Diet and colorectal cancer in UK Biobank: a prospective study

Bradbury, K.E.,  Murphy, N., Key, T. | 2019| Diet and colorectal cancer in UK Biobank: a prospective study|  International Journal of Epidemiology| dyz064| https://doi.org/10.1093/ije/dyz064

A research team behind a study into diet and the impact of diet on colorectal cancer used data from the UK Biobank research project in conjunction with  questionnaires to learn about the dietary habits of men and women aged between 40- 69 years and their potential risk of developing colorectal cancer. 

At follow up five years later the participants who had consumed (on average) 76g of red meat, compared to 21g, had a higher risk of developing cancer than other participants.

Participants who ate red meat on four or more occasions a week had a fifth increased risk of developing colorectal cancer compared with subjects who ate red meat twice weekly. 
Subjects who consumed the most wholegrains had a 14% lower risk of developing  colorectal cancer.
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Key Messages
  • Previous studies have found an increased risk of colorectal cancer in those with high intakes of red and processed meat. Most previous studies collected information on dietary intakes during the 1990s or earlier and patterns in meat consumption have since changed.
  • In addition, few studies have used re-measured intakes to reduce the impact of measurement error, and to quantify the amount of red and processed meat that is associated with an increased risk. Measurement error generally biases the associations towards the null value; the associations observed in previous studies that did not re-measure intakes may be underestimated.
  • Our study found that people who were consuming red and processed meat four or more times per week, had a 20% increased risk of colorectal cancer compared with those who were consuming red and processed meat less than twice a week.

Abstract

Background

Most of the previous studies on diet and colorectal cancer were based on diets consumed during the 1990s.

Methods

We used Cox-regression models to estimate adjusted hazard ratios for colorectal cancer by dietary factors in the UK Biobank study. Men and women aged 40–69 years at recruitment (2006–10) reported their diet on a short food-frequency questionnaire (n = 475 581). Dietary intakes were re-measured in a large sub-sample (n = 175 402) who completed an online 24-hour dietary assessment during follow-up. Trends in risk across the baseline categories were calculated by assigning re-measured intakes to allow for measurement error and changes in intake over time.

Results

During an average of 5.7 years of follow-up, 2609 cases of colorectal cancer occurred. Participants who reported consuming an average of 76 g/day of red and processed meat compared with 21 g/day had a 20% higher risk of colorectal cancer. Participants in the highest fifth of intake of fibre from bread and breakfast cereals had a 14% lower risk of colorectal cancer. Alcohol was associated with an 8% higher risk per 10 g/day higher intake. Fish, poultry, cheese, fruit, vegetables, tea and coffee were not associated with colorectal-cancer risk.

Conclusions

Consumption of red and processed meat at an average level of 76 g/d that meets the current UK government recommendation (less than or equal to 90 g/day) was associated with an increased risk of colorectal cancer. Alcohol was also associated with an increased risk of colorectal cancer, whereas fibre from bread and breakfast cereals was associated with a reduced risk.

 

The article is available to read in full in the International Journal of Epidemiology 

In the news:

The Independent Even government guideline amounts of red meat and bacon increase risk of bowel cancer, study finds 

The Guardian Even moderate intake of red meat raises cancer risk, study finds

BBC News A rasher of bacon a day ‘ups cancer risk’ 

Familial colorectal cancer risk in half siblings and siblings: nationwide cohort study

Tian, Y.  et al. | 2019|  Familial colorectal cancer risk in half siblings and siblings: nationwide cohort study | 

The BMJ has published a cohort study that looked at relatives with colorectal cancer, unlike previous research this study also focused on second-degree relatives half siblings. The research identifies that second- degree relatives, for example half siblings, also had an association with colorectal cancer risk similar to that in first-degree relatives such as siblings or parents. 

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Abstract

Objective To explore the risk of colorectal cancer in family members of patients with colorectal cancer, with an emphasis on subtypes of second degree relatives, especially half siblings, which were lacking in the literature.

Design Ambidirectional cohort study.

Setting Nationwide Swedish Family Cancer Data (record linkage).

Participants All people residing in Sweden and born after 1931, with their biological parents, totalling more than 16 million individuals (follow-up: 1958-2015); of those with clear genealogy, 173 796 developed colorectal cancer.

Main outcome measures Lifetime (0-79 years) cumulative risk and standardised incidence ratio of colorectal cancer among first degree relatives and second degree relatives.

Results The overall lifetime cumulative risk of colorectal cancer in siblings of patients was 7%, which represents a 1.7-fold  (n=2089) increase over the risk in those without any family history of colorectal cancer. A similarly increased lifetime cumulative risk (6%) was found among half siblings. The risk in people with colorectal cancer in both a parent and a half sibling (n=32) was close to the risk in those with both an affected parent and an affected sibling (n=396). Family history of colorectal cancer in only one second degree relative other than a half sibling (without any affected first degree relatives), such as a grandparent, uncle, or aunt, showed minor association with the risk of colorectal cancer.

Conclusion Family history of colorectal cancer in half siblings is similarly associated with colorectal cancer risk to that in siblings. The increase in risk of colorectal cancer among people with one affected second degree relative was negligible, except for half siblings, but the risk was substantially increased for a combination of family history in one affected second degree relative and an affected first degree relative (or even another second degree relative). These evidence based findings provide novel information to help to identify people at high risk with a family history of colorectal cancer that can potentially be used for risk adapted screening.

Full abstract available from the BMJ

Read and download the full article online from the BMJ

Rapid cancer diagnostic and assessment pathways

NHS England has published three rapid cancer diagnostic and assessment pathways.  These documents set out how diagnosis within 14 days and diagnosis within 28 days can be achieved for the colorectal, lung, and prostate cancer pathways:

Implementing a timed colorectal cancer diagnostic pathway:

This handbook sets out how the 28 day standard can be achieved in colorectal cancer patients, in preparation for full monitoring against the standard from April 2020.

Implementing a timed lung cancer diagnostic pathway:

This handbook sets out how the 28 day standard can be achieved for lung cancer patients, in preparation for full monitoring against the standard from April 2020.

Implementing a timed prostate cancer diagnostic pathway:

This handbook sets out how the 28 day standard can be achieved for prostate cancer patients, in preparation for full monitoring against the standard from April 2020.

 

New use of low-dose aspirin and risk of colorectal cancer by stage at diagnosis

Evidence from clinical trial populations suggests low-dose aspirin reduces the risk of colorectal cancer (CRC). Part of this reduction in risk might be due to protection against metastatic disease | BMC Cancer

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Image source: Bayer AG – Wikimedia // CC BY-SA 3.0

We investigated the risk of CRC among new-users of low-dose aspirin (75–300 mg), including risk by stage at diagnosis. Using The Health Improvement Network, we conducted a cohort study with nested case–control analysis. Two cohorts (N = 170,336 each) aged 40–89 years from 2000 to 2009 and free of cancer were identified: i) new-users of low-dose aspirin, ii) non-users of low-dose aspirin, at start of follow-up, matched by age, sex and previous primary care practitioner visits. Patients were followed for up to 12 years to identify incident CRC. 10,000 frequency-matched controls were selected by incidence density sampling where the odds ratio is an unbiased estimator of the incidence rate ratio (RR). RRs with 95% confidence intervals were calculated. Low-dose aspirin use was classified ‘as-treated’ independent from baseline exposure status to account for changes in exposure during follow-up.

Patients starting low-dose aspirin therapy have a reduced risk of Stages B–D CRC, suggesting a role for low-dose aspirin in the progression of established CRC; a substantial reduction in the risk of Dukes A CRC may occur after 5 years’ therapy.

Full reference: García Rodríguez, L.A. et al. (2017) New use of low-dose aspirin and risk of colorectal cancer by stage at diagnosis: a nested case–control study in UK general practice. BMC Cancer. 17:637

Computer-tailored physical activity intervention for prostate and colorectal cancer patients and survivors

Cancer and cancer treatment coincide with substantial negative physical, psychological and psychosocial problems | BMC Cancer

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Background: Physical activity (PA) can positively affect the negative effects of cancer and cancer treatment and thereby increase quality of life in CPS. Nevertheless, only a minority of CPS meet PA guidelines. We developed the OncoActive (OncoActief in Dutch) intervention: a computer-tailored PA program to stimulate PA in prostate and colorectal CPS, because to our knowledge there are only a few PA interventions for these specific cancer types in the Netherlands

Discussion: Using the Intervention Mapping protocol resulted in a systematically adapted, theory and evidence-based intervention providing tailored PA advice to prostate and colorectal CPS. If the intervention turns out to be effective in increasing PA, as evaluated in a RCT, possibilities for nationwide implementation and extension to other cancer types will be explored.

Full reference: Golsteijn, R.H.J. et al. (2017) Development of a computer-tailored physical activity intervention for prostate and colorectal cancer patients and survivors: OncoActive. BMC Cancer. 17:446

Discovery in fight against bowel cancer

New research has discovered how a genomic approach to understanding bowel (colorectal) cancer could improve the prognosis and quality of life for patients.

Bowel cancer is the fourth most common cancer in the UK, with 41,200 people newly diagnosed each year. A number of treatment options are available but mortality rates remain high, with bowel cancer the second most common cause of cancer death in the UK.

Researchers at Queen’s University Belfast, in collaboration with the University of Oxford and the University of Leeds have made a significant advance in the treatment of bowel cancer. The study, which has been published in the journal Nature Communications, has shown how defining precise gene signatures within bowel cancer cells can allow us to develop novel prognostic and predictive markers for bowel cancer and help to drive personalised medicine approaches.

Full story via ScienceDaily

Link to the research:  Dunne, P.D. et al. Cancer-cell intrinsic gene expression signatures overcome intratumoural heterogeneity bias in colorectal cancer patient classification. Nature Communications, 2017

Chance of colon cancer recurrence nearly cut in half in people who eat nuts

Something as simple as eating tree nuts may make a difference in the long-term survival of patients with colon cancer, a new study concludes.American Society of Clinical Oncology (ASCO) | ScienceDaily | 18th May 2017

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An observational study of 826 patients with stage III colon cancer showed that those who consumed two ounces or more of nuts per week had a 42% lower chance of cancer recurrence and 57% lower chance of death than those who did not eat nuts.

A secondary analysis revealed the benefit of nut consumption was limited to tree nuts. Tree nuts include almonds, walnuts, hazelnuts, cashews, and pecans, among others. These findings will be presented at the upcoming 2017 ASCO Annual Meeting in Chicago.

Read more at ScienceDaily