EPIC Working Groups - Cancer Working Groups

The Colorectal Cancer Working Group

Colorectal cancer (CRC), which consists of cancers of the colon and rectum, is one of the most common cancers in terms of incidence and mortality worldwide. Several lines of evidence, including a 25-fold worldwide variation in CRC incidence rates and results from migration studies, implicate dietary and lifestyle factors as central to CRC etiology. Thus, changes in these habits aimed at preventing CRC may have a strong public health impact in reducing overall incidence of this disease.

Much research has been conducted within the EPIC CRC Working Group to explore associations with dietary and lifestyle factors using the detailed dietary and lifestyle data of EPIC along with biological samples for biomarker and genetic analyses. These studies suggest a multifactorial etiology with compelling evidence for a strong promotive or predisposing role of obesity [1–6], metabolic syndrome [7] and its associated factors, namely hyperinsulinaemia [8,9], hyperglycaemia [10], dyslipidaemia [11], inflammation [12], and oxidative stress [13]. These factors appear to be, in large part, metabolic consequences of dietary habits characterized by high intakes of red/processed meats [14] and low intakes of dietary fibre [15,16] (particularly cereal fibres [17]), fish [14], nuts, seeds [18], and fruits and vegetables [19].

The Working Group has also identified smoking, heavy alcohol consumption, and low body vitamin D levels as important CRC risk factors [20–22]. Certain dietary and lifestyle patterns, such as adherence to a Mediterranean diet [23] and to the cancer prevention recommendations of the World Cancer Research Fund [24], have also been shown to be associated with reduced CRC risk.

The Working Group is currently focused on studies exploring the role of gut barrier function, advanced glycation end-products, inflammatory and obesity biomarkers, as well as genetic susceptibility and gene—nutrient interactions in determination of CRC risk.


Selected publications:

  1. Pischon T et al. Body size and risk of colon and rectal cancer in the European Prospective Investigation Into Cancer and Nutrition (EPIC). J Natl Cancer Inst. 2006 Jul 5;98(13):920-31. PMID: 16818856

  2. Aleksandrova K et al. Total and high-molecular weight adiponectin and risk of colorectal cancer: the European Prospective Investigation into Cancer and Nutrition Study. Carcinogenesis. 2012 Jun;33(6):1211-8. PMID: 22431719

  3. Aleksandrova K et al. Leptin and soluble leptin receptor in risk of colorectal cancer in the European Prospective Investigation into Cancer and Nutrition cohort. Cancer Res. 2012 Oct 15;72(20):5328-37. PMID: 22926557

  4. Aleksandrova K et al. Adiposity, mediating biomarkers and risk of colon cancer in the European prospective investigation into cancer and nutrition study. Int J Cancer. 2014 Feb 1;134(3):612-21. PMID: 23824948

  5. Aleksandrova K et al. Adult weight change and risk of colorectal cancer in the European Prospective Investigation into Cancer and Nutrition. Eur J Cancer. 2013 Nov;49(16):3526-36. PMID: 23867126

  6. Steins Bisschop CN et al. Weight change later in life and colon and rectal cancer risk in participants in the EPIC-PANACEA study. Am J Clin Nutr. 2014 Jan;99(1):139-47. PMID: 24225355

  7. Aleksandrova K et al. Metabolic syndrome and risks of colon and rectal cancer: the European prospective investigation into cancer and nutrition study. Cancer Prev Res (Phila). 2011 Nov;4(11):1873-83. PMID: 21697276

  8. Jenab M et al. Serum C-peptide, IGFBP-1 and IGFBP-2 and risk of colon and rectal cancers in the European Prospective Investigation into Cancer and Nutrition. Int J Cancer. 2007 Jul 15;121(2):368-76. PMID: 17372899

  9. Rinaldi S et al. Serum levels of IGF-I, IGFBP-3 and colorectal cancer risk: results from the EPIC cohort, plus a meta-analysis of prospective studies. Int J Cancer. 2010 Apr 1;126(7):1702-15. PMID: 19810099

  10. Rinaldi S et al. Glycosylated hemoglobin and risk of colorectal cancer in men and women, the European prospective investigation into cancer and nutrition. Cancer Epidemiol Biomarkers Prev. 2008 Nov;17(11):3108-15. PMID: 18990751

  11. van Duijnhoven FJ et al. Blood lipid and lipoprotein concentrations and colorectal cancer risk in the European Prospective Investigation into Cancer and Nutrition. Gut. 2011 Aug;60(8):1094-102. PMID: 21383385

  12. Aleksandrova K et al. Circulating C-reactive protein concentrations and risks of colon and rectal cancer: a nested case-control study within the European Prospective Investigation into Cancer and Nutrition. Am J Epidemiol. 2010 Aug 15;172(4):407-18. PMID: 20634278

  13. Leufkens AM et al. Biomarkers of oxidative stress and risk of developing colorectal cancer: a cohort-nested case-control study in the European Prospective Investigation Into Cancer and Nutrition. Am J Epidemiol. 2012 Apr 1;175(7):653-63. PMID: 22422922

  14. Norat T et al. Meat, fish, and colorectal cancer risk: the European Prospective Investigation into cancer and nutrition. J Natl Cancer Inst. 2005 Jun 15;97(12):906-16. PMID: 15956652

  15. Bingham SA et al. Dietary fibre in food and protection against colorectal cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC). Lancet. 2003 May 3;361(9368):1496-501. PMID: 12737858

  16. Murphy N et al. Dietary fibre intake and risks of cancers of the colon and rectum in the European prospective investigation into cancer and nutrition (EPIC). PLoS One. 2012;7(6):e39361. PMID: 22761771

  17. Kyrø C et al. Plasma alkylresorcinols, biomarkers of whole-grain wheat and rye intake, and incidence of colorectal cancer. J Natl Cancer Inst. 2014 Jan;106(1):djt352. PMID: 24317181

  18. Jenab M et al. Association of nut and seed intake with colorectal cancer risk in the European Prospective Investigation into Cancer and Nutrition. Cancer Epidemiol Biomarkers Prev. 2004 Oct;13(10):1595-603. PMID: 15466975

  19. van Duijnhoven FJ et al. Fruit, vegetables, and colorectal cancer risk: the European Prospective Investigation into Cancer and Nutrition. Am J Clin Nutr. 2009 May;89(5):1441-52. PMID: 19339391

  20. Ferrari P et al. Lifetime and baseline alcohol intake and risk of colon and rectal cancers in the European prospective investigation into cancer and nutrition (EPIC). Int J Cancer. 2007 Nov 1;121(9):2065-72. PMID: 17640039

  21. Jenab M et al. Association between pre-diagnostic circulating vitamin D concentration and risk of colorectal cancer in European populations:a nested case-control study. BMJ. 2010 Jan 21;340:b5500. PMID: 20093284

  22. Leufkens AM et al. Cigarette smoking and colorectal cancer risk in the European Prospective Investigation into Cancer and Nutrition study. Clin Gastroenterol Hepatol. 2011 Feb;9(2):137-44. PMID: 21029790

  23. Bamia C et al. Mediterranean diet and colorectal cancer risk: results from a European cohort. Eur J Epidemiol. 2013 Apr;28(4):317-28. PMID: 23579425

  24. Romaguera D et al. Is concordance with World Cancer Research Fund/American Institute for Cancer Research guidelines for cancer prevention related to subsequent risk of cancer? Results from the EPIC study. Am J Clin Nutr. 2012 Jul;96(1):150-63. PMID: 22592101

Contact details/Working Group leaders

Elio Riboli, M.D., D.Sc., M.P.H.
Director, School of Public Health,
Head, Division of Epidemiology, Public Health and Primary Care, Faculty of Medicine,
Imperial College London, St Mary's Campus, Norfolk Place, Paddington, London W2 1PG, United Kingdom


Mazda Jenab, PhD
Nutritional Epidemiology Group (NEP)
International Agency for Research on Cancer (IARC/WHO)
150 cours Albert Thomas, 69008 Lyon, France