Martin Wiseman

World Cancer Research Fund International

University of Southampton, UK

Evidence-based recommendations for prevention of cancer and other chronic diseases

The 2007 and 2009 WCRF/AICR Reports

IUNS, Granada, 2013

www.wcrf.org/ICN2013

Who we are What we do

AICR

WCRF UK

WCRF Netherlands

WCRF Hong Kong

WCRF International

Fund research on the relationship of nutrition, physical activity and body weight to cancer risk

Interpret the accumulated scientific literature to derive Recommendations for Cancer Prevention

Educate people through our national Health Information programmes

Advocate effective policies to help people and populations to reduce their chances of developing cancer

Data from Parkin et al, Pisani et al, Globocan 2008, IARC

*Estimated new cases for 2030 from predictions in 2002

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

USA UK BRAZIL CHINA

Mouth, pharynx, larynx

63 67 63 44

Oesophagus 69 75 60 44

Lung 36 33 36 38

Stomach 47 45 41 33

Pancreas 19 15 11 8

Gallbladder 21 16 10 6

Liver 15 17 6 6

Colorectum 50 47 41 22

Breast 38 42 28 20

Endometrium 59 44 37 25

Prostate 11 20 N/A N/A

Kidney 24 19 13 8

Total for these cancers

35 37 29 27

Total for all cancers

24 27 19 22

Global variation in cancer incidence and impact of migration

Breast

Colorectum

Environment is a key determinant

of cancer patterns

Why nutrition?

Epidemiology links food, nutrition and physical activity to cancer

Experimental evidence links nutrition and cancer

1. New method

2. Systematic reviews

3. Review of evidence separate from judgement

4. Panel of international experts

5. Predetermined criteria for judgementsEpidemiology

Mechanisms

6. Flexibility

7. Continuous update of evidence

WCRF/AICR EXPERT REPORT The most authoritative

NUTRITION AND CANCERS

OBESITYBREAST (PM), COLORECTUM, ENDOMETRIUM, OESOPHAGUS,

PANCREAS, GALLBLADDER, KIDNEY

PHYSICAL ACTIVITYCOLON, BREAST, OBESITY

MEAT – RED AND PROCESSEDCOLORECTAL

PLANT FOODSMPL, OESOPHAGUS, STOMACH,) COLORECTAL, LUNG, OBESITY

ALCOHOL MPL, COLORECTUM, LIVER, BREAST

SALTSTOMACH

BREASTFEEDINGBREAST, EXCESS WEIGHT GAIN (CHILD)

The Panel emphasises the importance of not smoking and of avoiding exposure to tobacco smoke

• Keep evidence, conclusions and recommendations updated into the future• Working with team at ICL• Same principles: - Systematically review evidence- Meta analysis - Panel of experts

-draw conclusions -make recommendations

Continuous Update Project (CUP)

Novel aspects of CUP

1. Breast Cancer Survivors

2. Mechanisms

Cancer prevention

What to do…?

What determines people’s behaviour?

How to change it?

Behaviour

• People behave like those around them– social norms

• Asking people to behave very differently from their social norm only has limited or unsustained effect

• Personal choice determines individual variation around the social norm– small effect

• External factors determine social norms– big effect

Everybody has a role to play

Action needs to be coherent

Leadership from

Government

Health professionals

ConclusionsThe WCRF/AICR Expert Reports, and the CUP, are the

most rigorous and authoritative reviews available.They conclude that

• Cancer is a major cause of death, disability and lost life years

• Cancer is mostly environmentally determined and largely preventable

• With smoking, food, nutrition, body fatness and physical activity are the most important factors affecting cancer risk

• Evidence to support this comes from many different sources

• Preventing cancer through food, nutrition and physical activity will also prevent other major chronic diseases

• Changes are needed in people’s environment as well as in personal choices

www.dietandcancerreport.org/CUP

www.wcrf.org/ICN2013