WCRF International Continuous Update Project (CUP). Presentation given by Giota Mitrou PhD MSc, Head of Research Funding and Science Activities, World Cancer Research Fund International (WCRF International).

1. WCRF International Continuous
Update Project (CUP)
Giota Mitrou PhD MSc
Head of Research Funding and Science Activities
World Cancer Research Fund International

2. 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

3. World Cancer Research Fund Network
Vision: to live in a world where no one develops a preventable cancer
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:
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)
WCRF International (1999) leads and unifies the network of cancer charities

4. 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

5. 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

6. 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

7. People

Currently more than 100
scientists from 17
countries around the
world

International panel of 12
experts

Researchers, peer
reviewers, advisers

8. 26
24
22
20
18
16
14
12
10
8
6
4
2
0
Estimated global number of new cases of cancer
(excluding non-melanoma skin cancer)
(actual and predicted)
1970 1980 1990 2000 2010 2020 2030 2040
Number (millions)
Year
New cases…
Data from Parkin et al., Pisani et al., GLOBOCAN 2012, IARC

9. Changes in cancer incidence
30
25
20
15
10
5
0
1960 1965 1970 -
'71
1973 -
'77
1979 -
'82
1983 -
'87
1988 -
'92
1995 1997
Colon
Breast
Cancer Incidence (per 100,000
Cancer Incidence (per 100,000
Trends in cancer incidence within
one country: Japan
Migration data: Cancer incidence in
Japanese women by generation in Hawaii
and Japan (1968-1977)

10. Impact of
diet,
nutrition &
physical
activity on
cancer

11. 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

12. Hierarchy of evidence
Meta-analysis
RCT
Cohort
Case control
Ecological
Opinion

13. Continuous Update Project database
Second Expert Report databases
Research Team

14. 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

15. Grading the evidence
Decreases
risk
Increases
risk
Strong
evidence
Convincing
Probable
Limited
evidence
Limited -
suggestive
Limited – no
conclusion
Strong
evidence
Substantial
effect on risk
unlikely
Basis for recommendations

16. 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

17. Plan of work
Until 2015 2015 to 2017 From 2017
Rolling
programme
of updates
Panel to review
evidence across
cancers and
revise
recommendations
if necessary
Continuous Update Project
database continually updated
2017 Major report
published
Continue to
update, analyse
and review
evidence

18. Mouth, pharynx, larynx
Nasopharynx
Oesophagus
Lung
Stomach
Pancreas
Gallbladder
Liver
Colorectum7
Breast premenopause
Breast postmenopause
Ovary
Endometrium
Prostate
Kidney
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
Alcoholic drinks5
Coffee
Beta-carotene6
Physical activity
Body fatness
Adult attained height
Greater birth weight
Lactation
Convincing decreased risk
Probable decreased risk
Probable increased risk
Convincing increased risk
Substantial effect on risk unlikely
Continuous Update
Project matrix of
strong evidence

19. 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

20. World Cancer
Research Fund
network
Recommendations for
Cancer Prevention
The Panel emphasises the
importance of not smoking and
of avoiding exposure to tobacco
smoke

21. Publications timetable
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

22. 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.

23. 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)

24. 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

25. For further information
Giota Mitrou
Head of Research Funding and Science Activities
g.mitrou@wcrf.org
@wcrfint
facebook.com/wcrfint
www.wcrf.org