Professor Alan Jackson’s presentation, The Continuous Update Project: Recent Findings on Diet, Nutrition, Physical Activity and Cancer, at the African Organisation for Research & Training in Cancer (AORTIC) conference, 18-22 November 2015, Marrakech, Morocco.

1. The Continuous Update Project: Recent Findings on
Diet, Nutrition, Physical Activity and Cancer
Roadmap to Cancer Control in Africa,
Marrakech, Morocco, 18-22 November 2015
Alan Jackson
Professor of Human Nutrition, University of Southampton, UK
Panel Chair: Continuous Update Project

2. In all developing countries,
cancers now account for
a large enough share of
premature deaths and poverty
to merit an
urgent and coordinated
public policy response.
2005
2015
2030
0
2
4
6
8
10
12
totalcancerdeaths(millions)
Low- and middle income
countries
High-income countries
Source:
Deaths from cancers

3. Cancer - developed vs developing
transition in time
Low and Middle Income eg Asia, Africa
Mouth and pharynx Larynx
Oesophagus Stomach
Liver Cervix
Developed economies eg Europe and US
Colorectal Breast
Endometrium Prostate

4. Infectious Agents and Cancer
• ~16% cases of cancer likely caused by
infectious agents worldwide
– 25% in Africa
– <10% in Europe (1 in 33 in UK)
Agent Cancer
HPV Cervix, Head and Neck
EBV Hodgkin’s Lymphoma, Burkitts
HCV, HBV Liver
H. Pylori Stomach

5. - stomach
infection (H pylori), salted fish
refrigeration, fresh fruit vegetables
antioxidant, anti-inflammatory
- cervix
infection (HPV)
behaviour, fresh fruit vegetables
folic acid
- liver
infection (Hep C), toxin (aflatoxin)
cleaner environment
iron, alcohol
Cancer

6. Cancer incidence and mortality
World and Africa
World Africa
Globocan 2012

7. Comprehensive
Rigorous
Detailed
Sound Method
Authoritative

8. Around one quarter of
all cancers estimated
avoidable through
appropriate food,
nutrition and physical
activity

9. WCRF/AICR EXPERT REPORT
The most authoritative
• New method
• Systematic reviews
• Review of evidence separate from
judgement
• Panel of international experts
• Predetermined criteria for judgements
– Epidemiology
– Mechanisms
• Flexibility
• Continuous update of evidence

10. Liver

11. Dose-response meta-analysis of coffee and liver cancer, per one cup per day

12. Aflatoxins and liver cancer

13. Dose-response meta-analysis of alcohol and liver cancer, per 10 g per day

14. Dose-response meta-analysis of BMI and liver cancer, per 5 kg/m2

15. Prostate

16. BMI Waist circumference Waist to hip ratio
AdvancedNon-advanced
AdvancedNon-advanced
AdvancedNon-advanced
RR=1.12 (1.04-1.21) RR=1.15 (1.03-1.28)
RR=1.01 (0.90-1.12) RR=0.99 (0.90-1.09)
RR=1.08 (1.04-1.12)
Dose-response meta-analysis of body fatness and prostate cancer
RR=0.95 (0.92-0.98)

17. Allott et al., Eur Urol. 2013;63:800–9
Obesity-related biologic mechanisms and detection biases contributing to the
association between obesity and aggressive prostate cancer

18. Dose-response meta-analysis of height and prostate cancer, per 5 cm
RR=1.04 (1.03-1.05)

19. Height and prostate cancer risk
 Height should be thought of as a marker for exposure(s) that influence
cancer risk and not as a risk factor itself
 Adult height is determined both by genetics and by early life exposures1
 Greater intakes of total energy and milk during childhood and adolescence
are positively associated with adult height2,3
 Relations with total energy and milk may be mediated by alterations in
levels of growth factors and insulin2,3
 Height is associated with greater organ size, which may place more cells at
risk for malignant transformation4
1. Renehan, Lancet Oncol 2011;12:716-7
2. Wadsworth et al., Int J Epidem 2002;31:383-90
3. Berkey et al., CEBP 2009;18:1881-7
4. Albanes & Winick, JNCI 1988;80:772-4

20. Kidney

21. Dose-response meta-analysis of alcohol and kidney cancer, per 10 g per day

22. Dose-response meta-analysis of BMI and kidney cancer, per 5 kg/m2

23. Dose-response meta-analysis of height and kidney cancer, per 5 cm

24. Breast Cancer Survivors Report 2014
Report available at: http://www.wcrf.org/sites/default/files/Breast-Cancer-Survivors-2014-Report.pdf
 85 papers included in the report
 164,416 women
 42,572 cases of mortality

27. Summary
Incidence is increasing for common cancer sites in both high-income
and low-income countries (e.g. breast, colorectum, prostate)
Mortality is decreasing in most high-income countries, not in low
income countries
Total burden is increasing and pattern changing because of
demographic changes (ageing populations, increasing size), and
Westernization of lifestyles

28. Future directions
Studies of cancer incidence:
 Improve measurements of diet, nutrition, and physical activity
 Perform analyses by cancer molecular subtypes
 Examine potential interactions with genetic predisposition
 Elucidate underlying biologic mechanisms
Studies of cancer survival:
 Address potential confounding by cancer stage, treatment, and comorbidities
 Investigate timing of exposure in relation to cancer diagnosis and treatment

29. Nutrition and Cancer
Cancer numbers are increasing
Nutritional factors are major determinants of the pattern
of cancers in populations (25 – 30%)
With smoking, poor diet, obesity and physical inactivity
are the most important avoidable causes
Recommendations for cancer prevention will also prevent
other NCDs

30. Year Publications
2010 Breast
2011 Colorectum
2012 Pancreas
2013 Endometrium
2014 Ovary, prostate and breast cancer
survivors
2015 Liver, kidney, gallbladder, bladder
2015-
2016
Stomach, oesophagus, lung
2016-
2017
Breast, colorectum
2017 Major report – Recommendations
Timeline

31. www.wcrf.org/int/research-we-fund/continuous-update-project-cup
Data and information for Africa??