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The Colorectal Cancer Working Group

Colorectal cancer (CRC) is a common cancer in both men and women. CRC incidence rates worldwide demonstrate a large degree of heterogeneity, suggesting the etiological involvement of modifiable dietary and lifestyle risk factors. Adoption of dietary and lifestyle habits that are protective of CRC development may have considerable public health impact in reducing CRC incidence and possibly enhancing survival after diagnosis. Thus, the main objective of the EPIC CRC Working Group is to investigate the dietary, lifestyle, genetic and metabolic risk factors for CRC, along with exploring their underlying mechanisms of action. As of the most recent end-point update, over 6000 CRC cases have accrued within the cohort.

The Working Group has explored the role of dietary patterns, individual food groups, specific foods and nutrients in CRC development. Findings from EPIC on the strong inverse risk association of adherence to healthy dietary patterns (e.g. the Mediterranean Diet, intake of foods with low inflammatory potential), and higher consumption of dietary fibres as well as the promoting effects of obesity, weight gain and higher intake of processed meats have all been important evidence towards public health guidelines for CRC prevention. The Working Group has also provided strong evidence on smoking and alcohol drinking in CRC development. The term "colorectal" brings together two anatomical sub-sites, namely the colon and rectum. Evidence generated by the Working Group suggests that they may have some heterogeneous risk factors.

The Working Group has also delved into the underlying mechanisms of these exposures, showing the CRC-promoting role of metabolic dysfunction (metabolic syndrome, hyperinsulinemia, hyperglycemia, dyslipidemia, inflammation, oxidative stress), low vitamin D status and gut barrier dysfunction; and has shown that the associations of dietary and lifestyle exposures are in part mediated via these mechanisms. The Working Group is developing considerable targeted and untargeted metabolomics data to explore metabolic pathways involved in CRC development.

EPIC also participates in several international consortia including the NCI Cohort Consortium, the Harvard Pooling Project and the Genetics and Epidemiology of Colorectal Cancer Consortium GECCO on CRC genetics, pooling together GWAS data from studies worldwide to explore genetic risk and susceptibility and gene-exposure interactions in CRC development as well as application of Mendelian Randomization methods for causal inference of CRC risk factors. The Working Group is currently developing new projects to explore the role of the microbiome, steroid hormones, infections and glycotoxins in CRC development and the association of modifiable risk factors with CRC survival post-diagnosis. There is also a growing emphasis on risk prediction.

Selected publications from > 100 papers from the Working Group:

Dietary and Lifestyle Patterns, Weight Change:
31945199, 25948112, 24225355, 22592101,
Genetic and Gene-exposure Interactions:
31027226, 19706842
Dietary Variables, Foods, Food Groups and Nutrients:
31252190, 27193442, 26077137, 25042282, 24993766, 24317181
Metabolic Factors:
31435679, 30585640, 27046222, 26823475, 26404963, 25713165, 25611809, 22926557, 21383385, 20093284
Anatomical Subsites and Reproductive History:
30056182, 20533550
Consortia and Pooling Projects, Mendelian R approaches:
29912394, 32001714, 31884074, 31866242, 30510241
Infections and Microbiome:
29377173
Mediation Analyses:
29025032, 28387787

Contact details/Working Group leaders

Marc Gunter, PhD
Section of Nutrition and Metabolism (NME)
International Agency for Research on Cancer (IARC/WHO)
25 avenue Tony Garnier
CS 90627
69366 LYON CEDEX 07
France


Mazda Jenab, PhD
Nutritional Epidemiology Group (NEP)
International Agency for Research on Cancer (IARC/WHO)
25 avenue Tony Garnier
CS 90627
69366 LYON CEDEX 07
France


Amanda Cross, PhD
Cancer Screening and Prevention Research Group
School of Public Health and the Department of Surgery and Cancer, Imperial College London
Norfolk Place, London, W2 1PG, United Kingdom