Background: Cancer prevention guidelines have been developed to improve knowledge and adherence to modifiable cancer risk factors. The implementation of these guidelines has largely been studied in North American and European populations. The aim of this study was to examine the association between health care access and adherence to the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) cancer prevention guidelines in South Africa, where the cancer incidence is rising. Methods: Data from the 2003 South Africa World Health Survey was used to assess adherence to WCRF/AICR cancer prevention guidelines on alcohol, body mass index, nutrition, physical activity and smoking. Health care affordability, availability, accessibility, accommodation and acceptability in the past 12 months were assessed via self-report. Results: Residing in a high socio-economic status household (affordability), visiting a non-governmental health care facility (availability), perception of health care provider skills as adequate (accommodation) and lack of perception of worse treatment based on social class (acceptability) were each associated with higher levels of adherence to the WCRF/AICR guidelines. Conclusions: In South Africa, better access to health care is associated with better patient adherence to cancer prevention guidelines. Future studies and efforts can focus on improving access to quality health care in this population.