Symposium 6 Part ll BAPEN M d e i di l ca /N l/n t u irti ition S i oc t e y Nutritional Science i n in C ancer Cancer

Transcription

1 Symposium 6 Part ll BAPEN Medical/Nutrition iti Society Nutritional Science in Cancer

2 Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective Professor Martin Wiseman FRCP FRCPath Project Director, WCRF International University of Southampton

3 WCRF GLOBAL NETWORK AICR WCRF UK WCRF FR WCRF INTERNATIONAL ASSOCIATION WCRF NL WCRF HK

4 CAUSE SPECIFIC MORTALITY ENGLAND 2000 ACCIDENTS 2% RESPIRATORY 10% OTHER 20% CVD 40% ACCIDENTS 2% OTHER 24% RESPIRATORY 11% CVD 40% CANCER 28% CANCER 24% MALE FEMALE Dept of Health, 2000

5 Estimated Numbers of New Cancer Cases (Incidence) and Deaths (Mortality) in 2002 Parkin, D. M. et al. CA Cancer J Clin 2005;55: Copyright 2005 American Cancer Society

6 MISSION

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10 Underlying principles 1. Identify causal exposures - protective or adverse 2. Examine all relevant evidence 3. Use most robust methods 4. Transparency

11 Inferring causality 1. Strength 2. Consistency 3. Specificity 4. Timing 5. Dose Response 6. Plausibility 7. Coherence 8. Experiment 9. Analogy Bradford Hill

12 EXPERT REPORT PROCESS Peer Reviewers Review protocol and end product developed by SLR centres SECOND EXPERT REPORT Methodology Task Force Develop methodology to be used din reviews STAGE 1 Systematic Literature Review Centres Perform review on link between diet, physical activity, nutrition and cancer Panel Interpretation of the evidence STAGE 2 STAGE 3 Advisory Group Guidance and feedback to SLR centres and to Executive Team

13 Systematic reviews e 1. Expert international Task Force for method 2. Seven centres - USA, UK, NL, Italy 3. SLR centre coordinator 4. Test of reproducibility 5. Standardised search, analysis and display 6. Epidemiology and mechanisms 7. Quality assessment 8. Peer review - protocol, report 9. Defined expertise required Nutrition, epidemiology, systematic review, cancer biology, statistics

14 17 Cancer Sites Food, Nutrition, and Physical Activity Mouth, pharynx, larynx Nasopharaynx Oesophagus Lung Stomach Pancreas Gallbladder Liver Colon and Rectum Breast Ovary Endometrium Cervix Prostate Kidney Bladder Skin Other Cancers

15 Systematic reviews y Analysis

16 Mechanisms s 1. Site-specific - part of SLR 2. General - review papers 3. Mechanisms Working Group All SLR centre mechanisms experts

17 GRADING THE EVIDENCE 1. Convincing Basis for 2. Probable recommendations 3. Limited Evidence Suggestive 4. Limited Evidence No Conclusion 5. Substantial Effect on Risk Unlikely

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20 The Panel emphasises the importance of not smoking and of avoiding exposure to tobacco smoke

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22 Nutrition Research Cancer prevention vs after cancer PREVENTION Hundreds of studies Substantial evidence Cancer seen as end Modest interest in behaviour change Little commercial AFTER CANCER Only a few studies Limited evidence Cancer seen as start Keen interest in behaviour change Much commercial

23 Stages of cancer survivorship Pre-treatment During treatmentt t Recovering from treatment Preventing recurrence Preventing second primaries Preventing other chronic disease Living with advanced cancer

24 Current sources of evidence on nutritional change after cancer Extensions of observational studies Intermediate t biomarker studies Few RCTs WHEL and WINS studies RCTs of exercise to improve symptoms Early cancer effects in cancer prevention RCTs Beta-carotene carotene, Vitamin E, Selenium, Aspirin, folate

25 Obesity and risk of breast cancer recurrence Recurrence risk increased by 78% among obese (BMI > 30) vs normal weight (BMI<25) Obesity risk seen in various subgroups Postmenopausal Premenopausal ER positive ER negative Even with Tamoxifen use

26 Physical activity and breast cancer Several small RCTs in breast cancer Consistent evidence of many benefits Increased strength Decreased fatigue Fewer treatment side effects Effects on prognosis unknown

27 Trials of diet change and survival after breast cancer WINS Study Low fat diet (15% kcal from fats) Reduced risk of recurrence (ER negative) WHEL study WHEL study High fruit and vegetable diet (10 servings/d) No effect on recurrence

28 Recommendations for cancer survivors Follow cancer prevention recommendations Seek guidance from qualified provider Different stages of cancer survivorship have Different stages of cancer survivorship have different nutritional issues

29 SUMMARY 1. Rigorous standardised di d peer reviewed method 2. Independent review teams 3. Comprehensive skill set 4. Comprehensive inclusion of evidence 5. Separate collection of evidence from judgement 6. International expert Panel

30 GOING FORWARD GOING FORWARD: The Continuous Review Comprehensive database allows ongoing assessment of the evidence

31 Going forward: Policy report

32 THE SLR CD-ROM 1. With report 2. All SLRs (>30K pages), searchable electronically 3. Associated info on methodology & SLR centres 4. Info on global network

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34 Food, Nutrition, Physical Activity, and the Prevention of fcancer: a Global Perspective

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36 WHO 2006 Nutrition Transition

37 Prevalence of Obesity in European Adult Males % Obesity < 5 % 5-9.9% % % % 24 25%

38 Prevalence of Obesity in European Adult Males % Obesity < 5 % 5-9.9% % % % 24 25%

39 Prevalence of Obesity in European Adult Males % Obesity < 5 % 5-9.9% % % % 25% Self Reported data

40 Prevalence of Obesity in European Adult Males % Obesity < 5 % 5-9.9% % % % 25% Self Reported data

41 Prevalence of Obesity in European Adult Males % Obesity < 5 % 5-9.9% % % % 25% Self Reported data