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

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

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

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

- 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

Cancer incidence and mortalityWorld and Africa

World AfricaGlobocan 2012

Comprehensive

Rigorous

Detailed

Sound Method

Authoritative

Around one quarter of all cancers estimated avoidable through appropriate food, nutrition and physical activity

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

Liver

Dose-response meta-analysis of coffee and liver cancer, per one cup per day

Aflatoxins and liver cancer

Dose-response meta-analysis of alcohol and liver cancer, per 10 g per day

Dose-response meta-analysis of BMI and liver cancer, per 5 kg/m2

Prostate

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)

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

Dose-response meta-analysis of height and prostate cancer, per 5 cm

RR=1.04 (1.03-1.05)

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

Kidney

Dose-response meta-analysis of alcohol and kidney cancer, per 10 g per day

Dose-response meta-analysis of BMI and kidney cancer, per 5 kg/m2

Dose-response meta-analysis of height and kidney cancer, per 5 cm

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

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

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

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

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

www.wcrf.org/int/research-we-fund/continuous-update-project-cup

Data and information for Africa??