diminish the production of polycyclic aromatic hydrocarbons (26). Furthermore, incorporating antioxidants like vitamin C, found in lemon juice and other sources, can mitigate the formation of nitrosamines, especially in nitrate-rich pink meats such as ham, pork and bacon (27, 28).

Table: Carcinogenic Compounds in Meats and Strategies for Risk Reduction

Footnote: There are products of both bacon and macon (a mutton alternative to bacon for non-pork eaters) marketed as "nitrate-free" or "uncured." These products typically use natural sources of nitrates, such as celery juice powder, instead of synthetic sodium nitrate. While marketed as a healthier alternative, the nitrate content might still be present from these natural sources and the overall health impact can be similar.

The doneness level of red meat influences cancer risk due to the formation of heterocyclic amines and polycyclic aromatic hydrocarbons. Medium, medium-rare, or rare meat involves lower temperatures and shorter cooking times, reducing the formation of these compounds but posing a risk of bacterial infections. Well-done meat, cooked at higher temperatures and for longer durations, increases the formation of heterocyclic amines and polycyclic aromatic hydrocarbons, which are linked to a higher risk of cancers (23). Michelin-level chefs often prefer cooking meat to medium-rare or medium to preserve its flavour, juiciness, texture, and visual appeal, which also provides health benefits over well-done meat.

Preparation of raw meat in various cuisines involves several techniques aimed at enhancing flavour and safety. Mincing and seasoning are used in dishes like steak tartare, while thinly slicing is typical for carpaccio. Kibbeh Nayyeh mixes raw meat with grains and spices and Larb is a spiced raw meat salad. These methods often involve acids, herbs and minimal heat to ensure palatability and safety. In South Africa, sushi is sometimes made with red meat like beef instead of traditional seafood, creating unique fusion dish to cater for local tastes and preferences. Adopting these preparation methods, especially when incorporating herbs and antioxidants, can help mitigate the formation of harmful compounds, potentially reducing cancer risk associated with meat consumption. Maintaining high standards of meat quality and hygiene is crucial in preparing and consuming these raw meat dishes. There are currently no data to address the question of eating raw meat in relation to cancer risk (WHO, 2015; https://www.who.int/news-room/questions-and-answers/item/cancer-carcinogenicity-of-the-consumption-of-red-meat-and-processed-meat). However, the separate question of risk of infection from consumption of raw meat needs to be kept in mind.

Table: Raw Meat Dishes from Around the World

In addition to these, other raw meat preparations include jerky, biltong, or droë wors, which involve curing and drying (29). Biltong and similar dried meats' potential carcinogenicity stems from nitrates and nitrites used in curing, exposure to polycyclic aromatic hydrocarbons during smoking and high salt content (30). Salt itself is linked to cancer, particularly stomach cancer (31) and using salt in curing and preserving meat can add to the meat's carcinogenic potential. High salt intake can damage the stomach lining, leading to inflammation and increased susceptibility to carcinogens. When used in meat preservation, salt can contribute to the formation of harmful compounds like N-nitroso, which are known to be carcinogenic. While typically safe in moderation, these factors can increase cancer risk, particularly with high consumption or in diets rich in processed meats. Future research should continue to explore the impact of preparation methods on the carcinogenic potential of meats.

Lab-Grown Meat: A New Frontier in Reducing Cancer Risks and Its Future Implications

Lab-grown meat presents a unique opportunity to potentially reduce cancer risks associated with traditional meat consumption, such as lower contaminants and reduced need for harmful preservatives and does not contain any cancer-causing (oncogenic) compounds that have not been approved (32). However, like conventional meats, lab-grown varieties might still produce heterocyclic amines and polycyclic aromatic hydrocarbons when cooked at high temperatures. While lab-grown meat can be engineered for healthier fat content and fewer additives, the long-term effects and cancer risk profile are not yet understood, necessitating comprehensive studies and effective regulation to ensure safety and health benefits.

Guidelines for Healthy Meat Consumption: Quantity and Preparation

Meat is highly nutritious and can contribute to a balanced diet. It provides high-quality protein essential for muscle growth, tissue repair and enzyme production. Meat also supplies vital micronutrients such as iron, zinc and B vitamins (especially B₁₂), crucial for energy, immune function, and neurological health. Haeme iron in meat, particularly red meat, is more readily absorbed than non-haeme iron from plants, preventing iron deficiency anaemia. Zinc supports immune response, DNA synthesis and cell division. Vitamin B₁₂, found almost exclusively in animal products, is essential for nerve health and red blood cell production. While meat is valuable for a healthy diet, it is important to consume it prudently.

The dietary guidelines for meat consumption, whether processed, unprocessed or lab-grown, can vary based on the latest research, cultural dietary norms and individual health profiles. However, general guidelines have been provided by various health organisations. The WCRF and the American Institute for Cancer Research have a general recommendation regarding animal foods: "Limit intake of red meat and avoid processed meat" (2, 3). The South African Food-Based Dietary Guidelines (SAFBDG) that pertains to red meat is: “Fish, chicken, lean meat or eggs can be eaten daily” (33). This promotes lean red meat in moderation as part of a balanced diet with varied protein sources.

Table: Dietary Guidelines and Healthy Meat Preparation Tips

Footnote: These guidelines are general and may not apply to every individual. It's essential to consult with healthcare providers or a genetic counsellor for personalised advice, especially if there's a known genetic predisposition to cancer. Emphasise variety and balance by incorporating plenty of fruits, vegetables, whole grains and other plant-based protein sources into your diet alongside meat, regardless of genetic predisposition. Ensure early detection and prevention strategies through regular medical screening and consultations, especially important for those with a known genetic predisposition. Adopting other healthy lifestyle choices including maintaining a healthy weight, exercising regularly, and avoiding smoking and excessive alcohol consumption.

Reducing unhealthy meat intake while still including meat in your diet involves making informed choices about the type, quantity and preparation methods of meat. Understanding portion sizes is crucial; a portion of 90–120 grams (3–4 ounces) of meat is roughly equivalent to the size of a standard deck of cards, the palm of an adult's hand, or a typical smartphone. To reduce portion sizes one can use substitutions, however, certain substitutions are not necessarily healthier. For instance substituting minced beef with cricket powder, while safe, is not inherently a healthier option compared to beef (35). Replacing red or processed meat with legumes do not reduce the risk of liver cancer (36). Replacing red or processed meat with whole grains, vegetables, or fruits, even in small amounts, could reduce the risk of colorectal cancer in populations that consume a lot of meat (37). Another option is substituting red or processed meat with chicken or fish (14, 38) or with plant-based meat alternatives such as mushroom-based protein products (39).

Table: Practical tips to reduce unhealthy meat intake

Conclusion

The correlation between meat consumption and increased cancer risk is evident, particularly with processed and red meats linked to various malignancies. Current research points to haeme iron and carcinogens formed during meat processing and cooking as key factors. However, understanding these risks empowers individuals to make informed dietary decisions. By moderating meat intake, choosing healthier cuts and preparation methods, and balancing diets with plant-based foods, individuals can mitigate these risks. Incorporating regular screenings and staying informed about the latest dietary guidelines are also crucial steps in maintaining health and reducing cancer risk. Beyond meat intake, adopting a holistic approach to cancer prevention involves addressing other modifiable risk factors such as avoiding tobacco, limiting alcohol consumption, maintaining a healthy weight, engaging in regular physical activity and reducing exposure to environmental toxins. Ultimately, while meat can be part of a balanced diet, awareness and thoughtful consumption, alongside a comprehensive approach to lifestyle choices, are essential for reducing cancer risk and promoting overall health.

Reflections:

What types of meat do you consume over a week? How much do you eat in one sitting? Note down red and processed meat quantities, cooking methods and frequency. How does your consumption align with the recommended guidelines for red and processed meat intake? How do you feel about the health implications associated with your consumption patterns? Do you want to reduce the amount of red or processed meat, try healthier cooking methods, or introduce more meat-free days? Consider experimenting with the doneness of your meat. Would you be willing to try cooking your meat to medium or medium-rare instead of well-done? Reflect on how this change might affect the flavour and juiciness of your meals, as well as the potential health benefits. Based on your reflections and what you have learned, set specific, measurable, achievable, relevant, and time-bound (SMART) goals for your meat intake. If you have specific health concerns or a family history of cancer, schedule a time to discuss with a healthcare provider or a dietitian how you can tailor your diet to reduce risks.

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In the process of creating this work, the author employed ChatGPT 4 to streamline the text and to perform language editing.