the continuous update project: recent findings on diet, nutrition, physical activity and cancer
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The Continuous Update Project: Recent Findings on Diet, Nutrition, Physical Activity and CancerRoadmap to Cancer Control in Africa, Marrakech, Morocco, 18-22 November 2015 Alan JacksonProfessor of Human Nutrition, University of Southampton, UK Panel Chair: Continuous Update Project
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In all developing countries, cancers now account for a large enough share of premature deaths and poverty to merit an urgent and coordinated public policy response.
2005 2015 2030
2.1
5.5million
2.3
6.7million
2.5
8.9million
0
2
4
6
8
10
12
tota
l can
cer d
eath
s (m
illio
ns)
Low- and middle income countries
High-income countries
Source:
Deaths from cancers
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Cancer - developed vs developingtransition in time
Low and Middle Income eg Asia, AfricaMouth and pharynx LarynxOesophagus StomachLiver CervixDeveloped economies eg Europe and USColorectal BreastEndometrium Prostate
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Infectious Agents and Cancer
• ~16% cases of cancer likely caused by infectious agents worldwide
– 25% in Africa– <10% in Europe (1 in 33 in UK)
Agent Cancer
HPV Cervix, Head and Neck
EBV Hodgkin’s Lymphoma, Burkitts
HCV, HBV Liver
H. Pylori Stomach
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- stomachinfection (H pylori), salted fishrefrigeration, fresh fruit vegetablesantioxidant, anti-inflammatory
- cervixinfection (HPV)behaviour, fresh fruit vegetablesfolic acid
- liverinfection (Hep C), toxin (aflatoxin)cleaner environmentiron, alcohol
Cancer
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Cancer incidence and mortalityWorld and Africa
World AfricaGlobocan 2012
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Comprehensive
Rigorous
Detailed
Sound Method
Authoritative
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Around one quarter of all cancers estimated avoidable through appropriate food, nutrition and physical activity
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WCRF/AICR EXPERT REPORT The most authoritative
• New method• Systematic reviews• Review of evidence separate from
judgement • Panel of international experts• Predetermined criteria for
judgements– Epidemiology– Mechanisms
• Flexibility• Continuous update of evidence
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Liver
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Dose-response meta-analysis of coffee and liver cancer, per one cup per day
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Aflatoxins and liver cancer
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Dose-response meta-analysis of alcohol and liver cancer, per 10 g per day
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Dose-response meta-analysis of BMI and liver cancer, per 5 kg/m2
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Prostate
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BMI Waist circumference Waist to hip ratio
Adv
ance
dN
on-a
dvan
ced
Adv
ance
dN
on-a
dvan
ced
Adv
ance
dN
on-a
dvan
ced
RR=1.12 (1.04-1.21) RR=1.15 (1.03-1.28)
RR=1.01 (0.90-1.12) RR=0.99 (0.90-1.09)
RR=1.08 (1.04-1.12)
Dose-response meta-analysis of body fatness and prostate cancer
RR=0.95 (0.92-0.98)
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Allott et al., Eur Urol. 2013;63:800–9
Obesity-related biologic mechanisms and detection biases contributing to the association between obesity and aggressive prostate cancer
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Dose-response meta-analysis of height and prostate cancer, per 5 cm
RR=1.04 (1.03-1.05)
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Height and prostate cancer risk
Height should be thought of as a marker for exposure(s) that influence cancer risk and not as a risk factor itself
Adult height is determined both by genetics and by early life exposures1
Greater intakes of total energy and milk during childhood and adolescence are positively associated with adult height2,3
Relations with total energy and milk may be mediated by alterations in levels of growth factors and insulin2,3
Height is associated with greater organ size, which may place more cells at risk for malignant transformation4
1. Renehan, Lancet Oncol 2011;12:716-72. Wadsworth et al., Int J Epidem 2002;31:383-903. Berkey et al., CEBP 2009;18:1881-74. Albanes & Winick, JNCI 1988;80:772-4
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Kidney
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Dose-response meta-analysis of alcohol and kidney cancer, per 10 g per day
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Dose-response meta-analysis of BMI and kidney cancer, per 5 kg/m2
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Dose-response meta-analysis of height and kidney cancer, per 5 cm
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Breast Cancer Survivors Report 2014
Report available at: http://www.wcrf.org/sites/default/files/Breast-Cancer-Survivors-2014-Report.pdf
85 papers included in the report
164,416 women
42,572 cases of mortality
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Summary Incidence is increasing for common cancer sites in both high-income and low-income countries (e.g. breast, colorectum, prostate) Mortality is decreasing in most high-income countries, not in low income countries
Total burden is increasing and pattern changing because of demographic changes (ageing populations, increasing size), and Westernization of lifestyles
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Future directionsStudies of cancer incidence:
Improve measurements of diet, nutrition, and physical activity
Perform analyses by cancer molecular subtypes
Examine potential interactions with genetic predisposition
Elucidate underlying biologic mechanisms
Studies of cancer survival:
Address potential confounding by cancer stage, treatment, and comorbidities
Investigate timing of exposure in relation to cancer diagnosis and treatment
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Nutrition and CancerCancer numbers are increasing
Nutritional factors are major determinants of the pattern of cancers in populations (25 – 30%)
With smoking, poor diet, obesity and physical inactivity are the most important avoidable causes
Recommendations for cancer prevention will also prevent other NCDs
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Year Publications2010 Breast2011 Colorectum2012 Pancreas2013 Endometrium2014 Ovary, prostate and breast cancer
survivors2015 Liver, kidney, gallbladder, bladder 2015-2016
Stomach, oesophagus, lung
2016-2017
Breast, colorectum
2017 Major report – Recommendations
Timeline
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www.wcrf.org/int/research-we-fund/continuous-update-project-cup
Data and information for Africa??