2. Managing normal population risk
Managing those at increased risk of colorectal cancer.

3. Managing normal population risk
Managing those at increased risk of colorectal cancer.

4. What is the NZ situation?
3000 diagnoses per year
1200 deaths per year

6. Commonest cancer diagnosis in nz. 2nd leading cause of cancer death
Commonest cancer diagnosis in nz. 2nd leading cause of cancer death. >3000 cases per year deaths per yr.

7. Lifetime 1:16 (6%)

8. Family history of colorectal cancer
Three main risk groups
Risk group
Increase in risk
Slight increase
≤ 2 x
Moderate increase
3 – 6 x
High risk
> 50% risk of CRC

9. ? Managing normal population risk
Managing those at increased risk of colorectal cancer.

12. 4 dose–response variables examined
Daily consumption (RR = 1.38 for an increase of 40 cigarettes/day)
Duration (RR = 1.20 for an increase of 40 years of duration)
Pack-years (RR = 1.51 for an increase of 60 pack-years)
Age of initiation (RR = 0.96 for delay of 10 years in smoking initiation)

15. Criteria for evidence – ‘Convincing’
Evidence from more than one study type
Evidence from at least two independent cohort studies
Good quality studies
Presence of plausible biological gradient (‘dose response’)
Strong and plausible experimental that typical human exposures can lead to relevant cancer outcomes.

19. Physical activity

24. Exposure RR
High-risk
Low-risk
Foods containing fibre
1.14
<10g/day
≥30g/day
Red meat
1.17
≥80g/day
Processed meat
1.42
Alcoholic drinks
1.27
≥20g/day
Physical activity
1.33
≥150mins/week
Body fatness
1.22
BMI ≥30
BMI<25

25. WHO cut-offs and risk of metabolic complications
Indicator
Male
Female
Risk of metbolic complications
Waist circumference
>94cm
>80cm
Increased
>102cm
>88cm
Substantially increased
Waist:hip ratio
≥0.90
≥0.85

28. 400 g of dairy products consumed daily
RR 0.83
daily consumption of 200g of milk or 50 g of cheese associated with a lower risk
Every 300 mg of daily calcium intake (one cup of milk) – 8-9% RRR

32. Round 1 and 2 results (1st January 2012 to 30th September 2015)
‘A bowel screening programme has the potential to reduce deaths from bowel cancer by at least 20% (after 8 to 10 years) in the population offered screening.’
NZ in 2011
960 by 2025 ?

33. Body fatness

34. Physical activity

35. Plant foods

36. Animal foods

37. Alcoholic drinks