Teresa NoratContinuous Update ProjectSchool of Public Health, Imperial College London, UK

The WCRF/AICR Continuous Update

Aims and Process

ICN17 September 2013

The Continuous Update Project. Aims

Ensure everyone has access

Based on the most up to date scientific evidence

WCRF/AICR Recommendations for Cancer Prevention:

Continuous update epidemiologic evidence (SLR- Imperial College London)

Up-to-date database

Mechanistic evidence (University of Bristol)

Evaluation of evidence (Independent panel of experts)

Recommendations

Education and research priorities

What is the Continuous Update Project?

The Continuous Update Process

Continuous update epidemiologic evidence (SLR- Imperial College London)

CUP people at Imperial College:

http://www.dietandcancerreport.org/cancer_resource_center/continuous_update_project.php

CUP Search Literature Review PROTOCOL(SLR- Imperial College London)

Research topic :The associations between food, nutrition and physical activity and Cancer risk Mortality and second cancers in breast cancer survivors.

Main objective :Summarize the evidence from prospective studies and randomised controlled trials (case-control studies if requested by the Panel).

Search strategy:Medline, Central, ClinialTrials.govHand search of references (reviews, meta-analysis, recent relevant papers)

(http://www.dietandcancerreport.org/cancer_resource_center/downloads/SLR_Manual.pdf)

Team

One central database for cancer prevention research

Database

CUP Expert PanelWCRF Secretariat

Number of articles from cohort studies in the WCRF database (updated August

2013)

* Update of cancers of mouth, pharynx and larynx to start on October 2013

Statistical methodsDose-response meta-analysis using generalized least-squares for trend estimation (command GLST in Stata)

Statistical methods

Publication bias Exploratory analyses

Statistical methods

Stratified analyses, sensitivity analyses

The Continuous Update ProjectExpert Panel

Breast cancer (premenopause) Judgement of the Panel, 2007 and 2010

Second Expert Report 2007 CUP 2010

Colorectal cancer Judgement of the Panel, 2007 and 2011

Second Expert Report 2007

CUP 2011

Foods containing fibre ----- Convincing

Colorectal cancer and dietary fibreper 10 g increase

CUP Colorectal cancer report 2011 BMJ 2011;343:d6617 doi: 10.1136/bmj.d6617

Colorectal cancer and dietary fibre (by food source)

CUP Colorectal cancer report 2011 BMJ 2011;343:d6617 doi: 10.1136/bmj.d6617

Pancreatic cancer Judgement of the Panel, 2007 and 2012

CUP 2012Second Expert Report 2007

.81

1.5

23

RR

0 10 20 30 40Total alcoholic drinks (drinks/week)

Best fitting fractional polynomial95% confidence interval

12

34

Est

ima

ted

RR

0 10 20 30 40Total alcoholic drinks (drinks/week)

Reference categoriesRR for alcohol exposure

Overall I-squared = 93.0%, p = 0.000

Shibata

Gapstur

Zheng

Harnack

Jiao

Author

Stevens

1994

2011

1993

1997

2009

Year

2009

M/F

M/F

M

F

M/F

Gender

F

1.00 (0.99, 1.01)

1.00 (0.93, 1.07)

1.01 (1.00, 1.01)

1.65 (1.11, 2.47)

1.36 (0.98, 1.89)

1.01 (1.00, 1.01)

RR (95% CI)Per 1 drink/week

0.99 (0.98, 0.99)

100.00

2.82

32.83

0.09

0.13

31.69

32.43

Leisure World

CPS II

LBS

IWHS

NIH-AARP

Study

MWS

1.00 (0.99, 1.01)

1.00 (0.93, 1.07)

1.01 (1.00, 1.01)

1.65 (1.11, 2.47)

1.36 (0.98, 1.89)

1.01 (1.00, 1.01)

0.99 (0.98, 0.99)

Weight

%

1.85 1 2

Pancreatic cancer SLR 2012Alcoholic drinks

Linear dose-response meta-analysis Nonlinear dose-response analysis of total alcoholic drinks and pancreatic cancer

Scatter plot of risk estimates of total alcoholic drinks and pancreatic cancer

http://www.dietandcancerreport.org/cancer_resource_center/downloads/cu/Pancreatic-Cancer-SLR-2011.pdf

Endometrial cancer Judgement of the Panel, 2007 and 2012

Second Expert Report 2007 CUP 2013

 

Friberg

Author

Moore

Patel

2006

Year

2009

2008

 

1.66 (1.05, 2.61)

High vs low

RR (95% CI)

1.45 (1.10, 1.92)

1.40 (1.03, 1.89)

 

SMC

Study

NIH-AARP

CPS-II

High vs low

Contrast

9+h/day vs <3 h

6+ vs <3 hour/day

 

1.66 (1.05, 2.61)

High vs low

RR (95% CI)

1.45 (1.10, 1.92)

1.40 (1.03, 1.89)

 

1.5 .75 1 1.5 2 3

Conroy

Gierach

Patel

Friedenreich

Frieberg

Schouten

Folsom

Furberg

Terry

Author

2009

2009

2008

2007

2006

2004

2003

2003

1999

Year

0.87 (0.60, 1.27)

0.56 (0.46, 0.68)

0.67 (0.44, 1.03)

0.94 (0.75, 1.18)

0.90 (0.67, 1.21)

0.54 (0.34, 0.85)

1.05 (0.84, 1.33)

0.71 (0.34, 1.49)

0.10 (0.04, 0.60)

RR (95% CI)

High vs low

WHS

NIH-AARP

CPS II

EPIC

SMC

NLCS

IWHS

NNHSS

STR

>=20.4 vs <2.7 METh/week

>=5 times/week vs Never/rarely

>=31.5 vs 0-<7 METh/week

>=41.26 vs <12.01 METh/week

>=20 min/d vs <20 min/d

>=90 vs <30 min/d

High vs Low

Active vs sedentary

Hard activity vs None

Contrast

0.87 (0.60, 1.27)

0.56 (0.46, 0.68)

0.67 (0.44, 1.03)

0.94 (0.75, 1.18)

0.90 (0.67, 1.21)

0.54 (0.34, 0.85)

1.05 (0.84, 1.33)

0.71 (0.34, 1.49)

0.10 (0.04, 0.60)

RR (95% CI)

High vs low

WHS

NIH-AARP

CPS II

EPIC

SMC

NLCS

IWHS

NNHSS

STR

Study

1.1 .25 .5 11.5

Physical activity Sitting time

Endometrial cancer

Forest plots. Highest vs lowest

http://www.wcrf.org/cancer_research/cup/key_findings/index.php

The WCRF/AICR Continuous Update

Reports

What next?

Ovarian cancer (December 2013)

What next?

Breast cancer survivors (early 2014)

What next?

Panel meetings:

June 2014:

Prostate

Kidney

Bladder

Gallbladder

June 2015:

Stomach

Oesophagus

Mouth, pharynx, larynx

Nasopharynx

April 2016:

Lung

Skin

Cervix

CUP Team

Dagfinn Aune; Snieguole Vingeliene; Deborah Navarro Rosenblatt; Teresa Norat; Doris Chan; Ana Rita Vieira, Leila Abar and Christophe Stevens (not in photo)

Darren Greenwood, University of Leeds, Statistical Advisor (not in photo)

Thanks!