Abstract P3-10-06: What is the latest evidence on diet, nutrition, physical activity and cancer – key findings from the WCRF/AICR continuous update project

Introduction:

Since 1997, World Cancer Research Fund (WCRF) International and the American Institute for Cancer Research (AICR) have been at the forefront of synthesizing and interpreting the accumulated scientific literature on the link between diet, nutrition, physical activity and cancer, and deriving evidence-based Cancer Prevention Recommendations. The 2007 WCRF/AICR 2nd Expert Report, using a robust method and systematic literature reviews, was a landmark in the analysis of evidence linking diet, body weight and physical activity to cancer and led to the establishment of the Continuous Update Project (CUP). New findings from the CUP systematic review have been released for 12 cancers, and updated findings for breast cancer have just been released. The 2018 WCRF/AICR 3rd Expert Report, to be published in 2018, will include a new review of the WCRF/AICR Cancer Prevention Recommendations.

Methods:

The review was conducted as part of the Continuous Update Project (CUP).

The research team at Imperial College London searched PubMed for relevant prospective studies up to April 30, 2015.

Dose-response meta-analyses were conducted and summary relative risks (RR) were calculated using a random effects model. Analyses comparing the highest versus the lower categories were also conducted. An international panel of experts (CUP Panel) reviewed the evidence and drew conclusions.

Results:

The updated Breast Cancer Report included 119 studies from around the world, comprising more than 12 million women and over 260,000 cases of breast cancer.

The latest evidence suggests that vigorous physical exercise reduces your risk of breast cancer before menopause by 17%. In addition, the report reconfirms the link between physical activity and decreased risk of breast cancer after menopause. Taking at least 30 minutes of moderate physical activity, such as brisk walking, or 15 minutes of vigorous physical activity each day can reduce your risk of breast cancer after menopause by 10%.

Greater body fatness and weight gain as an adult does increase the risk of breast cancer after menopause. However, in contrast we observed greater body fatness in young adulthood may reduce breast cancer risk both before and after menopause.

The report found strong evidence that drinking just the equivalent of a small glass of wine or half a pint of beer a day (about 10g alcohol content), could increase your pre-menopausal breast cancer risk by 5% and your post-menopausal breast cancer risk by 9%.

Conclusions:

Recent evidence has resulted in new findings and changes to the CUP Panel's conclusions from the 2010 Breast Cancer Report with regard to physical activity and body fatness at different life periods. In addition, new evidence confirmed their judgements on alcohol.

The CUP provides a unique resource synthesizing epidemiological and other evidence on diet, nutrition, physical activity and cancer, to facilitate related research, and underpin advice to the public and policy-makers.

Evidence is accumulating that the degree of adherence to WCRF/AICR recommendations is associated with lower mortality of cancer overall, of specific cancers and of all-cause mortality.

Citation Format: Thune I, Allen K, Thompson RL, Wiseman MJ, Mitrou P, McGinley-Gieser D. What is the latest evidence on diet, nutrition, physical activity and cancer – key findings from the WCRF/AICR continuous update project [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-10-06.

Kinematic Gait Analysis of the Trot in Healthy Mixed Breed Dogs

Computer aided kinematic and synchronized force plate gait analysis were used to characterize joint movement in 14 large mixed breed dogs at a trot. A curvilinear relationship of joint angle to time was described, for three forelimb and three hindlimb joints. Two peaks of maximum extension, one preceding the onset and at the end of stance phase were observed for the femorotibial, tarsus and cubital joints. The carpus, scapulohumeral and coxofemoral joint exhibited one peak of maximum extension. The variance in joint angle measurement was calculated for repeated trials for a given dog and for differences between dogs using a 2-factor repeated measures ANOVA. The mean variance for all joints except the carpal joint for trial repetition was 12.6 (degrees)2 (range, 2.6-23.9) and for differences between dogs 6.2 (degrees)2 (range, 1.0-11.3). The carpal joint exhibited greater variation with a mean variance, attributable to trial repetition, of 42.5 (degrees)2 (range, 39.4-44.3) and a variance between dogs of 52.4 (degrees)2 (range, 18.5-89.4).

The results obtained would suggest that computer assisted kinematics is an accurate means of assessing joint angle movement in large mixed breed dogs with a low level of variance attributable to trial repetition and to differences between dogs, with the exception of the carpal joint. The sample of mixed breed dogs in this study is similar to dogs that would be seen in a clinical sample population. Our results suggest that computer assisted kinematics could be an important tool in providing objective information on gait, in clinical and research studies, using mixed breed dogs.

This study describes the trot in 14 large mixed breed dogs using computer aided kinematic and force plate gait analysis techniques. Variances in fore and hindlimb joint angle measurements were deter-mined, for a given dog, by repeated trials and for differences between dogs. The measured variances were low in all joints except the corpus, despite diverse dog conformation in the study.

The association between higher maternal pre-pregnancy body mass index and increased birth weight, adiposity and inflammation in the newborn

BACKGROUND

Excess adiposity and adiposity-related inflammation are known risk factors for cardiovascular disease in adults; however, little is known regarding the determinants of adiposity-related inflammation at birth.

OBJECTIVES

The aim of this study was to investigate the association between maternal pre-pregnancy BMI and newborn adiposity and inflammation.

METHODS

Paired maternal (28-week gestation) and infant (umbilical cord) blood samples were collected from a population-derived birth cohort (Barwon Infant Study, n = 1074). Data on maternal comorbidities and infant birth anthropomorphic measures were compiled, and infant aortic intima-media thickness was measured by trans-abdominal ultrasound. In a selected subgroup of term infants (n = 161), matched maternal and cord lipids, high-sensitivity C-reactive protein (hsCRP) and maternal soluble CD14 were measured. Analysis was completed by using pairwise correlation and linear regression. Because of their non-normal distribution, pathology blood measures were log transformed prior to analysis.

RESULTS

Maternal pre-pregnancy BMI was positively associated with increased birth weight (mean difference 17.8 g per kg m^-2 , 95% CI 6.6 to 28.9; p = 0.002), newborn mean skin-fold thickness (mean difference 0.1 mm per kg m^-2 , 95% CI 0.0 to 0.1; p < 0.001) and cord blood hsCRP (mean difference of 4.2% increase in hsCRP per kg m^-2 increase in pre-pregnancy BMI, 95% CI 0.6 to 7.7%, p = 0.02), but not cord blood soluble CD14. Inclusion of maternal hsCRP as a covariate attenuated the associations between pre-pregnancy BMI and both newborn skin-fold thickness and cord blood hsCRP.

CONCLUSION

Higher maternal pre-pregnancy BMI is associated with increased newborn adiposity and inflammation. These associations may be partially mediated by maternal inflammation during pregnancy.

A randomised controlled trial of three psychological treatments for anorexia nervosa

BACKGROUND

There is a lack of evidence pointing to the efficacy of any specific psychotherapy for adults with anorexia nervosa (AN). The aim of this study was to compare three psychological treatments for AN: Specialist Supportive Clinical Management, Maudsley Model Anorexia Nervosa Treatment for Adults and Enhanced Cognitive Behavioural Therapy.

METHOD

A multi-centre randomised controlled trial was conducted with outcomes assessed at pre-, mid- and post-treatment, and 6- and 12-month follow-up by researchers blind to treatment allocation. All analyses were intention-to-treat. One hundred and twenty individuals meeting diagnostic criteria for AN were recruited from outpatient treatment settings in three Australian cities and offered 25-40 sessions over a 10-month period. Primary outcomes were body mass index (BMI) and eating disorder psychopathology. Secondary outcomes included depression, anxiety, stress and psychosocial impairment.

RESULTS

Treatment was completed by 60% of participants and 52.5% of the total sample completed 12-month follow-up. Completion rates did not differ between treatments. There were no significant differences between treatments on continuous outcomes; all resulted in clinically significant improvements in BMI, eating disorder psychopathology, general psychopathology and psychosocial impairment that were maintained over follow-up. There were no significant differences between treatments with regard to the achievement of a healthy weight (mean = 50%) or remission (mean = 28.3%) at 12-month follow-up.

CONCLUSION

The findings add to the evidence base for these three psychological treatments for adults with AN, but the results underscore the need for continued efforts to improve outpatient treatments for this disorder. Trial Registration Australian New Zealand Clinical Trials Registry (ACTRN 12611000725965) http://www.anzctr.org.au/.

Examining the psychological and social impact of relative age in primary school children: a cross-sectional survey

BACKGROUND

A number of studies demonstrate that children who are younger within their school year have poorer academic attainment and are more likely to have special educational needs. Few, however, have considered the impact relative age may have on child mental health, behaviour and happiness in school.

METHODS

This paper utilized data from the Supporting Teachers and Children in Schools study (2075 pupils aged 5 to 9 years from 80 primary schools) to explore the relationship among relative age, behaviour and happiness in school. Behavioural and emotional development was assessed by using the teacher-reported and parent-reported Strengths and Difficulties Questionnaire and the Pupil Behaviour Questionnaire. Children's happiness within school was assessed by using the How I Feel About My School Questionnaire.

RESULTS

Relatively younger children had higher Total Difficulties scores on the Strengths and Difficulties Questionnaire than their peers. There was a mean increase per 30-day decrease in relative age of 0.09 (95% CI: 0.03 to 0.16; p = 0.007) in teacher-reported and 0.08 (0.001 to 0.16; p = 0.05) in parent-reported scores. There was little evidence of a relationship between relative age and children's behaviour and happiness in school.

CONCLUSIONS

For children with complex difficulties, being relatively young for their school year may be an additional stressor that may undermine mental health.

Novel outreach settings to enhance sexually transmitted infection/HIV awareness, diagnosis and treatment in hard-to-reach populations

Despite recent rises in the number of cases of sexually transmitted infections (STIs) such as syphilis and gonorrhoea in England and increasing rates of HIV diagnosis among several men who have sex with men populations, many individuals are still not engaging with sexual health services. The John Hunter Clinic for Sexual Health, Chelsea and Westminster Hospital, London set up outreach clinics at the two world's largest adult lifestyle exhibitions in 2013 and 2015. This was the first time that a sexual health screening and promotion service was available at these large-scale (over 10,000 attendees at each) adult lifestyle events. A total of 381 individuals underwent STI screening across the two events. Nineteen (5.0%) patients were diagnosed with an infection. Twelve (3.1%) patients with Chlamydia trachomatis, three (0.8%) patients with syphilis, one (0.3%) patient with Neisseria gonorrhoeae, one (0.3%) patient with HIV, one (0.3%) patient with hepatitis B and one (0.3%) patient with hepatitis C. All 19 patients were promptly contacted with their results and had arrangements made for treatment or were referred for specialist follow up. Where possible, contact tracing was also performed. Implementing such outreach-based projects is challenged by lack of on-site laboratory support, high staffing demands and potentially high costs. However, we achieved a total HIV screening uptake rate of 94.5% amongst our outreach clinic attendees (versus 67% nationally in conventional sexual health clinic attendees) with an HIV positivity rate of 0.3% (versus 0.2% nationally in high HIV prevalence band populations). Additionally, 30.7% had never been tested for HIV previously (versus 20.7% nationally). Our work demonstrates that these strategies can help to address issues related to lack of STI/HIV screening in hard-to-reach populations and promote risk reduction behaviour.

Winning margins in British Thoroughbred racehorses

In human sporting events the difference between finishing first and second is often less than 1%. For each sporting discipline it is important to know how large an enhancement of performance needs to be before it makes a difference to the medal winning prospects of that athlete. In contrast to the known winning margins in many human sporting disciplines, the winning margins in horse racing are unknown. The winning margins for group 1, 2 and 3 flat and national hunt races over a 5 year period were calculated. For flat races 3 categories were included: (1) flat races of 6 furlongs; (2) 1 mile; or (3) 1 mile 4 furlongs1. For national hunt 2 categories were included: (1) hurdle races over 2 miles; or (2) chase races over 3 miles. Race times from a total of 416 races were included (275 flat races and 141 national hunt races). Overall the percentage difference between first place and second place was only 0.32%, the difference between coming first and third was 0.75% and between first and fourth was 1.15%. Overall, the winning margins between first place and second place were closer for flat races than for national hunt races. When a 1% improvement was applied to the fourth placed horse this would result in the winning time in 76% of flat races and 50% of national hunt races. This study shows the very small margins between winning and placing in horseracing. These results are similar to those of elite human sporting disciplines. This suggests that training strategies and veterinary interventions that result in a small percentage improvement in performance may translate to a meaningful difference in terms of winning/placing.

Abstract P3-13-08: A prospective, single-arm, multi-site, clinical evaluation of the SAVI SCOUT® surgical guidance system for the location of non-palpable breast lesions during excision

Background and Objectives: The standard preoperative technique for localizing non-palpable breast lesions is wire localization (WL). Radioactive seed localization (RSL) is an alternative approach that addresses a number of clear disadvantages associated with WL but, the adoption of RSL has been impacted by considerable regulatory requirements for the handling of radioactive materials. To advance the progress made with RSL and eliminate issues associated with radioactive components, the SAVI SCOUT® surgical guidance system was developed. SAVI SCOUT is an FDA-cleared medical device that utilizes non-radioactive electromagnetic wave technology to provide real-time guidance during excisional breast procedures. The purpose of this study is to evaluate the performance of SAVI SCOUT in guiding the removal of non-palpable breast lesions.

Methods: Following a 50 patient pilot study that showed SAVI SCOUT to be safe and effective, IRB approval was granted for this prospective, single-arm, multi-site study for women with a non-palpable breast lesion. Pts underwent localization and excision with the SAVI SCOUT system, which consists of an electromagnetic wave reflective device (reflector), handpiece and console. Using mammographic or ultrasound guidance, the reflector was implanted into the target tissue. Before making an incision, the surgeon used the handpiece, which emits electromagnetic waves and infrared light, to detect the location of the reflector and subsequently plan the surgical incision. During the procedure, the surgeon used the handpiece to guide the localization and removal of the reflector along with the surrounding breast tissue. The console provides audible feedback of reflector proximity to the handpiece. Successful reflector placement, localization and retrieval were the primary endpoints.

Results: A total of 61 pts have participated in the study to date, along with 7 surgeons and 9 radiologists across 6 institutions. The reflectors were successfully placed in all pts, including 27 under mammographic guidance and 34 under ultrasound guidance. In 28 cases, the reflectors were placed on the same day as surgery. Otherwise, the reflectors were placed up to 7 days (average 2.9 days) before surgery. Thirteen pts underwent excisional biopsy and 48 pts had a lumpectomy. The intended lesion and reflector were successfully removed in all pts. Reflector migration did not occur and no adverse events occurred. Final pathology is currently available for 52 pts: 8/10 excisional biopsy pts had no invasive or in situ carcinoma identified. For pts with cancer and complete data, 39/39 had clear margins, but one patient was recommended for re-excision due to a close margin (1 mm) for DCIS.

Conclusions: The preliminary data from this prospective, multi-site study show that real-time surgical guidance with SAVI SCOUT is an accurate technique for directing the removal of non-palpable breast lesions and is reproducible at multiple clinical sites. At present, the study has yielded 100% surgical success with a re-excision rate of 3.0%. Ongoing accrual to this clinical evaluation study will validate these findings with planned enrollment of 150 pts at up to 15 total sites.

Citation Format: Cox CE, Prati R, Blumencranz P, Allen K, Banull C, Cline M, Howard T, Portillo M, Whitworth P, Funk K, Police A, Lin E, Combs F, Anglin B, King J, Shivers SC. A prospective, single-arm, multi-site, clinical evaluation of the SAVI SCOUT® surgical guidance system for the location of non-palpable breast lesions during excision. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-13-08.

Disparities in osteoporosis treatments

Osteoporosis treatment rates within 2 years following an index event (fragility fracture, osteoporotic bone mineral density (BMD) T-score, or osteoporosis ICD-9 codes) were determined from 2005 to 2011. Most patients were not treated. Fracture patients had the lowest treatment rate. Low treatment rates also occurred in patients that were male, black, or had non-commercial insurance.

INTRODUCTION

Clinical recognition of osteoporosis (osteoporotic BMD, assignment of an ICD-9 code, or the occurrence of fragility fractures) provides opportunities to treat patients at risk for future fracture.

METHODS

A cohort of 36,965 patients was identified from 2005 to 2011 in the Indiana Health Information Exchange, with index events after age 50 of either non-traumatic fractures, an osteoporosis ICD-9 code, or a BMD T-score ≤ -2.5. Patients with osteoporosis treatment in the preceding year were excluded. Medication records during the ensuing 2 years were extracted to identify osteoporosis treatments, demographics, comorbidities, and co-medications. Predictors of treatment were evaluated in a multivariable logistic regression model.

RESULTS

The cohort was 78 % female, 11 % black, 91 % urban-dwelling, and 53 % commercially insured. The index events were as follows: osteoporosis diagnosis (47 % of patients), fragility fracture (44 %), and osteoporotic T-scores (9 %). Within 2 years after the index event, 23.3 % received osteoporosis medications (of which, 82.2 % were oral bisphosphonates). Treatment rates were higher after osteoporosis diagnosis codes (29.3 %) or osteoporotic T-score (53.9 %) than after fracture index events (10.5 %) (p < 0.001). Age had an inverted U-shaped effect for women with highest odds around 60-65 years. Women (OR 1.86) and non-black patients (OR 1.52) were more likely to be treated (p < 0.001). Patients with public (versus commercial) insurance (OR 0.86, p < 0.001) or chronic comorbidities (ORs about 0.7-0.9, p < 0.001) were less likely to be treated.

CONCLUSION

Most osteoporosis treatment candidates remained untreated. Men, black patients, and patients with fracture or chronic comorbidities were less likely to receive treatment, representing disparity in the recognition and treatment of osteoporosis.