European Prospective Investigation into Cancer and Nutrition

The European Prospective Investigation into Cancer and Nutrition (EPIC) study is a Europe-wide prospective cohort study of the relationships between diet and cancer, as well as other chronic diseases, such as cardiovascular disease. With over half a million participants, it is the largest study of diet and disease to be undertaken.

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EPIC is coordinated by the International Agency for Research on Cancer (IARC), part of the World Health Organization, and funded by the 'Europe Against Cancer' programme of the European Commission as well as multiple nation-specific grants and charities.

521,457 healthy adults, mostly aged 35-70 years, were enrolled in 23 centres in ten European countries: Denmark (11%), France (14%), Germany (10%), Greece (5%), Italy (9%), The Netherlands (8%), Norway (7%), Spain (8%), Sweden (10%) and the United Kingdom (17%). One UK centre (Oxford) recruited 27,000 vegetarians and vegans; this subgroup forms the largest study of this dietary group. Recruitment to the study took place between 1993 and 1999, and follow up is planned for at least ten years, with repeat interview/questionnaires every three to five years. The main prospective data collected are standardised dietary questionnaires (self administered or interview based), seven-day food diaries, blood samples and anthropometric measurements, such as body mass index and waist-to-hip ratio. Additionally, the GenAir case-control study is studying the relationship of passive smoking and air pollution with cancers and respiratory diseases.

Up to 2004, there were over 26,000 new cases of cancer recorded among participants, with the most common being cancers of the breast, colorectum, prostate and lung. Current analyses are focusing particularly on stomach, colorectal, breast, prostate and lung cancers. The different dietary patterns in the different countries should enable reliable associations to be made between particular diets and cancers. The analysis of stored blood samples should also allow dissection of genetic factors involved in cancers, as well as the effects of hormones and hormone-like factors.

Key findings

• Consumption of fibre, fish, milk and cheese reduce risk of colorectal cancer, while red and processed meat increase risk
• Consumption of fruit and vegetables does not affect risk of breast or prostate cancer

Selected papers

Review

• Riboli, E. The European Prospective Investigation into Cancer and Nutrition (EPIC): Plans and Progress J. Nutr. (2001) 131: 170S-175S

Primary

• Bingham SA, Day NE, Luben R, et al. Dietary fibre in food and protection against colorectal cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC): an observational study. Lancet (2003) 361: 1496-1501 PubMed
• Gonzalez CA, Jakszyn P, Pera G, et al. Meat intake and risk of stomach and esophageal adenocarcinoma within the European Prospective Investigation Into Cancer and Nutrition (EPIC). J. Natl Cancer Inst. (2006) 98: 345-354
• Khaw KT, Bingham S, Welch A, et al. Relation between plasma ascorbic acid and mortality in men and women in EPIC-Norfolk prospective study: a prospective population study. European Prospective Investigation into Cancer and Nutrition. Lancet (2001) 357: 657-663 PubMed
• Miller AB, Altenburg HP, Bueno-de-Mesquita B, et al. Fruits and vegetables and lung cancer: Findings from the European Prospective Investigation into Cancer and Nutrition. Int. J. Cancer (2004) 108: 269-276 PubMed
• Norat T, Bingham S, Ferrari P, et al. Meat, fish, and colorectal cancer risk: the European Prospective Investigation into cancer and nutrition. J. Natl Cancer Inst. (2005) 97: 906-916

• Trichopoulou A, Orfanos P, Norat T, et al. Modified Mediterranean diet and survival: EPIC-elderly prospective cohort study. BMJ (2005) 330: 991
• van Gils CH, Peeters PH, Bueno-de-Mesquita HB, et al. Consumption of vegetables and fruits and risk of breast cancer. JAMA (2005) 293: 183-193 PubMed
• Verheus M, Peeters PH, Rinaldi S, et al. Serum C-peptide levels and breast cancer risk: results from the European Prospective Investigation into Cancer and Nutrition (EPIC). Int. J. Cancer (2006) 119: 659-667 PubMed