1 British Journal of Cancer 2009 Vol: 101(1):192-197. DOI: 10.1038/sj.bjc.6605098

Cancer incidence in British vegetarians

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References
  1. Alexander DD, Mink PJ, Adami HO, Chang ET, Cole P, Mandel JS, Trichopoulos DThe non-Hodgkin lymphomas: a review of the epidemiologic literature. Int J Cancer 120(Suppl 12): 1-39 , (2007) .
    • . . . Previous research has suggested inconsistently that consumption of meat and/or exposure to live animals and raw meat among farmers and butchers might be associated with an increased risk for some of these cancers (Zhang et al, 1999; Alexander et al, 2007) . . .
  2. Appleby PN, Thorogood M, Mann JI, Key TJThe Oxford Vegetarian Study: an overview. Am J Clin Nutr 70(3 Suppl): 525S-531S , (1999) .
    • . . . To provide more information on cancer incidence in vegetarians, in this study, we report on the incidence of malignant cancer at 20 sites or groups of sites, plus all incident malignant cancers combined, in a pooled analysis of data from two prospective studies in the United Kingdom, namely the Oxford Vegetarian Study (Appleby et al, 1999) and the EPIC-Oxford cohort (Davey et al, 2003). . . .
  3. Chan JM, Gann PH, Giovannucci ELRole of diet in prostate cancer development and progression. J Clin Oncol 23: 8152-8160 , (2005) .
    • . . . The role of diet in the aetiology of prostate cancer is poorly understood; there is some evidence that high intakes of dairy products might be associated with an increase in risk (Chan et al, 2005), but to explore this hypothesis further in our data we would need to examine the cancer rates among vegans, among whom there are currently too few cancers to be informative. . . .
  4. Cross AJ, Lim UThe role of dietary factors in the epidemiology of non-Hodgkin's lymphoma. Leuk Lymphoma 47: 2477-2487 , (2006) .
    • . . . Potential mechanisms could include mutagenic compounds and viruses (Cross and Lim, 2006; Alexander et al, 2007). . . .
  5. Cross AJ, Leitzmann MF, Gail MH, Hollenbeck AR, Schatzkin A, Sinha RA prospective study of red and processed meat intake in relation to cancer risk. PLoS Med 4: 1973-1984 , (2007) .
    • . . . In the largest single prospective study on this relationship, Cross et al (2007) reported that the risk for colorectal cancer was increased by 20% at moderate red meat intakes (equivalent to ~86 g per day in men and ~44 g per day in women) . . .
  6. Davey GK, Spencer EA, Appleby PN, Allen NE, Knox KH, Key TJEPIC-Oxford: lifestyle characteristics and nutrient intakes in a cohort of 33 883 meat-eaters and 31 546 non meat-eaters in the UK. Public Health Nutr 6: 259-269 , (2003) .
    • . . . To provide more information on cancer incidence in vegetarians, in this study, we report on the incidence of malignant cancer at 20 sites or groups of sites, plus all incident malignant cancers combined, in a pooled analysis of data from two prospective studies in the United Kingdom, namely the Oxford Vegetarian Study (Appleby et al, 1999) and the EPIC-Oxford cohort (Davey et al, 2003). . . .
    • . . . The EPIC-Oxford cohort was recruited throughout the United Kingdom between 1993 and 1999 (Davey et al, 2003) . . .
  7. Forman D, Burley VJGastric cancer: global pattern of the disease and an overview of environmental risk factors. Best Pract Res Clin Gastroenterol 20: 633-649 , (2006) .
    • . . . Previous research has suggested that processed meat may increase the risk for stomach cancer, perhaps due to the presence of N-nitroso compounds (Forman and Burley, 2006) . . .
  8. Fraser GEAssociations between diet and cancer, ischemic heart disease, and all-cause mortality in non-Hispanic white California Seventh-day Adventists. Am J Clin Nutr 70(3 Suppl): 532S-538S , (1999) .
    • . . . Some findings on cancer incidence rates in vegetarians have been reported from the Adventist Health Study in California (Fraser, 1999), the Oxford Vegetarian Study (Sanjoaquin et al, 2004), the UK Women's Cohort Study (Taylor et al, 2007) and EPIC-Oxford (Key et al, 2009) . . .
    • . . . In the Adventist Health Study in California, vegetarians had a significantly lower risk for cancers of the colon and prostate than non-vegetarians, but the risk for breast cancer did not differ significantly between these dietary groups (Fraser, 1999) . . .
    • . . . In the Adventist Health Study, a lower risk for colon cancer was observed among vegetarians compared with non-vegetarians (rectal cancer was not reported; Fraser, 1999) . . .
  9. García-Closas R, Castellsagué X, Bosch X, González CAThe role of diet and nutrition in cervical carcinogenesis: a review of recent evidence. Int J Cancer 117: 629-637 , (2005) .
    • . . . Dietary factors have been suspected of influencing risk, but no firm conclusions have been drawn (García-Closas et al, 2005) . . .
  10. Key TJ, Fraser GE, Thorogood M, Appleby PN, Beral V, Reeves G, Burr ML, Chang-Claude J, Frentzel-Beyme R, Kuzma JW, Mann J, McPherson KMortality in vegetarians and non-vegetarians: detailed findings from a collaborative analysis of 5 prospective studies. Am J Clin Nutr 70(3 Suppl): 516S-524S , (1999) .
    • . . . In our pooled analysis of mortality in five prospective studies, comprising the Adventist Mortality Study, the Adventist Health Study, the Health Food Shoppers Study, the Oxford Vegetarian Study and the Heidelberg Study, we observed no difference between vegetarians and non-vegetarians in mortality from colorectal cancer (Key et al, 1999) . . .
  11. Key TJ, Appleby PN, Spencer EA, Travis RC, Roddam AW, Allen NECancer incidence in vegetarians: results from the European Prospective Investigation into Cancer and Nutrition (EPIC-Oxford). Am J Clin Nutr 89(Suppl): 1620S-1626S , (2009) .
    • . . . Some findings on cancer incidence rates in vegetarians have been reported from the Adventist Health Study in California (Fraser, 1999), the Oxford Vegetarian Study (Sanjoaquin et al, 2004), the UK Women's Cohort Study (Taylor et al, 2007) and EPIC-Oxford (Key et al, 2009) . . .
    • . . . The first results from EPIC-Oxford suggested that the incidence of breast cancer did not differ significantly between vegetarians and non-vegetarians (Travis et al, 2008), that the incidence of colorectal cancer was higher in vegetarians than in meat eaters, that the incidence of lung cancer was lower in fish eaters than in meat eaters, and that the risk for all malignant cancers was lower in fish eaters and possibly lower in vegetarians than in meat eaters (Key et al, 2009). . . .
    • . . . In this paper, we have pooled the individual participant data from the Oxford Vegetarian Study and EPIC-Oxford; hence, this includes data previously reported from these individual studies (Sanjoaquin et al, 2004; Travis et al, 2008; Key et al, 2009) . . .
    • . . . There is also some evidence that a high intake of fruit and vegetables might reduce the risk for stomach cancer, but the data are not consistent (Forman and Burley, 2006) and, although on average vegetarians eat more fruit and vegetables than meat eaters, the difference in intake is modest (Key et al, 2009). . . .
    • . . . Our earlier publications from the Oxford Vegetarian Study and EPIC-Oxford also did not report a reduction in risk for colorectal cancer among vegetarians (Sanjoaquin et al, 2004; Key et al, 2009) . . .
    • . . . We also noted previously in EPIC-Oxford, that the incidence of colorectal cancer among vegetarians was identical to that in the general population of England and Wales (standardised incidence ratio 102% (95% CI: 80–129); Key et al, 2009) . . .
    • . . . Meat intake among meat eaters in EPIC-Oxford was estimated as 78.1 and 69.7 g per day in men and women, respectively (Key et al, 2009), lower than intakes reported in the National Diet and Nutrition Survey for the United Kingdom, but still providing a substantial difference in intake between meat eaters and non-meat eaters . . .
    • . . . When the diet group in EPIC-Oxford was assigned on the basis of answers to the same four questions in a follow-up questionnaire 5 years later, 85% of the vegetarians were allocated to the same diet group as at the time of recruitment (Key et al, 2009), suggesting that the assessment of vegetarian status is accurate and stable over at least several years, and may be a substantially more stable dietary characteristic than epidemiological estimates of nutrient intakes. . . .
  12. Lijinsky WN-nitroso compounds in the diet. Mutat Res 443: 129-138 , (1999) .
    • . . . Some previous studies have suggested that certain meats, such as bacon, might increase the risk for bladder cancer, perhaps due to preformed nitrosamines (Lijinsky, 1999; Michaud et al, 2006), and this area deserves further investigation. . . .
  13. Michaud DS, Holick CN, Giovannucci E, Stampfer MJMeat intake and bladder cancer risk in 2 prospective cohort studies. Am J Clin Nutr 84: 1177-1183 , (2006) .
    • . . . Some previous studies have suggested that certain meats, such as bacon, might increase the risk for bladder cancer, perhaps due to preformed nitrosamines (Lijinsky, 1999; Michaud et al, 2006), and this area deserves further investigation. . . .
  14. Sanjoaquin MA, Appleby PN, Thorogood M, Mann JI, Key TJNutrition, lifestyle and colorectal cancer incidence: a prospective investigation of 10998 vegetarians and non-vegetarians in the United Kingdom. Br J Cancer 90: 118-121 , (2004) .
    • . . . Some findings on cancer incidence rates in vegetarians have been reported from the Adventist Health Study in California (Fraser, 1999), the Oxford Vegetarian Study (Sanjoaquin et al, 2004), the UK Women's Cohort Study (Taylor et al, 2007) and EPIC-Oxford (Key et al, 2009) . . .
    • . . . In Britain, the Oxford Vegetarian Study suggested no large difference in the incidence of colorectal cancer between vegetarians and non-vegetarians (Sanjoaquin et al, 2004), whereas the UK Women's Cohort Study suggested that women who did not eat any meat had a lower risk for breast cancer than did meat eaters (Taylor et al, 2007) . . .
    • . . . In this paper, we have pooled the individual participant data from the Oxford Vegetarian Study and EPIC-Oxford; hence, this includes data previously reported from these individual studies (Sanjoaquin et al, 2004; Travis et al, 2008; Key et al, 2009) . . .
    • . . . Our earlier publications from the Oxford Vegetarian Study and EPIC-Oxford also did not report a reduction in risk for colorectal cancer among vegetarians (Sanjoaquin et al, 2004; Key et al, 2009) . . .
  15. Schulz M, Lahmann PH, Riboli E, Boeing HDietary determinants of epithelial ovarian cancer: a review of the epidemiologic literature. Nutr Cancer 50: 120-140 , (2004) .
    • . . . In a review, Schulz et al (2004) concluded that high meat consumption may be associated with an increased risk of ovarian cancer . . .
  16. Taylor EF, Burley VJ, Greenwood DC, Cade JEMeat consumption and risk of breast cancer in the UK Women's Cohort Study. Br J Cancer 96: 1139-1146 , (2007) .
    • . . . Some findings on cancer incidence rates in vegetarians have been reported from the Adventist Health Study in California (Fraser, 1999), the Oxford Vegetarian Study (Sanjoaquin et al, 2004), the UK Women's Cohort Study (Taylor et al, 2007) and EPIC-Oxford (Key et al, 2009) . . .
    • . . . In Britain, the Oxford Vegetarian Study suggested no large difference in the incidence of colorectal cancer between vegetarians and non-vegetarians (Sanjoaquin et al, 2004), whereas the UK Women's Cohort Study suggested that women who did not eat any meat had a lower risk for breast cancer than did meat eaters (Taylor et al, 2007) . . .
  17. Thorogood M, Mann J, Appleby P, McPherson KRisk of death from cancer and ischaemic heart disease in meat and non-meat eaters. BMJ 308: 1667-1670 , (1994) .
    • . . . In the Oxford Vegetarian Study, participants were recruited throughout the United Kingdom between 1980 and 1984 (Thorogood et al, 1994) . . .
  18. Travis RC, Allen NE, Appleby PN, Spencer EA, Roddam AW, Key TJA prospective study of vegetarianism and isoflavone intake in relation to breast cancer risk in British women. Int J Cancer 122: 705-710 , (2008) .
    • . . . The first results from EPIC-Oxford suggested that the incidence of breast cancer did not differ significantly between vegetarians and non-vegetarians (Travis et al, 2008), that the incidence of colorectal cancer was higher in vegetarians than in meat eaters, that the incidence of lung cancer was lower in fish eaters than in meat eaters, and that the risk for all malignant cancers was lower in fish eaters and possibly lower in vegetarians than in meat eaters (Key et al, 2009). . . .
    • . . . In this paper, we have pooled the individual participant data from the Oxford Vegetarian Study and EPIC-Oxford; hence, this includes data previously reported from these individual studies (Sanjoaquin et al, 2004; Travis et al, 2008; Key et al, 2009) . . .
  19. World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR)Food, Nutrition, Physical Activity and the Prevention of Cancer: a Global Perspective. AICR: Washington DC , (2007) .
    • . . . For example, in the systematic review by the WCRF/AICR (World Cancer Research Fund/American Institute for Cancer Research), an expert panel concluded that both red meat and processed meat are convincing causes of colorectal cancer, and that there was some evidence suggesting that high intakes of red or processed meat increased the risk for cancers of the oesophagus, stomach, pancreas, lung, endometrium and prostate (WCRF/AICR, 2007). . . .
    • . . . The 2007 report from the WCRF/AICR concluded that the evidence that high intakes of red and processed meat cause colorectal cancer is convincing (WCRF/AICR, 2007) . . .
  20. World Health OrganizationInternational statistical classification of deseases and related health problems-10th revision. World Health Organization: Geneva , (1992) .
    • . . . Malignant neoplasms were defined as codes C00-97 of the Tenth Revision of the International Classification of Diseases (ICD; World Health Organization, 1992), excluding code C44 (non-melanoma skin cancer) . . .
  21. Zhang S, Hunter DJ, Rosner BA, Colditz GA, Fuchs CS, Speizer FE, Willett WCDietary fat and protein in relation to risk of non-Hodgkin's lymphoma among women. J Natl Cancer Inst 91: 1751-1758 , (1999) .
    • . . . Previous research has suggested inconsistently that consumption of meat and/or exposure to live animals and raw meat among farmers and butchers might be associated with an increased risk for some of these cancers (Zhang et al, 1999; Alexander et al, 2007) . . .
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