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’ 

NHS waiting times for elective and cancer treatment

National Audit Office | March 2019 | NHS waiting times for elective and cancer treatment

A new report from the National Audit Office (NAO) has found that waiting time standards continues to get worse for both elective (non-urgent care) and cancer treatment, and the waiting list for elective care continues to grow. The review- NHS waiting times for elective and cancer treatment– presents data on the NHS’s performance against current waiting times standards for elective and cancer care in England, and some of the factors associated with that performance. It collates existing evidence and analysis by the Department, NHS England, NHS Improvement and other stakeholders.

NAO build on this evidence base with their own analysis to provide additional insight into:

  • changes in waiting times performance, and variations in that performance;
  • the impact of waiting times performance on patients;
  • the factors that influence waiting times performance; and
  • NHS England’s and NHS Improvement’s approach to managing and improving waiting times performance

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ONS’ findings indicate that while increased demand and funding constraints affect the entire system, other factors that are linked to declining waiting time performance include NHS staff shortages for diagnostic services, a lack of available beds and pressure on trusts from emergency care.

The elective care waiting list grew from 2.7 million to 4.2 million between March 2013 and November 2018, while the number waiting more than 18 weeks grew from 153,000 to 528,000. During this period, the number of people treated each month increased from 1.2 million to 1.3 million.

A growing and ageing population only accounts for a relatively small proportion of the increase in referrals for elective care and cancer. For cancer, the major factor is likely to be NHS England’s policy of encouraging more urgent referrals to improve early cancer diagnosis. However, the reason behind the increase in elective referrals is less well understood by the NHS.

The plan also commits to increasing the proportion of patients diagnosed with cancer at early stages from 50% to 75% by 2028. The NHS is now preparing local implementation plans for these new commitments. It is hard to see how the NHS will be able to recover its position on waiting times in the near future without significant investment in staffing and infrastructure (Source: NAO).

Full details from NAO

Full report- NHS waiting times for elective and cancer treatment

Summary- NHS waiting times for elective and cancer treatment 

ePub- NHS waiting times for elective and cancer treatment

See also:

NAO Press release 

NHS waiting times for elective and cancer treatment

This report examines waiting time standards for elective and cancer treatment and factors associated with performance in meeting these standards | National Audit Office

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This review presents data on the NHS’s performance against current waiting times standards for elective and cancer care in England, and some of the factors associated with that performance. It draws together existing evidence and analysis by the Department, NHS England, NHS Improvement and other stakeholders. The National Audit Office builds on this evidence base with it’s own analysis to provide added insight into:

  • changes in waiting times performance, and variations in that performance;
  • the impact of waiting times performance on patients;
  • the factors that influence waiting times performance; and
  • NHS England’s and NHS Improvement’s approach to managing and improving waiting times performance.

The report concludes that while increased demand and funding constraints affect the entire system, other factors are linked with differences in performance both over time and across trusts. These include staff shortages for diagnostic services, a lack of available beds, inefficient processes and, in some cases, patient choices. The report calls for significant investment in staffing and infrastructure to meet new commitments outlined in the new NHS Long Term Plan.

See also: NHS must focus on routine care to tackle growing waiting lists, says spending watchdog | BMJ

Low levels of exercise are beneficial for adults

Even low levels of leisure-time physical activities are beneficial for adults, whilst doing more vigorous exercise has additional health benefits in terms of reducing mortality.  Authors call for the promotion of any amount and intensity of physical activity, to reduce mortality risk in the general population | British Journal of Sports Medicine

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Abstract
Background:  Evidence on the role of very low or very high volumes of leisure time physical activity (PA) on the risk of all-cause and cause-specific mortality is limited. We aimed to examine the associations of different levels of leisure time PA with the risk of all-cause, cardiovascular disease (CVD) and cancer-specific mortality.

Methods:  Data were from 12 waves of the National Health Interview Surveys (1997–2008) linked to the National Death Index records through 31 December 2011. A total of 88 140 eligible participants aged 40–85 years were included.

Results:  Compared with inactive individuals, those performing 10–59 min/week of PA had 18% lower risk of all-cause mortality. Those who reported 1–2 times (150–299 min/week) the recommended level of leisure time PA had 31% reduced risk of all-cause mortality. Importantly, the continued benefits were observed among those performing leisure time PA 10 or more times the recommended minimum level. In addition, there was a larger reduction in all-cause and cause-specific mortality for vigorous vs. moderate intensity PA.

Conclusions: We found that beneficial association between leisure time PA and mortality starts from a low dose. Doing more vigorous exercise could lead to additional health benefits.

Full abstract at British Journal of Sports Medicine

Full reference: Zhao M, Veeranki SP, Li S, et al | Beneficial associations of low and large doses of leisure time physical activity with all-cause, cardiovascular disease and cancer mortality: a national cohort study of 88,140 US adults | British Journal of Sports Medicine | Published Online First: 19 March 2019

See also: Even low amounts of exercise are beneficial | OnMedica

Government response to the Independent Breast Cancer Screening Review

Department of Health and Social Care | March 2019 | Government response to the Independent Breast Cancer Screening Review

The Independent Breast Screening Review looked into an incident in the breast screening programme in England, which resulted in thousands of women aged between 68 and 71 not being invited to their final breast screening. The review published its report in December 2018.

This document sets out the government’s response to each recommendation made in the report. The government has accepted all the recommendations.

Following publication of the report from the Independent Breast Screening Review on 13 December 2018 and the written ministerial statement that I made at the time, with the report the Department of Health and Social Care publish the Government’s substantive response to each of the 15 recommendations made in the report (Source: Department of Health and Social Care).

Full details are available from the Department of Health and Social Care