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Continuous Update Project: Database update and systematic literature reviewTeresa NoratPrincipal Investigator Continuous Update Project, Imperial College London
Protocol
Research topic : The associations between food, nutrition and physical activity and Cancer risk Mortality and second cancers in breast cancer survivors.
Main objective : Summarize the evidence from prospective studies and randomised
controlled trials (case-control studies if requested by the Panel).
Search strategy: Medline, Central, ClinialTrials.gov Hand search of references (reviews, meta-analysis, recent relevant
papers)
Database
Continuous Update Project Expert PanelWorld Cancer Research Fund Secretariat
Architecture
DB server
client application
client application
client application
A Client/Server architectureCentral Database (server)
Application (client)
MySQL (high-performance relational DB) Internal structure designed to accommodate the variety of publications
Located on a dedicated server in Imperial College London
Java platform (compatible with most OS) Features to facilitate data extraction Supports retrieval of information in several formats
Written in a modular way allowing future extensibility
Continuous Update Project Database
One central database
Data Entry
Data Export
Relevant papers are identified and the data extracted and double checked by reviewers
Data are structured and stored for further analysis
Data could be retrieved by a wide range of factors
Data could be exported in MS Word tables MS Excel Datasets
Ready for analysis
Usage
Continuous Update Project Database
Continuous Update Project Database
Screen data entry: Study characteristics
Screen data entry: Study results
Screen query builder
Data exported for analyses
Author, Year, WCRF Code,
Country
Study name, characteristics
Cases/Study sizeFollow-up
(years)
Case ascertainment
Outcome ComparisonRR (95%CI)
PtrendAdjustment factors
Yates, 2014oes00894
UK
EPIC-Norfolk, Prospective Cohort, Age: 39-74 years,
M/W
65/24 066
15 years
Cancer and pathology registries
Incidence, esophageal adenocarc.,
gastroesophageal junction
≥35 vs 18.5-<23 kg/m^2 4.95 (1.11-22.17) Age, gender
Hardikar, 2013oes00875
USA
SBES, Prospective Cohort,
Age: 30- years, M/W
45/411
5 months
Biopsy and follow up Incidence, oesophageal adenocarcinoma 1.01 (0.94-1.10) Age, cigarette smoking,
nsaid, gender
>35.1 vs 25 kg/m2 1.21 (0.32-4.48)
Chen, 2012oes00843
China
CNRPCS, Prospective Cohort, Age: 40-79 years,
M
706/142 21415 years
Review of medical records and death
certificates
Mortality, upper aerodigestive cancer, BMI 15 to <23.5kg/m²
Per 5 kgm^2 1.06 (0.83-1.37)Age, alcohol
consumption, smoking habbits, area, education
140/ BMI 23.5 to <35kg/m²Per 5 kgm^2 0.87 (0.51-1.50)
ODoherty, 2012oes00844
USA
NIH- AARP Diet and Health Study,
Prospective Cohort, Age: 50-71 years,
M/W, Retired
253/218 8549 years
Linkage of the cohort with database to state cancer
registries
Incidence, oesophageal adenocarcinoma
≥35 vs <18.5 kg/m^2 2.11 (1.09-4.09)
Age, sex, alcohol consumption, antacid
use, aspirin use, cigarette smoking, diabetes, ethnicity,
marital status, physical activity, red meat intake,
education, fruit and vegetable intake, non-
steroidal anti-inflammatory drug use, total energy, white meat
intake
Andreotti, 2010oes00845
USA
AHS, Prospective Cohort,
M, Pesticide applicators and
their spouses
33/67 947
10 years
Cancer registry Incidence, esophageal cancer, men ≥35 vs 18.5-24.9 kg/m^2 Age, smoking status
Per 1 kgm^2 1.01 (0.94-1.10)
Oesophageal 8.1.1 Bmi
Data exported for tabulation
Number of articles in the Continuous Update Project
(Last search: June 30, 2014)
Breast
Colorectal
Prostate
Lung
Stomach
Pancreas
Liver
Bladder
Endometrial
Ovary
Kidney
Oesophageal
Polyps
Gallbladder
0 100 200 300 400 500 600 700 800
2005 SLRCUP
Prospective studies
Polyps
Lung
Stomach
Prostate
Colorectal
Breast
Bladder
Pancreas
Endometrial
Kidney
Ovary
Oesophageal
Liver
Gallbladder
0 5 10 15 20 25 30 35 40 45 50
Randomized controlled trials
4230 218
BMI
Total alcoholic drinks
Alcohol (as ethanol)
Alcohol consumption
Energy intake
Fruits
Fish
Total fat (as nutrients)
CoffeeWeight
Vitamin C
Beta-carotene
Eggs
Height
Vegetables
Tea
Vitamin ESaturated fatty acids
Red meat
Total proteinDietary fibre
Vitamin A
Retinol
Milk
MUFA
0 200 400 600 800 1000 1200 1400 1600
Number of articles in the Continuous Update Project database for selected items
(Last search: June 30, 2014)
Data analysis:Statistical methods
Dose-response meta-analysis using generalized least-squares for trend estimation (command GLST in Stata)
Data analysis:Statistical methods
Stratified analyses, sensitivity analyses
NOTE: Weights are from random effects analysis
.
.
.
Self-reported
Abnet
Merry
Reeves
Subtotal (I-squared = 73.4%, p = 0.023)
Measured
Hardikar
Steffen
Corley
Samanic
Engeland
Subtotal (I-squared = 0.0%, p = 0.446)
Medical records
Lindblad
Subtotal (I-squared = .%, p = .)
Author
2008
2007
2007
2013
2009
2008
2006
2004
2005
Year
M/W
M/W
W
M/W
M/W
M/W
M
M/W
M/W
Sex
1.28 (1.13, 1.45)
1.93 (1.47, 2.59)
1.54 (1.26, 1.89)
1.52 (1.22, 1.89)
1.05 (0.73, 1.61)
1.54 (1.12, 2.10)
1.61 (1.22, 2.19)
1.56 (1.15, 2.10)
1.56 (1.39, 1.75)
1.53 (1.39, 1.67)
1.41 (1.13, 1.76)
1.41 (1.13, 1.76)
RR (95% CI)
per 5 kg/m2
40.44
26.15
33.41
100.00
5.66
8.98
10.08
9.74
65.55
100.00
100.00
100.00
Weight
%
NIH- AARP
NLCS
MWS
SBES
EPIC
KPMCP
SCWC
Norwegian 1963-1989
GPRDC
Description
Study
1.28 (1.13, 1.45)
1.93 (1.47, 2.59)
1.54 (1.26, 1.89)
1.52 (1.22, 1.89)
1.05 (0.73, 1.61)
1.54 (1.12, 2.10)
1.61 (1.22, 2.19)
1.56 (1.15, 2.10)
1.56 (1.39, 1.75)
1.53 (1.39, 1.67)
1.41 (1.13, 1.76)
1.41 (1.13, 1.76)
RR (95% CI)
per 5 kg/m2
40.44
26.15
33.41
100.00
5.66
8.98
10.08
9.74
65.55
100.00
100.00
100.00
Weight
%
1.386 1 2.59
Figure 16 Relative risk of oesophageal adenocarcinoma for 5 kg/m2 increase of BMI by exposure assessment methods
Publication and related biasExploratory analyses
Data analysis:Statistical methods
http://www.wcrf.org/cancer_research/cup/key_findings/index.php
Continuous Update Project Reports
Breast cancer Premenopause
Second Expert Report 2007Continuous Update Project 2010
Second Expert Report 2007 Continuous Update Project 2010
Breast cancer Postmenopause
Colorectal cancer
Second Expert Report 2007 Continuous Update Project 2011
Relative Risk .3 .5 .75 1 1.5 2
Study Relative Risk (95% CI)
Kabat, 2008 1.03 ( 0.85, 1.25) Nomura, 2007 0.87 ( 0.81, 0.94) Schatzkin, 2007 0.99 ( 0.87, 1.12) Wakai, 2007 0.55 ( 0.33, 0.93) McCarl, 2006 0.90 ( 0.83, 0.99) Otani, 2006 0.82 ( 0.61, 1.10) Shin, 2006 0.97 ( 0.61, 1.53) Bingham, 2005 0.82 ( 0.74, 0.90) Lin, 2005 0.82 ( 0.60, 1.12) Michels, 2005, NHS 0.96 ( 0.78, 1.18) Michels, 2005, HPFS 0.94 ( 0.80, 1.11) Sanjoaquin, 2004 0.90 ( 0.65, 1.25) Mai, 2003 0.98 ( 0.73, 1.31) Terry, 2001 0.99 ( 0.72, 1.37) Pietinen, 1999 1.00 ( 0.79, 1.27) Heilbrun, 1989 0.94 ( 0.64, 1.40)
Overall 0.90 ( 0.86, 0.94)
Dietary fibre dose-response per 10 g/d
.6.8
1E
stim
ated
RR
0 10 20 30 40Dietary fiber (g/day)
Best fitting fractional polynomial95% confidence interval
Dietary fibre, dose-response curve
Continuous Update Project Colorectal cancer report 2011 BMJ 2011;343:d6617 doi: 10.1136/bmj.d6617
Colorectal cancerFibre
Relative Risk .3 .5 .75 1 1.5 2
Study Relative Risk (95% CI)
Nomura, 2007 0.88 ( 0.78, 0.99)
Schatzkin, 2007 1.11 ( 0.95, 1.28)
Wakai, 2007 1.90 ( 0.40, 9.04)
Bingham, 2005 0.63 ( 0.33, 1.19)
Lin, 2005 0.90 ( 0.31, 2.63)
Michels, 2005, NHS 0.76 ( 0.53, 1.08)
Michels, 2005, HPFS 0.83 ( 0.62, 1.11)
Mai, 2003 1.11 ( 0.64, 1.90)
Terry, 2001 0.97 ( 0.45, 2.09)
Overall 0.93 ( 0.82, 1.05)
Fibre from legumes, dose-response per 10 g/d
Relative Risk .01 .3 .5 .75 1 1.5 2 4
Study
Relative Risk
(95% CI)
Schatzkin, 2007 0.85 ( 0.65, 1.11)
Bingham, 2005 1.09 ( 0.34, 3.53)
Lin, 2005 0.02 ( 0.00, 0.37)
Mai, 2003 0.53 ( 0.15, 1.86)
Overall 0.62 ( 0.27, 1.42)
Fibre from fruits, dose-response per 10 g/d
Relative Risk .3 .5 .75 1 1.5 2
Study Relative Risk (95% CI)
Nomura, 2007 0.93 ( 0.84, 1.03)
Schatzkin, 2007 1.04 ( 0.89, 1.21)
Wakai, 2007 0.71 ( 0.26, 1.91)
Bingham, 2005 0.78 ( 0.37, 1.64)
Lin, 2005 2.32 ( 0.35, 15.50)
Michels, 2005, HPFS 1.08 ( 0.83, 1.41)
Michels, 2005, NHS 1.10 ( 0.81, 1.51)
Mai, 2003 0.91 ( 0.48, 1.72)
Terry, 2001 3.15 ( 0.63, 15.64)
Overall 0.98 ( 0.91, 1.06)
Fibre from vegetables, dose-response per 10 g/d
Fibre from cereals, dose-response per 10 g/d
Relative Risk .3 .5 .75 1 1.5 2
Study Relative Risk (95% CI)
Nomura, 2007 0.95 ( 0.84, 1.07)
Schatzkin, 2007 0.79 ( 0.67, 0.93)
Bingham, 2005 0.85 ( 0.58, 1.24)
Lin, 2005 0.94 ( 0.28, 3.12)
Michels, 2005, NHS 0.88 ( 0.63, 1.24)
Michels, 2005, HPFS 0.86 ( 0.66, 1.13)
Mai, 2003 1.01 ( 0.63, 1.61)
Terry, 2001 1.02 ( 0.73, 1.43)
Overall 0.90 ( 0.83, 0.97)
Continuous Update Project Colorectal cancer report 2011 BMJ 2011;343:d6617 doi: 10.1136/bmj.d6617
Colorectal cancerFibre by food source
Continuous Update Project 2012Second Expert Report 2007
Pancreatic cancer
Pancreatic cancer
Alcohol (as ethanol)Fructose, dose-response per 25
g/day
Saturated fat, dose-response per 10 g/day
Endometrial cancer
Coffee, dose-response per 1 cup/day
Glycaemic load, dose-response per 50 units/day
Sitting time, highest compared to lowest
Endometrial cancer
Ovarian cancer
Ovarian cancer
BMI, dose-response per 5 units Height, dose-response per 5 cm
Breast Cancer Survivors Final report to be published 2014,
outcomes mortality (all cause & breast cancer) and second primary breast cancer.
Talk on Friday 3 October Poster
Continuous Update Project TeamDagfinn Aune; Snieguole Vingeliene; Deborah Navarro Rosenblatt; Teresa Norat; Doris Chan; Ana Rita Vieira, Leila Abar and Christophe Stevens (not in photo)
Darren Greenwood, University of Leeds, Statistical Advisor (not in photo)
Thanks!
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