Regulatory impact analyses of proposed environmental, occupational, and consumer product safety regulations often rely on a metric known as the Value per Statistical Case of Cancer (VSCC), that is, the public’s willingness to pay (WTP) for reductions in the risk of developing cancer. In this paper, we ask whether the VSCC depends on cancer survival prospects. We develop a simple theoretical model that shows that under standard assumptions the VSCC is decreasing in the chance of surviving cancer. We empirically test this prediction by means of a stated preference survey, where we ask subjects aged 45–60 from the general population in the Czech Republic to report information about their WTP for reductions in the risk of getting cancer. One half of the sample was told that, if they got cancer, the 5-year survival rate was 60 % (corresponding to the average survival chances across all types of cancer), while the other half was told that it was 75 %. Consistent with the theoretical model, we find that the VSCC is larger in the former group. The ratio between the VSCC of the two groups is approximately equal to the ratio between the conditional cancer mortality risks implied by the survey’s survival rates, suggesting that the VSCC is proportional to conditional cancer mortality. Our findings have important policy implications in the context of regulations that focus on pollutants linked to cancers with different chances of survival.

The Food Standards Agency Nutrient Profiling System (FSA-NPS) constitutes the basis for the Five-Colour Nutrition Label suggested in France to be put on the front-of-pack of food products. At the individual level, a dietary index (FSA-NPS DI) has been derived and validated and corresponds to a weighted mean of all FSA-NPS scores of foods usually consumed by the individual, reflecting the nutritional quality of his/her diet. Our aim was to investigate the association between the FSA-NPS DI and cancer risk in a large cohort. This prospective study included 6435 participants to the SUpplémentation en VItamines et Minéraux AntioXydants cohort (1994–2007) who completed at least six 24 h dietary records during the first 2 years of follow-up. FSA-NPS DI was computed for each subject (higher values representing lower nutritional quality of the diet). After a median follow-up of 12·6 years, 453 incident cancers were diagnosed. Associations were characterised by multivariate Cox proportional hazards models. The FSA-NPS DI was directly associated with overall cancer risk (hazard ratio (HR)for a 1-point increment=1·08 (95 % CI 1·01, 1·15), Ptrend=0·02; HRQ5 v. Q1=1·34 (95 % CI 1·00, 1·81), Ptrend=0·03). This association tended to be more specifically observed in subjects with moderate energy intake (≤median, HRfor a 1-point increment=1·10 (95 % CI 1·01-1·20), Ptrend=0·03). No association was observed in subjects with higher energy intake (Ptrend=0·3). Results were not statistically significant for breast and prostate cancer risks. For the first time, this study investigated the prospective association between the FSA-NPS individual score and cancer risk. The results suggest that unhealthy food choices may be associated with a 34 % increase in overall cancer risk, supporting the public health relevance of developing front-of-pack nutrition labels based on this score.

Cereal-based foods are key components of the diet and they dominate most food-based dietary recommendations in order to achieve targets for intake of carbohydrate, protein and dietary fibre. Processing (milling) of grains to produce refined grain products removes key nutrients and phytochemicals from the flour and although in some countries nutrients may be replaced with mandatory fortification, overall this refinement reduces their potential nutritional quality. There is increasing evidence from both observational and intervention studies that increased intake of less-refined, whole-grain (WG) foods has positive health benefits. The highest WG consumers are consistently shown to have lower risk of developing CVD, type 2 diabetes and some cancers. WG consumers may also have better digestive health and are likely to have lower BMI and gain less weight over time. The bulk of the evidence for the benefits of WG comes from observational studies, but evidence of benefit in intervention studies and potential mechanisms of action is increasing. Overall this evidence supports the promotion of WG foods over refined grain foods in the diet, but this would require adoption of standard definitions of ‘whole grain’ and ‘whole-grain foods’ which will enable innovation by food manufacturers, provide clarity for the consumer and encourage the implementation of food-based dietary recommendations and public health strategies.

High intakes of fruit and vegetables may reduce the risk of cancer at several sites. Evidence has been derived mainly from case–control studies. We reviewed the relationship between consumption of vegetables and fruit and the risk of several common cancers in a network of Italian and Swiss case–control studies including over 10 000 cases of fourteen different cancers and about 17 000 controls. Data were suggestive of a protective role of vegetable intake on the risk of several common epithelial cancers. OR for the highest compared with the lowest levels of consumption ranged from 0·2 (larynx, oral cavity and pharynx) to 0·9 (prostate). Inverse associations were found for both raw and cooked vegetables, although for upper digestive tract cancers the former were somewhat stronger. Similar inverse associations were found for cruciferous vegetables. Frequent consumption of allium vegetables was also associated with reduced risk of several cancers. Fruit was a favourable correlate of the risk of several cancers, particularly of the upper digestive tract, with associations generally weaker than those reported for vegetables. A reduced risk of cancers of the digestive tract and larynx was found for high consumption of citrus fruit. Suggestive protections against several forms of cancer, mainly digestive tract cancers, were found for high consumption of apples and tomatoes. High intakes of fibres, flavonoids and proanthocyanidins were inversely related to various forms of cancer. In conclusion, data from our series of case–control studies suggested a favourable role of high intakes of fruit and vegetables in the risk of many common cancers, particularly of the digestive tract. This adds evidence to the indication that aspects of the Mediterranean diet may have a favourable impact not only on CVD, but also on several common (epithelial) cancers, particularly of the digestive tract.

Cancer is a leading cause of death, and the dietary pattern in Korea is changing rapidly from a traditional Korean diet to a Westernised diet. In the present study, we investigated the effects of dietary factors on cancer risk with a prospective cohort study. Among 26 815 individuals who participated in cancer screening examinations from September 2004 to December 2008, 8024 subjects who completed a self-administered questionnaire concerning demographic and lifestyle factors, and a 3 d food record were selected. As of September 2013, 387 cancer cases were identified from the National Cancer Registry System, and the remaining individuals were included in the control group. The hazard ratio (HR) of cancer for the subjects older than or equal to 50 years of age was higher (HR 1·80, 95 % CI 1·41, 2·31; P< 0·0001) than that for the other subjects. Red meat consumption, Na intake and obesity (BMI ≥ 25 kg/m2) were positively associated with overall cancer incidence in men (HR 1·41, 95 % CI 1·02, 1·94; P= 0·0382), gastric cancer (HR 2·34, 95 % CI 1·06, 5·19; P= 0·0365) and thyroid cancer (HR 1·56, 95 % CI 1·05, 2·31; P= 0·0270), respectively. Participants who had at least three dietary risk factors among the high intakes of red meat and Na, low intakes of vegetables and fruits, and obesity suggested by the World Cancer Research Fund/American Institute for Cancer Research at baseline tended to have a higher risk of cancer than the others (HR 1·26, 95 % CI 0·99, 1·60; P= 0·0653). In summary, high intakes of red meat and Na were significant risk factors of cancer among Koreans.

Uranium is known for both chemical and radiologicaltoxicity. East Singhbhum is known for uranium mining, and radionuclidescan be expected in its groundwater. Groundwater was collected aroundtwo proposed sites of Bagjata and Banduhurang and analysed for U(nat).The study reveals that the U(nat) varied from <0.5–11.2 and <0.5–27.5 µg.L-1 for the Bagjata and Banduhurang mining areas, respectively.The excess lifetime cancer risk due to the consumption of uraniumin water was calculated to be in the range of 8.81 × 10-6 to4.34 × 10-5 and 3.36 × 10-6 to 9.55 × 10-5 forthe two study areas, which are within the acceptable cancer riskvalue of 1 × 10-4. However, the risk at a few locationsis very close to the threshold value. The chemical risk evaluatedby the hazard quotient was found to be within 0.05–0.23 and 0.02–0.6for the two study areas and did not exceed the limit of 1. Thus,the concentration of U(nat) in the groundwater presently does notpose any serious threat to local people but must be monitored periodicallyand adequate actions must be taken in the few areas with elevatedlevels of uranium in the groundwater.

microRNAs are small, non-coding RNAs that influence gene expression on a post-transcriptional level. They participate in diverse biological pathways and may act as either tumor suppressor genes or oncogenes. As they may have an effect on thousands of target mRNAs, single-nucleotide polymorphisms in microRNA genes might have major functional consequences, because the microRNA's properties and/or maturation may change. miR-196a has been reported to be aberrantly expressed in breast cancer tissue. Additionally, the SNP rs11614913 in hsa-mir-196a-2 has been found to be associated with breast cancer risk in some studies although not in others. This study evaluated the association between rs11614913 and breast cancer risk in a Caucasian case-control cohort in Queensland, Australia. Results do not support an association of the tested hsa-mir-196a-2 polymorphism with breast cancer susceptibility in this cohort. As there is a discrepancy between our results and previous findings, it is important to assess the role of rs11614913 in breast cancer by further larger studies investigating different ethnic groups.

Ingestion of radionuclides through food intake accounts for a substantial part ofradiation doses and vegetables constitute essential components of the diet, bycontributing protein, vitamins, iron, calcium and other nutrients. Radionuclides can beapprehended in the ecosystem of the East Singhbhum region which is known for its viablegrades of uranium. In the present study, vegetables were collected from the villagesaround the proposed Bagjata mining area and analysed for U(nat), 226Ra,230Th and 210Po. The geometric mean concentration of U(nat),226Ra, 230Th, and 210Po were 0.05, 0.09, 0.17 and 1.12Bq kg-1 fresh weight, respectively. The intake of the radionuclides fromvegetables was found to be 49.58 Bq y-1while the ingestion dose was calculatedto be 11.51 µSv y-1, respectively. The estimated doses are reflecting thenatural background dose via the route of ingestion, which is much belowthe 1 mSv limit set in the new ICRP recommendations. It is lower than the global averageannual radiation dose of 2 400 µSv to man from the natural radiation sources as proposedby UNSCEAR. The total cancer risk due to the consumption of vegetables was calculated tobe 6.65 × 10-9 which is negligible and much lower than the threshold risk valueof 10-6. The study also reveals that water is more conducive forhigh radioactivity occurrence in vegetables compared to soil systems.

The prevalence of obesity, defined as a BMI of ≥30·0 kg/m2, has increased substantially over previous decades to about 20% in industrialized countries, and a further increase is expected in the future. Epidemiological studies have shown that obesity is a risk factor for: post-menopausal breast cancer; cancers of the endometrium, colon and kidney; malignant adenomas of the oesophagus. Obese subjects have an approximately 1·5–3·5-fold increased risk of developing these cancers compared with normal-weight subjects, and it has been estimated that between 15 and 45% of these cancers can be attributed to overweight (BMI 25·0–29·9 kg/m2) and obesity in Europe. More recent studies suggest that obesity may also increase the risk of other types of cancer, including pancreatic, hepatic and gallbladder cancer. The underlying mechanisms for the increased cancer risk as a result of obesity are unclear and may vary by cancer site and also depend on the distribution of body fat. Thus, abdominal obesity as defined by waist circumference or waist:hip ratio has been shown to be more strongly related to certain cancer types than obesity as defined by BMI. Possible mechanisms that relate obesity to cancer risk include insulin resistance and resultant chronic hyperinsulinaemia, increased production of insulin-like growth factors or increased bioavailability of steroid hormones. Recent research also suggests that adipose tissue-derived hormones and cytokines (adipokines), such as leptin, adiponectin and inflammatory markers, may reflect mechanisms linked to tumourigenesis.

It was the aim of the present study to estimate the intake of heterocyclic aromatic amines (HCA) from meat, which have been associated with cancer risk in several epidemiological studies, of 21 462 subjects who participated in the European Prospective Investigation into Cancer and Nutrition (EPIC) in Heidelberg. This was accomplished by using a detailed dietary questionnaire that assessed meat consumption, cooking methods, and degree of browning of the respective food items. Median total HCA intake from meat was 31 ng/d (mean 69 ng/d), which was lower than results observed in previous studies. 2-Amino-1-methyl-6-phenylimidazo[4,5b]pyridine was the most common HCA in this cohort (median 17; mean 48 ng/d). The present study offers the opportunity of a detailed examination of the associations between meat cooking as well as HCA intake from meat and cancer risk in a prospective way.

Although oestrogen replacement therapy (ERT), which can affect the risk of major cancers, has been known to reduce total plasma homocysteine concentrations in postmenopausal women, the mechanisms and subsequent molecular changes have not yet been defined. To investigate the effect of ERT on homocysteine metabolism, thirteen healthy postmenopausal women were enrolled in a double-blind, placebo-controlled, randomized, cross-over study consisting of two 8-week long phases, placebo and conjugated equine oestrogen (CEE; 0·625 mg/d). Concentrations of total plasma homocysteine, vitamin B6 and serum folate and vitamin B12 were measured by conventional methods. Genomic DNA methylation was measured by a new liquid chromatography/MS method and promoter methylation status of the oestrogen receptor (ER)α, ERβ and p16 genes was analysed by methylation-specific PCR after bisulfite treatment. The CEE phase demonstrated a significantly decreased mean of total plasma homocysteine concentrations compared with the placebo phase (8·08 μmol/l (6·82–9·39) v. 9·29 (7·53–11·35), P < 0·05) but there was no difference in the blood concentrations of the three B vitamins. The CEE phase also showed a significantly increased genomic DNA methylation in peripheral mononuclear cells compared with the placebo phase (2·85 (SD 0·12) ng methylcytosine/μg DNA v. 2·40 ± (SD 0·15) P < 0·05). However, there was no difference in promoter methylation in the ERα, ERβ and p16 genes. This study demonstrates that decreased homocysteinaemia by CEE therapy parallels with increased genomic DNA methylation, suggesting a potential new candidate mechanism by which ERT affects the risk of cancers and a possible new candidate biomarker for the oestrogen-related carcinogenesis through folate-related one-carbon metabolism.

The relationship between frequency of consumption of whole-grain foods and cancer risk has been analysed using data from an updated series of case-control studies conducted in Northern Italy between 1983 and 1997. The overall dataset included the following incident histologically-confirmed neoplasms: oral cavity and pharynx 524, oesophagus 410, stomach 745, colon 955, rectum 625, liver 435, gallbladder 65, pancreas 402, larynx 388, soft tissue sarcomas 217, breast 3412, endometrium 750, ovary 971, prostate 127, bladder 431, kidney 190, thyroid 428, Hodgkin's disease 201, non-Hodgkin's lymphomas 529, multiple myelomas 185. Controls were 10 058 patients admitted to hospital for acute non-neoplastic conditions unrelated to long-term modifications in diet, tobacco or alcohol use. The multivariate odds ratios for the highest category of whole-grain cereal consumption were 0.3–0.5 for upper digestive tract and respiratory neoplasms and colon, 0.6 for rectum and liver, 0.4 for gallbladder, 0.8 for pancreas, 0.2 for soft tissue sarcomas, 0.9 for breast and endometrium, 0.7 for ovary, 0.7 for prostate, 0.4 for bladder and kidney, 1.1 for thyroid and about 0.5 for lymphomas and 0.6 for myelomas. In this population whole-grain food consumption is an indicator of reduced risk of several neoplasms.

Many studies have shown that overall dietary patterns, dietary components consumed, or mode of food preparation are all possibly relevant in either reducing or increasing the risk of cancer in animals or man. Yet, dietary intervention studies, stemming from laboratory and epidemiological observational studies have often failed to demonstrate the anticipated protection against cancer. One possible explanation for the discrepancy between the results of various observational and experimental chemo-prevention studies is the lack of control for biological diversity of the participants of these studies. It is suggested that future epidemiological studies provide evidence stratified by status of major metabolic polymorphisms pertinent to the study subject, and that future intervention studies take these differences into account in the design and analysis phases.

Evidence is accumulating that high levels of physical activity are associated with a reduced risk of some cancers. This evidence is most consistent for colon cancer, which is reduced by 40–50 % among the most active individuals, compared with the least active. The effect is evident in men and women, and appears to be independent of important confounding factors. However, there may be important interactions with body fatness; a high BMI has been reported to be associated with an increased risk of colon cancer in sedentary men but not in physically-active men. Whilst the evidence on breast cancer is less consistent, case–control studies typically suggest a reduction of 25–30 % among the most active women, although several studies have found no effect. Potential mechanisms include systemic influences and others relevant only to site-specific cancers. One unifying hypothesis is that physical inactivity reduces insulin sensitivity, leading to a growth-promotional environment which may facilitate neoplasia. The non-specific immune system may be improved by physical activity, possibly through the summative effects of repeated exercise bouts. Regular exercise, even at a recreational level, probably reduces exposure to oestrogen and thus decreases the risk of breast cancer. Increased colonic peristalsis, and thus reduced bowel transit time, might partly explain the lower risk of colon cancer in active people. Physical activity emerges as one of the few modifiable risk factors for some cancers and, as such, justifies further study.

There is a clear and consistent association between overweight and risk of hormone-related cancers, large bowel cancer and cancer at some other sites. Overweight is the consequence of an excess of energy intake over expenditure, but there is little evidence of an association between high energy intake and cancer risk in humans at any site other than the endometrium. This may be because of the difficulties in measuring total energy intake in the tens of thousands of individuals used in large prospective epidemiological studies. In contrast, despite the difficulties in measuring physical activity in the large numbers of persons needed in epidemiology, there is a growing body of evidence that a high level of recreational physical activity is protective against cancer at all sites associated with overweight.