The Continuous Update Project

Transcription

1 Teresa Norat, PhD Department of Epidemiology and Biostatistics School of Public Health Imperial College London WCRF International 2-day conference September 2010 Nutrition, Physical Activity and Cancer Prevention: Current Challenges, New Horizons

2 The Continuous Update Project

3 WCRF/AICR Global Report Systematic Reviews: Process 9 centres: US, UK, NL, Italy Centre coordinator Test of reproducibility Standardised search, analysis and display Quality assessment Peer review protocol, report Defined expertise Nutrition, epidemiology, systematic review, cancer biology, statistics

4 WCRF/AICR Global Report Systematic Reviews: Process

5 Continuous Update Project Keep Report updated into the future WCRF working with team at ICL Same principles: - Systematically review evidence - Meta analysis - Panel of experts - draw conclusions - make recommendations Various outputs

6 Aims Comprehensive, up-to-date evidence related to food, nutrition, physical activity, and weight management, and cancer Trusted source for scientists, health professionals, policy makers Update Expert Report recommendations as necessary.

7 SECOND EXPERT REPORT PROCESS Peer Reviewers Review protocol and end product developed by Literature Review Teams Distinguish evidence and Methodology Task Force Develop methodology to be used in systematic literature reviews Systematic Literature Review Teams Perform reviews on link between diet, nutrition and cancer Panel Interpretation of the evidence Development of recommendations Final approval of report content opinion to improve transparency Advisory Group Guidance and feedback to the Literature Review Teams Strategic Advice

8 CONTINUOUS UPDATE PROCESS Methodology Task Force SLR Protocols Peer Reviewers Review protocol and end product developed by Continuous Update team Continuous Update Team ICL Prepare protocol Perform reviews on link between diet, nutrition and cancer Panel Strategic advice Interpretation of the evidence Final approval of report content Development of recommendations Distinguish evidence and opinion to improve transparency Update Report

9 Panel Strategic advice MEMBERS AND OBSERVERS OF THE PANEL Elisa Bandera, MD, PhD The Cancer Institute of New Jersey United States David Hunter, ScD Harvard Unversity Boston, United States Alan Jackson CBE,MD,FRCP,FRCPCH,FRCPath University of Southampton,UK John Milner, PhD National Cancer Institute Bethesda, MD United States Hilary J Powers, PhD RNutr University of Sheffield, UK Elio Riboli (observer) MD, HonFPH, FMedSci Imperial College London,UK Arthur Schatzkin, MD DrPH National Cancer Institute Rockville, MD, USA Ricardo Uauy, MD PhD Instituto de Nutricion y Tecnologia de los Alimentos Santiago, Chile Steven H Zeisel MD PhD University of North Carolina Chapel Hill, NC, USA

10 ( Database(s 2007 WCRF SLR Center 1 Center 2 Center 3 Center 9 SLR1 SLR2 SLR3 SLR9 2006

11 Database WCRF CUP internet central

12 Rolling Programme Cancer sites Year cancers & cancer survivors 2008 Breast 2009 Breast Prostate Colon & rectum 2010 Breast Prostate Colon & rectum Pancreas Breast cancer survivors 2011 Breast Prostate Colon & rectum Pancreas Breast cancer survivors Cancer x Cancer y All sites continually updated

13 Imperial College Review Team March 2010 D. Aune March 2007 July 2007 Jan 2007 July 2008 R. Vieira D. Chan T. Norat R. Lao

14 Limited funds Strategic decisions 1.Priority should be given to update the database: Unique resource for research and public health

15 Limited funds Strategic decisions 1. Update the database: Cohort studies, case-control nested in cohort studies Intervention trials Peer-reviewed journals English language References and abstracts of other relevant studies central Ref Man

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17 Limited funds Strategic decisions 2.But only creating a database is not enough Data analysis When to do a meta-analysis? Three or more added publications after the Second Global Report By recommendation of the Panel

18 ACHIEVEMENTS Creation of a more efficient merged database Database updated for prostate, breast, pancreas bowel cancer (May 2010) CUP database: Number of articles (cohort studies) by publication period No. articles / / /206 Continuous Update (Jul/2006-May/2010) / WCRF/AICR (-----June/2006) 0 Pancreas Prostate Colorectal Breast cancer

19 ACHIEVEMENTS Creation of a more efficient merged database Database updated for prostate, breast, pancreas bowel cancer (May 2010) Full report on breast cancer in 2008 Reinforced the conclusions of the 2007 Expert Report Report summary

20 2008. Continuous Update Report on Breast Cancer Articles identified in PubMed during Jan 2006 and May 2008 Inclusion 231 Relevant articles Exclusion 3598 excluded articles 2887 out of the research topic 1, 392 review, 105 no specific outcome, 102 no exposure of interest, 64 commentary, 12 no measure of relationship, 12 metaanalysis, 10 duplicates/extracted, 5 articles in foreign language 2, 4 ecological studies, 2 case series,, 2 crosssectional studies, 1 no report of analytical result 1 Randomised controlled trial 74 Prospective cohort 4 Historical cohort 1 Case-cohort design 21 Nested-casecontrol design 131 Articles with a case-control design Extraction 101 Articles extracted up to May Hospitalbased casecontrol studies 48 Populationbased casecontrol studies 56 Case-control studies (type undetermined)

21 2008. Continuous Update Report on Breast Cancer Alcohol and post-menopausal breast cancer Study Alcohol RR (95% CI) for 10g/day increase Study ** Ericson, U. et al. (2007) ** Zhang et al. (2007) ** Mellemkjoer et al. (2006) 1.18 (1.00, 1.39) 1.07 (0.99, 1.15) 1.08 (1.03, 1.13) Malmo Diet and Cancer Women's Health Study Diet, Cancer and Health ** Stolzenberg-Solomon, R.Z. (2006) Suzuki R. (2005) Horn-Ross, P.L. (2004) Sellers, T. A. (2004) Feigelson, H. S. (2003) Chen, Wendy, Y. (2002) Rohan, T.E. (2000) Holmberg, L. (1995) van den Brandt, P. A. (1995) Barrett-Connor, E. (1993) Overall (I-squared = 21.0%, p = 0.231) 1.14 (0.94, 1.38) 1.21 (1.06, 1.37) 1.05 (0.99, 1.11) 1.09 (0.99, 1.21) 1.06 (1.00, 1.13) 1.09 (1.04, 1.14) 1.05 (0.99, 1.12) 5.80 (1.71, 19.64) 1.12 (0.99, 1.26) 0.85 (0.56, 1.31) 1.08 (1.05, 1.11) PLCO Cancer Screening Trial cohort Sweden, 1987 California Teachers Study Iowa Women's Health Study CPS-II US cohort Nurses' Health Study NBSS The Swedish Mammography Cohort The Netherlands Cohort Study Rancho Bernardo, 1972 NOTE: Weights are from random effects analysis Continuous update 2009 RR (95% CI)=1.08 ( ) Second expert report 2007 RR (95% CI)=1.08 ( )

22 2008. Continuous Update Report on Breast Cancer Study Body mass index and post-menopausal breast cancer 2 units BMI % ID RR (95% CI) Weight WCRF_Code StudyDescription ** Iwasaki et al. (2007) 1.07 (0.98, 1.17) 2.54 BRE20027 ** Lundqvist et al (2007) 1.06 (1.02, 1.10) 6.49 BRE80002 ** Palmer, J.R. et al. (2007) 1.01 (0.97, 1.04) 6.70 BRE80122 Black Women's Health Study ** Reeves, G.K. et al. (2007) 1.07 (1.06, 1.08) BRE80146 The Million Women Study ** Chang S.C. (2006) 1.04 (1.00, 1.08) 6.94 BRE80110 ** Krebs E.E. (2006) 1.05 (0.99, 1.12) 4.18 BRE80106 Study of Osteoporotic Fractures ** Lukanova A. (2006) 1.00 (0.95, 1.06) 4.40 BRE80100 Northern Sweden Health and Disease Cohort ** Suzuki, R. (2006) 1.07 (1.01, 1.14) 4.26 BRE80116 The Swedish Mammography Cohort Lahmann PH (2004) 1.03 (1.00, 1.06) 7.63 BRE15804 EPIC Macinnis, R.J et al. (2004) 1.05 (1.01, 1.10) 5.83 BRE80159 Sellers, Thomas, A. (2002) 1.10 (1.07, 1.13) 8.42 BRE20892 Iowa Women's Health Study Manjer, J (2001) 0.97 (0.88, 1.07) 2.09 BRE17790 Malmo Preventive Project (MPP) Sonnenschein, E. (1999) 1.20 (1.08, 1.32) 1.93 BRE11604 New York Women's Health Study Galanis, D.J. (1998) 1.09 (1.01, 1.17) 3.24 BRE03058 Hawaii State Department of Health Kaaks, R. (1998) 0.96 (0.83, 1.10) 1.08 BRE04522 DOM-project Utrecht Huang, Z. (1997) 1.02 (0.99, 1.05) 8.32 BRE04117 Nurses' Health Study (NHS) Cohort Tulinius, H. (1997) 1.05 (1.00, 1.10) 5.34 BRE12565 Reykjavik Study van den Brandt, P. A. (1997) 1.03 (0.97, 1.09) 4.38 BRE12717 The Netherlands Cohort Study on diet and cancer Tornberg, S. A. (1994) 1.05 (1.01, 1.10) 5.97 BRE12417 Sweden, 1971 Overall (I-squared = 59.8%, p = 0.000) 1.05 (1.03, 1.07) NOTE: Weights are from random effects analysis Continuous update 2009 RR (95% CI)=1.05 ( ) Second expert report 2007 RR (95% CI)=1.03 ( )

23 2008. Continuous Update Report on Breast Cancer Physical activity and post-menopausal breast cancer Study High vs.low ID RR (95% CI) WCRF_Code StudyDescription contrast Units Total Physical Activity ** Lahmann et al. (2007) 0.83 (0.73, 0.95) BRE20026 EPIC > vs. < 54.0 MET-hour Sesso, H.D. (1998) 0.49 (0.28, 0.86) BRE16626 College Alumni Health Study > vs. < Kcal/week. Vigorous Physical Activity ** Dallal et al. (2007) 0.90 (0.74, 1.10) BRE80016 California Teachers Study > 5.01 vs hours/week Silvera, S. A. N. (2005) 1.00 (0.78, 1.29) BRE24118 NBSS > 60.0 vs. < 0.0 min/day McTiernan, A. (2003) 0.91 (0.68, 1.22) BRE17819 Women's Health Initiative Observational Study > 4.0 vs. < 0.0 hours/week Moore, D. B. (2000) 1.05 (0.72, 1.53) BRE16124 Iowa Women's Health Study >4 vs. rarely/never times/week. Occupational Physical Activity ** Lahmann et al. (2007) 1.08 (0.91, 1.29) BRE20026 EPIC Manual & heavy manual vs. sedentary Mertens, A. J. (2005) 0.85 (0.57, 1.27) BRE23405 Atherosclerosis Risk in Communities Study Quantile 4 vs. Quantile 1 Dirx, M. J. (2001) 0.83 (0.51, 1.35) BRE02326 The Netherlands Cohort Study on diet and cancer > 12.1 vs. < 7.9 KJ/min Thune, I. (1997) 0.78 (0.52, 1.17) BRE12313 Norway National Health Screening Service Lifting/heavy manual vs. sedentary Albanes (1989) 0.67 (0.33, 1.34) BRE00236 NHANES I Very active vs. quite inactive. Recreational Physical Activity ** Lahmann et al. (2007) 0.96 (0.85, 1.08) BRE20026 EPIC > 43.0 vs. < 13.0 MET-hour/week ** Bardia et al. (2006) 0.91 (0.82, 1.01) BRE20028 Iowa Women's Health Study Quantile 3 vs. Quantile 1 ** Chang S.C. (2006) 0.78 (0.61, 0.99) BRE80110 PLCO Cancer Screening Trial Cohort > 4.0 vs. 0 hours/week Mertens, A. J. (2005) 1.06 (0.64, 1.75) BRE23405 Atherosclerosis Risk in Communities Study Quantile 4 vs. Quantile 1 Schnohr P. (2005) 1.12 (0.82, 1.52) BRE24028 Copenhagen Center for Prospective Population Studies Vigorous vs. low McTiernan, A. (2003) 0.78 (0.61, 0.99) BRE17819 Women's Health Initiative Observational Study > 40.1 vs. < 0.0 MET-hour/week Patel, A.V. (2003) 0.85 (0.49, 1.49) BRE16299 CPS-II US cohort >31.5 vs. <0.0 MET-hour/week Dirx, M. J. (2001) 0.76 (0.58, 0.99) BRE02326 The Netherlands Cohort Study on diet and cancer > 91.0 vs. < 29.0 min/day Lee, I.-M. (2001) 0.67 (0.44, 1.02) BRE15848 Women's Health Study > vs. < KJ/week Thune, I. (1997) 0.67 (0.41, 1.10) BRE12313 Norway National Health Screening Service Regular exercise vs. sedentary Albanes (1989) 0.59 (0.31, 1.12) BRE00236 NHANES I Moderate vs. little/no exercise

24 ACHIEVEMENTS Creation of a more efficient merged database Database updated for prostate, breast, pancreas bowel cancer (May 2010) Full report on breast cancer in 2008 Reinforced the conclusions of the 2007 Expert Report Report summary Full report bowel cancer to be discussed by Panel in November 2010

25 Report Colorectal Cancer 2010 Fish and colorectal cancer

26 Report Colorectal Cancer 2010 Dietary heme iron and colorectal cancer % Author Year (Sex) Country RR (95% CI) for 1 mg/day Weight Study Lee 2004 (F) China 1.23 (1.00, 1.53) SWHS Larsson 2005 (F) Sweden 1.49 (1.09, 2.03) SMC Balder 2006 (M/F) Netherlands 1.06 (0.91, 1.24) NCS Kabat 2007 (F) Canada 0.98 (0.87, 1.10) NBCS Cross 2010 (M/F) USA 1.13 (0.89, 1.45) NIH-AARP Overall (I-squared = 54.2%, p = 0.068) 1.12 (0.99, 1.27) NOTE: Weights are from random effects analysis

27 Outputs: Database of epidemiologic evidence on cancer incidence cancer survivors Systematic reviews and meta-analysis The data will be made accessible to users

28 Thank you!