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Mc Tiernan - 20th International Nutrition Congress 2013
Mc Tiernan - 20th International Nutrition Congress 2013
Mc Tiernan - 20th International Nutrition Congress 2013
Mc Tiernan - 20th International Nutrition Congress 2013
Mc Tiernan - 20th International Nutrition Congress 2013
Mc Tiernan - 20th International Nutrition Congress 2013
Mc Tiernan - 20th International Nutrition Congress 2013
Mc Tiernan - 20th International Nutrition Congress 2013
Mc Tiernan - 20th International Nutrition Congress 2013
Mc Tiernan - 20th International Nutrition Congress 2013
Mc Tiernan - 20th International Nutrition Congress 2013
Mc Tiernan - 20th International Nutrition Congress 2013
Mc Tiernan - 20th International Nutrition Congress 2013
Mc Tiernan - 20th International Nutrition Congress 2013
Mc Tiernan - 20th International Nutrition Congress 2013
Mc Tiernan - 20th International Nutrition Congress 2013
Mc Tiernan - 20th International Nutrition Congress 2013
Mc Tiernan - 20th International Nutrition Congress 2013
Mc Tiernan - 20th International Nutrition Congress 2013
Mc Tiernan - 20th International Nutrition Congress 2013
Mc Tiernan - 20th International Nutrition Congress 2013
Mc Tiernan - 20th International Nutrition Congress 2013
Mc Tiernan - 20th International Nutrition Congress 2013
Mc Tiernan - 20th International Nutrition Congress 2013
Mc Tiernan - 20th International Nutrition Congress 2013
Mc Tiernan - 20th International Nutrition Congress 2013
Mc Tiernan - 20th International Nutrition Congress 2013
Mc Tiernan - 20th International Nutrition Congress 2013
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Mc Tiernan - 20th International Nutrition Congress 2013

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The 20th International Congress of Nutrition (ICN) hosted by the International Union of Nutritional Science (IUNS) took place on the 15th-20th September 2013, Granada, Spain. WCRF International held a …

The 20th International Congress of Nutrition (ICN) hosted by the International Union of Nutritional Science (IUNS) took place on the 15th-20th September 2013, Granada, Spain. WCRF International held a 2-hour symposium on the Continuous Update Project (CUP) entitled ‘Food, Nutrition, Physical Activity and Cancer – Keeping the Evidence Current: WCRF/AICR Continuous Update Project (CUP).’ It included four presentations exploring the latest updates from the CUP.

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  • 1. The WCRF/AICR Continuous Update Project – Systematic Reviews on Nutrition, Physical Activity & Health Outcomes in Cancer Survivors Anne McTiernan, MD, PhD Fred Hutchinson Cancer Research Center, Seattle, WA, USA WCRF/AICR CUP Panel ICN September 2013
  • 2. Recognition  World Cancer Research Fund International   American Institute for Cancer Research, USA   Dr. Susan Higginbotham, PhD Imperial College London   Dr. Rachel Thompson, PhD PHNutr, Professor Martin Wiseman, FRCP FRCPath, & colleagues Dr. Teresa Norat, PhD & colleagues Continuous Update Project Panel  International scientific experts
  • 3. Why Study Cancer Survivors?     U.S. National Cancer Institute: In cancer, a person is considered to be a survivor from the time of diagnosis until the end of life ~ 28 million cancer survivors worldwide Growing evidence of associations between nutrition, weight, physical activity & cancer prognosis Role of lifestyle may differ for cancer prognosis vs. prevention, and may differ by cancer type
  • 4. Second Expert Report (2007)     ‘Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective’ Not possible to draw firm conclusions that apply to cancer survivors specifically Evidence was emerging but not sufficiently developed Panel concluded cancer survivors should aim to follow the recommendations for prevention of cancer
  • 5. Rationale for Focus on Breast Cancer     Globally, 1.38 million new breast cancer cases diagnosed in 2008 (23% of all cancers) Ranks second overall (10.9% of all cancers) Most available data on nutrition and cancer survivors is for breast cancer Additional cancer sites will be studied
  • 6. Global Health Statistics: Breast Cancer CA: A Cancer Journal for Clinicians 2011;61(2):69-90 WHO IARC GLOBOSCAN http://globocan.iarc.fr/factsheet.asp
  • 7. Types of Studies   Most studies with mortality endpoints are observational Greater weight placed on randomized clinical trials vs. follow-up studies
  • 8. Criteria for Study Inclusion  Randomised controlled trials     ≥ 50 women ≥ 6 months follow-up Only 2 identified (both low-fat diet trials) Prospective cohort (follow-up) studies  Primary analysis, secondary analysis or ancillary analysis of randomized controlled trials, or follow-up studies in breast cancer survivors
  • 9. Breast Cancer Survivors Included     Pre-menopausal women Post-menopausal women Incident in-situ breast cancer Incident invasive breast cancer
  • 10. Exposures Included         Specific foods Micro- and macro-nutrients Dietary patterns Alcohol Overweight, obesity, underweight, weight change Body composition Dietary supplements Physical activity
  • 11. Timing of Exposures Included   Pre-diagnosis Immediate 12 months following diagnosis   Period of intensive primary therapy (surgery, radiation, chemotherapy) After 12 months post-diagnosis   Patients may be receiving targeted therapy during this period (e.g. hormonal therapy, HER2neu, bone metastases prevention) Data may extend 20 years or more
  • 12. Outcomes Included     Total mortality Breast cancer specific mortality Second primary breast cancer Other cause-specific mortality, i.e. cardiovascular
  • 13. Nutrients Exposures  Dietary:        Fibre Folate Soy protein & isoflavones Total fat (g/d & % calories) Saturated fat Dietary patterns Alcohol
  • 14. Other Exposures  Physical activity    Total (work, home, commute, recreation) Recreational only Body fatness   Body mass index (kg/m2) Weight change
  • 15. Issues Relevant to Survivor Research  Confounding effects of:      Treatment types, efficacies, adverse effects Stage of disease Comorbidities Type of cancer Methodological:     Determining cause of death Determining and classifying recurrence Screening for second primary breast cancer Increasing length of survival
  • 16. Literature search (New search for CUP) 19831 unique records identified in Pubmed and Embase until 30th June 2012 and 18 articles found in handsearch 897 full-text articles retrieved and assessed for inclusion 319 articles on survival and health events in women with breast cancer 18952 records excluded on the basis of title and abstract 578 articles excluded for not fulfilling the inclusion criteria 85 no original data 278 did not report on the associations of interest 30 abstract/commentary 9 meta-analyses 94 irrelevant study design 33 follow-up less than 6 months 49 study smaller than 50 women 106 articles excluded on health events other than death or second primary cancer in women with breast cancer 213 articles have mortality or any second primary cancer as study endpoints
  • 17. Example: Alcohol        Alcohol use associated with increased risk of breast cancer development Unclear if use associated with survival Most data from pre-diagnosis or beyond 12-months post-diagnosis Data from self-report only Little information on specific alcohol types Little information on cancer treatments Major cultural/geographic variation in use
  • 18. Summary: Alcohol Total mortality Breast cancer mortality Second primary/ contralateral breast cancer N deaths RR (95%CI) N deaths N events Before diagnosis: High vs. Low 2650 0.93 (0.82-1.06) Before : Per 1 drink/week 2676 After diagnosis: High vs. Low 3827 After diagnosis: Per 10g/d 3779 1.00 (0.99-1.00) 0.89 (0.72-1.09) 0.98 (0.93-1.03) 1329 RR (95%CI) - - 1.00 (0.97-1.02) - - 403 1.22 (0.88-1.69) 2347 1.19 (0.96-1.47) 403 1.06 (0.79-1.42) 2347 1.01 (0.99-1.03) 1296 1.18 (0.81-1.72) RR (95%CI)
  • 19. Example: Body Mass Index (BMI)     Increased BMI associated with risk for postmenopausal breast cancer, but not for premenopausal breast cancer Measured or self-reported height & weight Data from clinical series, trials, & epidemiological studies Most data from 12-month period after diagnosis, and from before diagnosis
  • 20. Summary: Before diagnosis- BMI summary Second primary Total mortality Breast cancer mortality breast cancer N deaths RR (95%CI) 1.41 (1.29-1.54) N deaths High vs. Low 8318 9854 Underweight vs. normal weight 4944 1.10 (0.92-1.31) 4479 Per 5 kg/m2 6261 1.17 (1.13-1.21) Premenopause 644 Postmenopause 1103 RR (95%CI) 1.34 (1.23-1.46) N events RR (95%CI) 701 1.43 (0.87-2.34) 1.02 (0.85-1.21) - - 6600 1.17 (1.11-1.24) 701 1.21 (1.04-1.40) 1.25 (1.10-1.43) 1350 1.06 (0.85-1.32) - - 1.16 (1.01-1.34) 2866 1.15 (1.05-1.25) - -
  • 21. Summary: Around diagnosis- BMI summarymortality Second primary 1 Total mortality Breast cancer breast cancer N deaths RR (95%CI) N deaths High vs. Low BMI 16925 Premenopause 4604 1.28 (1.16-1.42) 586 Postmenopause 4614 1.13 (1.03-1.23) Underweight vs. normal weight 2598 Per 5 kg/m2 5875 1.27 (1.16-1.38) 10063 RR (95%CI) 1.36 (1.23-1.50) N events RR (95%CI) 3478 1.30 (1.14-1.48) 0.96 (0.45-2.06) - - 1067 1.57 (1.31-1.89) - - 1.23 (0.93-1.63) 1455 1.52 (1.26-1.84) - - 1.11 (1.06-1.17) 1918 1.18 (1.11-1.25) 3186 1.13 (1.06-1.21)
  • 22. Summary: After diagnosis – BMI summary Second primary Total mortality Breast cancer mortality breast cancer N deaths RR (95%CI) High vs. Low 2289 1.21 (1.06-1.38) Underweight vs. normal weight 1361 1.29 (1.02-1.63) Per 5 kg/m2 1703 1.08 (1.01-1.15) 4, 0%, p=0.52 N deaths RR (95%CI) 2 studies Both  risk, 1 significant N events RR (95%CI) No studies
  • 23. Global Implications
  • 24. Global Prevalence of Overweight & Obesity in Women
  • 25. Future considerations    Newly developed criteria specific for cancer survivors for judging evidence Recommendations for breast cancer survivors To reduce mortality, prevent further primary cancers, and other diseases
  • 26. Summary      Growing literature on nutrition, related factors, & breast cancer survival Time of exposure is dynamic Various outcomes are important to study Data are sufficient for meta-analyses for several variables Systematic literature review identifies patterns of associations for nutrientrelated factors & breast cancer survival

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