Aims: Identifying why and how different subtypes of specific cancers respond differently to diet, nutrition, physical activity and weight exposures.
The cancer incidence area encompasses two main components, the data prioritisation exercise and several collaboration projects.
Every 2–3 years, a data prioritisation exercise will determine when evidence could be/needs to be updated. This will include the evidence around specific cancer types eg any of the 17 cancer types covered previously in the original CUP as well as updating cancer prevention recommendations. It could also include evidence around specific exposures, eg around dairy, meat.
There will also be projects focusing on specific areas as highlighted below. Some of these projects will be carried out in collaboration with external groups, supported by the CUP Global team at Imperial College London.
Identifying why and how different subtypes of specific cancers respond differently to the same diet, nutritional, physical activity exposures
Benefit of approach
Our previous research has shown that subtypes of some cancers respond very differently to the same nutritional exposures. However, it hasn’t been possible to identify in detail how many cancers this applies to or the underpinning factors causing these differences.
The cancer subtypes workstream reviewed previous work carried out for the CUP and developed a framework for characterised the various subtypes of cancers and their potential associations with diet, nutrition and physical activity.
As part of CUP Global, we will develop an approach, protocols, and a strategy for interpretation that can be applied to cancer subtypes. These methods, along with the framework developed by the workstream, will enable cancer subtypes to be integrated into future CUP Global systematic reviews.
Ultimately this work raises the possibility of defining risk factors for specific cancer subtypes to guide prevention strategies (paralleling advances in targeted or precision therapy), enabling targeting advice to specific populations with distinct risk factor profiles of susceptibilities.
Aims: Identifying specific dietary and lifestyle patterns which have a significant impact on cancer risk
Benefits of approach
In recent years it has become clear that an integrated lifestyle pattern of a healthy balanced diet, physical activity and healthy weight has a greater impact on cancer risk than the sum of the individual parts. Previous CUP work identified the importance of dietary patterns in influencing cancer risk but it was not possible to review the evidence systematically and the Panel judged that the evidence was largely inconclusive.
It became clear that improved methodological approaches were needed for reviewing and synthesising evidence on dietary patterns and for its extension to overall lifestyle patterns in order to capture the growing body of research on patterns of diet and lifestyle characteristics.
To this end, the dietary and lifestyle patterns workstream has developed a Dietary and Lifestyle Patterns Protocol to enable these systematic reviews to be conducted in CUP Global. They also developed a specialised narrative synthesis approach for analysing the evidence on dietary and lifestyle patterns when meta-analyses are not possible.
This work comprises two commissioned research projects working with the CUP Global team at Imperial College London; breast and colorectal cancers have been prioritised since they are the most common cancers influenced by dietary and lifestyle patterns.
The breast cancer review is currently underway by Dr Romaguera’s group at the Health Research Institute of the Balearic Islands (working in liaison with the CUP Global Team at Imperial) in Spain.
This will be followed by a review on colorectal cancer, which will be carried out by Professor Ed Giovannucci at The Harvard T.H. Chan School of Public Health in the US.
Aims: Identifying how different life stages influence cancer risk, including critical windows of time that may be particularly amenable to lifestyle interventions
Benefits of approach
Previous CUP work touched on the fact that different life stages could influence cancer risk, but did not explicitly seek to gather data on lifecourse exposures and cancer risk through a lifecourse lens. It was therefore not possible to explore in detail the impact of critical windows of time, particularly earlier in life, that may be amenable to lifestyle interventions.
As part of CUP Global a better understanding of the impact of specific exposures on risk (both at chronological age and developmental biological life stage) will significantly enhance the evidence base, allowing us to better identify critical periods for prevention and intervention and potentially for the development of more tailored recommendations across age-groups.
This work comprises a commissioned research project carried out by Dr Trudy Voortman, from Erasmus Medical Center in the Netherlands, working with the CUP Global team at Imperial College London.
The work involves developing a protocol and applying this to a systematic literature review of diet, nutrition, and physical activity exposures from preconception to age 30 years (incorporating learnings from a student project already undertaken as part of the CUP Transition work) in three of the most common cancers (breast, colorectal, prostate).