WCRF International Continuous Update Project (CUP)

Giota Mitrou PhD MSc

Head of Research Funding and Science Activities

World Cancer Research Fund International

Outline

World Cancer Research Fund network

and World Cancer Research Fund

International

Continuous Update Project

– Process

– Conclusions

– Recommendations

Key aspects of Continuous Update

Project

Conclusions

World Cancer Research Fund Network

American Institute for Cancer Research (1982)

World Cancer Research Fund UK (1990)

World Cancer Research Fund Netherlands (1994)

World Cancer Research Fund Hong Kong (1997)

Members of the World Cancer Research Fund network of cancer charities with

a global reach, dedicated to the prevention of cancer through diet, weight and

physical activity:

WCRF International (1999) leads and unifies the network of cancer charities

Vision: to live in a world where no one develops a preventable cancer

World Cancer Research Fund International

Supports the scientific community in their research

Stimulates and nurtures research and innovation in cancer prevention and survivorship

Encourages more young scientists to enter the field

Encourages scientists to cite us in scientific papers and to help disseminate our information

Encourages and enables governments and policymakers to adopt and implement effective policy actions

Engages and influences decision-makers to involve us in the development of their policies on cancer prevention and non-communicable diseases

Continuous Update Project The Continuous Update Project analyses global cancer prevention

and survival research linked to diet, nutrition and physical activity.

Among experts worldwide it is a trusted, authoritative scientific

resource, which underpins current guidelines and policy for cancer

prevention

It ensures the World Cancer Research Fund network

Recommendations for Cancer Prevention are based on the latest

evidence

The Continuous Update Project is produced in partnership with the

American Institute for Cancer Research, World Cancer Research

Fund UK, World Cancer Research Fund NL and World Cancer

Research Fund HK

Continuous Update Project

Agreed process for systematically

reviewing evidence for 2007 Report

Researchers at Imperial College London

– Continuous Update Project database

of epidemiology research

– Systematically review the evidence

Expert Panel

– Draw conclusions

– Make recommendations

People

Currently more than 100

scientists from 17

countries around the

world

International panel of 12

experts

Researchers, peer

reviewers, advisers

0

2

4

6

8

10

12

14

16

18

20

22

24

26

1970 1980 1990 2000 2010 2020 2030 2040

Nu

mb

er (

mill

ion

s)

Year

Estimated global number of new cases of cancer (excluding non-melanoma skin cancer)

(actual and predicted)

New cases…

Data from Parkin et al., Pisani et al., GLOBOCAN 2012, IARC

0

5

10

15

20

25

30

1960 1965 1970 -

'71

1973 -

'77

1979 -

'82

1983 -

'87

1988 -

'92

1995 1997

Colon

Breast

Ca

nce

r In

cid

en

ce (

pe

r 1

00

,00

0

Ca

nce

r In

cid

en

ce (

pe

r 1

00

,00

0

Trends in cancer incidence within

one country: Japan

Changes in cancer incidence

Migration data: Cancer incidence in Japanese women by generation in Hawaii and Japan (1968-1977)

Impact of

diet,

nutrition &

physical

activity on

cancer

Issues in studying link with cancer

Cancer is an important global problem

Diet, nutrition and physical activity are

important risk factors

Exposures are complex

Outcomes are complex

Latent period is long

Hierarchy of evidence

Meta-analysis

RCT

Cohort

Case control

Ecological

Opinion

Continuous Update Project database

Research Team

Second Expert Report databases

Grading criteria

Predefined requirements for

Number and types of studies

Quality of exposure and outcome assessment

Heterogeneity within and between study types

Exclusion of chance, bias or confounding

Biological gradient

Evidence of mechanisms

Size of effect

Grading the evidenceDecreases

risk

Increases

risk

Strong

evidence

Convincing

Probable

Limited

evidence

Limited -

suggestive

Limited – no

conclusion

Strong

evidence

Substantial

effect on risk

unlikely

Basis for recommendations

Grading the evidence

Convincing

Strong and unlikely to change in future

No unexplained heterogeneity

At least two independent cohorts

Good quality studies that account for error

Dose response

Robust evidence from laboratory studies

Plan of work

Until 2015 2015 to 2017 From 2017

Rolling

programme

of updates

Continuous Update Project

database continually updated

Panel to review

evidence across

cancers and

revise

recommendations

if necessary

2017 Major report

published

Continue to

update, analyse

and review

evidence

Mouth

, phary

nx, la

rynx

Naso

phary

nx

Oeso

phagus

Lung

Sto

mach

Pancr

eas

Gallbla

dder

Liv

er

Colo

rect

um

7

Bre

ast

pre

menopause

Bre

ast

post

menopause

Ovary

Endom

etr

ium

Pro

state

Kid

ney

Skin

Foods containing dietary fibre

Aflatoxins

Non-starchy vegetables1

Allium vegetables

Garlic

Fruits2

Foods containing lycopene

Food containing selenium3

Red meat

Processed meat

Cantonese-style salted fish

Diets high in calcium4

Salt, salted and salty foods

Glycaemic load

Arsenic in drinking water

Maté

Coffee

Beta-carotene6

Physical activity

Body fatness

Adult attained height

Greater birth weight

Lactation

Alcoholic drinks5

Convincing decreased risk

Probable decreased risk

Probable increased risk

Convincing increased riskSubstantial effect on risk unlikely

Continuous Update

Project matrix of

strong evidence

From conclusions to recommendations

Exposures graded convincing or probable

Basis for policies, programmes, personal choices

Broad based - foods rather than nutrients

Global

Cancer in general

Prevention of other diseases

The Panel emphasises the

importance of not smoking and

of avoiding exposure to tobacco

smoke

World Cancer

Research Fund

network

Recommendations for

Cancer Prevention

Year Publication

2010 Breast

2011 Colorectum

2012 Pancreas

2013-14 Endometrium, ovary, breast cancer survivors, prostate

2014-15 Bladder, kidney, liver, gallbladder

2015-16 Stomach, oesophagus, lung

2016-17 Mouth, pharynx, larynx, nasopharynx, breast, colorectum

2017 Review Recommendations for Cancer Prevention

Publications timetable

Breast Cancer Survivors

Emerging evidence on survivorship for

2007 Report - No conclusions possible

Advise to follow Recommendations for

Cancer Prevention

Protocol applicable to other cancers

Final report to be published 2014,

outcomes mortality (all cause & breast

cancer) and second primary breast

cancer.

Continuous Update Project Request For Application

Second Expert Report – mechanisms in the form of

narrative reviews (not systematic reviews)

Increasingly, researchers are now highlighting the

importance of systematic reviews of these types of

studies

No existing systematic method similar to that followed

for epidemiological studies for the Continuous Update

Project

Working with University of Bristol to develop a

template protocol for systematically reviewing

mechanistic studies (human/animal/cell lines)

Conclusions

Continuous Update Project is trusted, authoritative

scientific resource, which underpins current

guidelines and policy for cancer prevention

Continuous Update Project database of evidence

largest of its kind on diet, nutrition and physical

activity

Enables comprehensive recommendations for

cancer prevention based on the most up-to-date

scientific evidence

For further information

@wcrfint

facebook.com/wcrfint

www.wcrf.org

Giota Mitrou

Head of Research Funding and Science Activities

g.mitrou@wcrf.org