Download Centre for Research into Cancer Prevention and Screening (CRiPS)

Centre for Research into
Cancer Prevention and Screening
(CRiPS)
Ongoing and Recently Completed Work
2007-2011
Division of Clinical & Population Sciences & Education
Level 7, Mailbox 7
Ninewells Hospital and Medical School
Dundee
DD1 9SY
Tel: +44 (0)1382 496443
Fax: +44 (0)1382 496452
CRiPs Contacts: Professor Annie S. Anderson BSc SRD PhD [email protected]
Professor Robert JC. Steele MD FRCS [email protected]
Updated June 2011
Contents
Centre for Research Into Cancer Prevention and Screening (CRiPS) ................................. 4
CRiPS Research Staff and Associates ................................................................................. 5
UK Academic Co-Investigators ................................................................................................................................. 8
International Academic Co-Investigators ................................................................................................................... 8
NGO Co-investigators .............................................................................................................................................. 9
Sources of Funding ................................................................................................................................................. 9
1. CRiPS Research Projects .............................................................................................. 10
I) Cancer Risk Awareness ................................................................................................ 10
Obesity and lifestyle interventions in colorectal cancer survivors - how well are clinicians prepared? ............................. 10
Response to being informed of weight status and body fat composition. Understandings, reactions and motivation to
achieve a healthy weight. ...................................................................................................................................... 10
Lifestyle issues for colorectal cancer survivors – perceived needs, beliefs and opportunities. ........................................ 10
II) Interventions for Cancer Risk Reduction ................................................................... 11
BeWEL: the impact of a BodyWEight and physicaL activity intervention on adults at risk of developing colorectal
adenomas
11
LIVEWELL- Development and feasibility of an intensive lifestyle intervention programme for the secondary prevention
of colorectal cancer. .............................................................................................................................................. 12
Review of lifestyle interventions used in successful disease prevention programmes ................................................... 12
Bowel Health to Better Health: The development and evaluation of a family based intervention aimed at changing diet
and physical activity in people at moderate to high risk of colo-rectal cancer .............................................................. 12
ENJOY- a Colorectal Cancer Patient Programme ...................................................................................................... 12
Breast Cancer Campaign: Breast – Activity & Healthy Eating after Diagnosis B-AHEAD ................................................ 12
Cancer as a Catalyst for Change? Predictors of changes in diet, alcohol, physical activity and tobacco use after
colorectal cancer diagnosis among patients and their partners .................................................................................. 13
5 Year Follow Up of Breast Cancer Survivors in RCT ................................................................................................. 13
III) Understanding Cancer Related Health Behaviours ................................................... 13
Secondary Analysis of the Expenditure and Food Survey – comparison of household and eating out with the Scottish
dietary targets and by area of residence ................................................................................................................. 13
Understanding food culture in Scotland and its comparison in an international context: implications for policy
development 13
Can a gender-sensitised weight management programme delivered by Scottish Premier League football clubs help
men lose weight? A feasibility study for a randomised controlled trial ....................................................................... 13
Football Fans in Training (FFIT): a randomised controlled trial of a gender-sensitive weight loss and healthy living
programme delivered to men aged 35-65 by Scottish Premier League Football clubs .................................................. 13
The Effect of Adherence to Adjuvant Endocrine Therapy on Breast Cancer Outcomes ................................................. 14
IV) Screening and Early Detection ................................................................................... 15
Bowel Screening Research Unit .............................................................................................................................. 15
Results from the First Three Rounds of the Scottish Demonstration Pilot of FOBT Screening for Colorectal Cancer ......... 15
Effect of Gender, Age and Deprivation on Key Performance Indicators in an FOBT Based Colorectal Screening
Programme 16
Clinico-pathological Characteristics and Outcome of Screen Detected Cancers ............................................................ 16
Interval Cancers and the “Certificate of Health” Effect .............................................................................................. 16
Prevalence and Incidence Screening ....................................................................................................................... 17
Adenoma Follow-up .............................................................................................................................................. 17
Effect of Colorectal Cancer Screening on Disease Specific Mortality ........................................................................... 17
Economic Impact of Screening ............................................................................................................................... 18
Faecal Immunological Testing ................................................................................................................................ 18
The Psychological Effect of Interval Cancers ............................................................................................................ 18
The Utility of DNA Mutations in Colorectal Cancer Screening ..................................................................................... 18
The Utility of Proteomics in Colorectal Cancer Screening........................................................................................... 19
Investigate the Diagnosis of Colorectal Polyps using Optical Projection Tomography ................................................... 19
Investigate the Utility of Quantitative Immunological Faecal Occult Blood Testing in Symptomatic Patients ................... 19
2
Evaluate Faecal Immunological Testing as a First-line Colorectal Screening Test in the Scottish Population ................... 19
2. CRiPS Publications 2007 - 2011 (original research) ..................................................... 20
3. Translating and Facilitating Research to Policy and Practice ....................................... 25
Current Government Advisory work (including UK Departments of Health and Research Councils) ................................ 25
Advisory Work for NGOs and Other Agencies ........................................................................................................... 26
Selected International/National Invited presentations for Scientific Professional Groups (since 2007)............................ 28
Publications for professional groups (excluding research findings) ............................................................................. 30
4. Public Understanding of Science and Advocacy in support of cancer prevention and
early detection ................................................................................................................. 31
Communications for General Public ........................................................................................................................ 31
5. CRiPS – Visits from International Scholars .................................................................. 31
3
Centre for Research Into Cancer Prevention and Screening (CRiPS)
The aims of the centre are to:
• Undertake research on:
o cancer risk awareness
o lifestyle modifications related to cancer development and recurrence
o cancer related health behaviours and health inequalities
o methodologies to improve early detection of cancer
• Facilitate the translation of behavioural and screening research into policy and practice
• Increase Public Understanding of Science related to cancer prevention and screening and gain support for
cancer control policies
Background Globally, each year, around 11 million people are diagnosed with cancer and almost 8 million people die.
Cancers cause one in four of all deaths in the UK and it is estimated that around one third of all cancer cases could be
avoided if nobody was exposed to tobacco. Obesity is now recognised as the major cancer risk factor in non-smokers.
Recent preventability estimates suggest that 42% of breast cancer and 43% of colorectal cancer could be avoided with
changes in body fatness, alcohol and physical activity (and in the case of colorectal cancer increase in dietary fibre and
decreases in red and processed meat).
However, increasing knowledge about the relationship between risk factors and cancer will not in itself reduce the
disease. Increasingly the role of health inequalities has been recognised as a major contributor to ill health. Research
is urgently needed to identify effective routes to decrease cancer risk through improved action on diet and physical
activity, environmental approaches that will facilitate changes in lifestyle by vulnerable groups and increase early
diagnosis of cancer at treatable stages. In turn, findings need to be translated into policy and practice.
The major behavioural challenge to cancer reduction in non smokers is obesity, caused by an imbalance between
energy intake and energy expenditure. Health departments, funding councils and research agencies are exploring
many opportunities for addressing this balance from new pharmacological approaches, strategies for tackling the built
environment and sustainable energy initiatives. However, the fundamental challenge remains that of controlling
energy intake (food, soft drinks and alcohol) and utilisation of energy (physical activity and sedentary behaviours).
Understanding dietary (including alcohol) and physical activity behaviours and effective routes for intervention are
high on the cancer prevention agenda and the main focus for behavioural modification research in CRiPS. This
research area is lead by Professor Annie S. Anderson (Director, Centre for Public Health Nutrition Research).
Unlike cardio-vascular disease there are no simple blood tests that can help identify people at increased risk of cancer
or with early disease symptoms. However, significant research efforts have helped to develop programmes of
population- based screening and early detection of pre-cancerous lesions or early stage cancers. These programmes
include breast and cervix screening and have been demonstrated to help avoid disease progression and improve
chances of survival.
Data from the Scottish Bowel screening pilot study has shown that for every 100,000 people invited for screening that
around 100 cancers and 300 pre-cancerous lesions will be detected. The Scotland wide programme is estimated to
reduce mortality rates by at least 15%. Faecal Occult Blood Test (FOBT) screening is being introduced throughout
Scotland providing a unique opportunity to study colorectal screening and to intervene to improve the testing process
and improve uptake. In addition, screening identifies many individuals with colorectal adenomas who require follow
up and form an ideal cohort in which to study preventative strategies. A CSO funded research unit has been
established in Tayside which has already reported on the key performance indicators for the first 3 biennial rounds of
screening in Scotland and carried out preliminary work on faecal immunological testing (FIT). Research is also ongoing
into developing improved strategies for increasing uptake across all socio-cultural population groups. This screening
and early detection research area is lead by Professor Robert Steele (Director, Bowel Screening Research Unit).
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CRiPS Research Staff and Associates (by area of expertise)
Alcohol
Professor Iain Crombie is head of the department of Public Health at the University of Dundee. His current
research interests focus mainly on alcohol-related problems. He has previously worked on cancer
epidemiology, chronic pain and the nature of public health policy.
Dr J Kevin Dunbar is a Specialty Registrar in Public Health Medicine with an interest in liver disease and
health behaviour interventions in hard to reach groups involving mobile phones and SMS messaging.
Dr Linda Irvine is a research fellow in public health with specific research interest on the prevention of
alcohol related-harm.
Cancer Survivorship
Dr Colin McCowan is a cancer epidemiologist
Dr Mary Wells is senior lecturer in cancer nursing within the School of Nursing and Midwifery and leads a
research programme on cancer care.
Diet, Obesity, Physical activity
Professor Annie S. Anderson is a Public Health Nutritionist with extensive experience in designing,
implementing and evaluating lifestyle intervention trials.
Mrs Karen Barton is a Research Nutritionist with expertise in diet survey methodology and assessment.
Her major focus is on trends analysis on the Scottish diet, funded by the Food Standards Agency.
Dr Anna Campbell is a lecturer in Sports Biomedicine
Dr Stephen Caswell is a Research psychologist, with a particular interest in utilising behaviour change
opportunities ('teachable moments') with both the colorectal cancer screening programme and colorectal
cancer survivors.
Miss Emma Cessford is a postgraduate student evaluating intervention work in the areas of material and
infant nutrition.
Dr Angela Craigie is a research nutritionist working on several behavioural intervention studies involving
modifications of lifestyle (diet and physical activity) at various stages through the lifespan, and has recently
been appointed as lecturer in Cancer Prevention within CRiPs.
Miss Sheila Fettes is a clinical dietician with responsibility for developing nutrition teaching in the medical
undergraduate curriculum.
Dr Maureen Macleod is a research nurse with extensive experience in clinical trials including weight loss
and lifestyle change.
Dr Jacqui Sugden is a research nurse with expertise in lifestyle interventions
Dr Wendy Wrieden is an honorary lecturer with expertise in dietary assessment and surveillance.
BeWEL Project Team:
Ms Erna Wilkie – Trial Manager
Ms Louise Bleazard
Ms Charlotte McEleney
Mrs Jill Hampton
Ms Fiona Robertson
Ms Catherine Savage
Ms Caron Leckie
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Health Behaviours
Professor Ruth Freeman is Director of the Oral Health and Health Services Research Programme which
focuses on health and oral health promotion and inequality and understanding behaviour change.
Oncology
Professor Alastair Munro is Professor of Radiation oncology with research interests in rehabilitation,
survivorship and social dimensions of health.
Public Health
NHS Tayside, Department of Public Health plays a key role in many of the centres research collaborations
and supporting innovative health promotion practice notably in the area of health inequalities, smoking
cessation, diet change and obesity.
Mr Paul Ballard is deputy director of Public Health
Ms Joyce Thompson is Consultant in Public Health Nutrition
Dr Drew Walker is Director of Public Health
Research methodology
Dr Shaun Treweek is Assistant Director of the Tayside Clinical Trials Unit and is also a leading member of
the Scottish Collaboration of Trialists.
Screening and early detection (by cancer site)
Breast cancer
Professor Andy Evans, Professor of Breast Imaging
Professor Alistair Thompson Professor of Surgical Oncology
Colo-rectal cancer
Professor Bob Steele is the Director of the Scottish Bowel Cancer Screening Programme and the Bowel
Screening Research Unit.
Professor Frank Carey is the Pathology Lead for Colorectal Cancer Screening in Scotland
Ms Gillian Libby is the Research Statistician in the Bowel Screening Research Unit
Ms Paula Macdonald is the Bowel Screening Laboratory Manager
Professor Callum Fraser is the Director of the Scottish Bowel Screening Laboratory
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Oral cancer
Professor Graham Ogden is an expert on screening for oral cancer
Tobacco control See UK Academic partners
Support staff
Dr Irene Allan is Research Manager for the group.
Kathleen Fotheringham is Divisional Manager for the group
Roz Taylor is research clerical assistant for the group
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UK Academic Co-Investigators
Centre for Tobacco Control Research, University of Stirling and Open University
Professor Gerard Hastings OBE
Food Ethics Council
Dr Tom McMillan
Gastro Intestinal Epidemiology, Imperial College London
Professor Wendy Atkin
General Practice Section, Division of Community Health Sciences, University of Edinburgh
Professor David Weller
Health Behaviour Research Centre, UCL, London
Professor Jane Wardle
Dr Anne Miles
Health Economics, University of Glasgow
Dr Andrew Walker
Health Economics Research Unit, University of Aberdeen
Professor Anne Ludbrook
Institute of Health & Well-being, University of Glasgow
Professor Sally Wyke
Institute for Social Marketing, University of Stirling and Open University
Professor Gerard Hastings OBE
Ms Martine Stead
ISD Scotland
Dr Roger Black
Dr David Brewster
Dr Paula McClements
MRC Social and Public Health Sciences Unit, Glasgow
Professor Kate Hunt
NHS Cancer Screening Programmes, Sheffield
Professor Julietta Patnick
NMAPP, University of Stirling
Professor Brian Williams
Physical Activity for Health Research Group, University of Strathclyde
Dr Alison Kirk
International Academic Co-Investigators
Centre for Behavioural Research in Cancer Control, Curtin University, Perth WA
Professor Peter Howatt
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Flinders Centre for Cancer Prevention and Control, Adelaide, Australia
Professor Graham Young
NGO Co-investigators
Australian Heart Foundation
Trevor Shilton
Cancer Council, Western Australia
Terry Slevin
British Heart Foundation
Andrew Carver
Sources of Funding
Bowel Cancer UK
Bowel Disease Research Foundation
Breast Cancer Research Scotland
Cancer Research UK (CRUK)
Chief Scientist Office (Scottish Government)
Macmillan
Medical Research Council
National Prevention Research Initiative (MRC)
New Opportunities Fund
NHS Health Scotland
NHS Tayside Endowment
NIHR
Randox Limited
Scottish Cancer Foundation
Tenovus
World Cancer Research Fund (WCRF)
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1. CRiPS Research Projects
I) Cancer Risk Awareness
Obesity and lifestyle interventions in colorectal cancer survivors - how well are
clinicians prepared?
Status: Complete
Funding: Cancer Research UK
Grant Holders: Anderson AS, Wells M, Steele RJC
Research Aims:
To explore clinicians’ views and educational needs in relation to obesity and lifestyle interventions for
patients treated for colorectal cancer.
Research Questions:
• To identify current knowledge and understanding about the risks and benefits of weight
management in cancer survivors
• To assess clinicians’ views of current practice in relation to weight management
• To examine perceived barriers to providing advice (written/verbal) on weight management to
cancer survivors
• To identify perceived training needs on weight management
• To raise clinicians awareness of obesity management as a relevant issue for cancer survivors
Response to being informed of weight status and body fat composition.
Understandings, reactions and motivation to achieve a healthy weight.
Status: Complete
Funding: Cancer Research UK
Investigators: Wyke S, Hunt K, Anderson AS
Research Aims:
To investigate response to the terms ‘overweight’ and ‘obese’ in relation to motivation to lose weight.
Research Questions:
• How are the terms ‘overweight’ and ‘obese’ interpreted and understood in relation to body
image and health risk?
• What is the response to being told one’s weight status in relation to self-image and motivation
to lose weight if necessary?
• Is response affected by information on one’s body fat composition?
• How, if at all, do responses to these questions vary by gender and weight status?
• What are the implications of the above findings for cancer prevention communications about
obesity and risk
Lifestyle issues for colorectal cancer survivors – perceived needs, beliefs and
opportunities.
Status: Complete
Funding: Bowel Cancer UK
Investigators: Anderson AS, Steele, RJC
10
II) Interventions for Cancer Risk Reduction
BeWEL: the impact of a BodyWEight and physicaL activity intervention on
adults at risk of developing colorectal adenomas
Status: In progress
Funding: National Prevention Research Inititiave (MRC)
Supervisors: Anderson AS, Steele RJC, Belch JJF, Daly F, Kirk A, Ludbrook A, Rodger J, Stead M, Thompson J, Trewick S,
Wardle J
Summary Colorectal cancer (CRC) is a major public health problem and often co-exists with other disorders
including obesity, type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). The proposed work
aims to evaluate the impact of the “BeWEL” intervention programme on body weight changes,
cardiovascular risk factors, diet and physical activity in healthy individuals with excess body weight
attending routine NHS clinics who have had pre-cancerous bowel polyps removed, but are at risk of
developing future cancer and other obesity related conditions. Men from the poorest backgrounds have
the highest rates of screen detected adenomas and the proposed work offers a rare opportunity to engage
with a hard to reach group. The 3 year study will be a two-arm, multi-centre, randomised controlled trial of
the BeWEL intervention against usual care. Participants will be men and women aged 50 to 74 years, with a
BMI 25m/kg2, who have been treated for the removal of a colorectal adenoma. They will be recruited after
discharge from follow-up clinics. The pre-trial development will take 6 months, participants will be
recruited over a 12 month period and undertake the intervention and follow up for 12 months with a
further 6 months for data collection, analysis and interpretation. The Intervention Group (IG) will receive
the “BeWEL” personalised, multiple contact, intervention programme (based on the clinically successful US
diabetes prevention programme), personal body weight scales and invitations to undertake supervised
monthly body weight recordings. The impact of the programme will be assessed by quantitative, qualitative
and economic analysis. The main outcomes measures will be physical activity, dietary intake and psychosocial variables as well as body weight, markers of insulin resistance and cardiovascular risk. The research
will also provide information on what factors influence decisions to engage in the programme, the response
to the intervention by deprivation category, patients’ experience of the intervention, and the NHS cost
implications. The findings will be relevant to increasing understanding of how the NHS can deliver effective
lifestyle interventions to people from diverse social backgrounds and has particular relevance for
combining disease prevention strategies with early detection procedures.
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LIVEWELL- Development and feasibility of an intensive lifestyle intervention
programme for the secondary prevention of colorectal cancer.
Status: Complete (Publication in Press Supportive Care in Cancer)
Funding: World Cancer Research Fund
Investigators: Anderson AS, Steele RJC, Wells M, Stead M
The acceptability and feasibility of a 3 month personalised lifestyle (diet ,exercise and weight management)
intervention in overweight adults who had completed curative treatment for colorectal cancer was
assessed by qualitative interviews, quality of life questionnaires, and subjective and objective measures of
diet and activity.
Over a 4 month period, 28 of 37 (75%) patients met the inclusion criteria and 20 (71%) of the eligible
patients agreed to participate in the study and 18 (90%) completed the 3 month study. Reported adherence
related to tailored advice, personalised feedback and family support. Reported barriers included time
following surgery, fatigue, having a stoma or chronic diarrhoea, and conflicting advice from clinicians. A
weight change of -1.2 (±4.4) kg was achieved overall and -4.1(±3.7) kg in the ten who had lost weight.
In Conclusion Colorectal cancer survivors will participate in a lifestyle change initiative. Interventions
should be personalised to suit abilities, provide feedback on personal goals and encourage social support.
Intervention timing and attaining greater support from clinicians should be explored prior to the
development of an efficacy trial.
Review of lifestyle interventions used in successful disease prevention
programmes
Status: Complete (See Publications)
Funding: Scottish Cancer Foundation
Investigators: Anderson AS, Steele RJC, Stead M
Bowel Health to Better Health: The development and evaluation of a family
based intervention aimed at changing diet and physical activity in people at
moderate to high risk of colo-rectal cancer
Status: Complete (See Publications)
Funding: Cancer Research UK
Investigators: Anderson AS and Steele RJC
ENJOY- a Colorectal Cancer Patient Programme
Status: Complete (Craig K (2007) Enjoy project. Evaluation of a lifestyle intervention programme for colorectal cancer
patients in Tayside. MPH thesis, University of Dundee
Funding: New Opportunities Fund
Investigators: Kerrigan J, Anderson AS, Steele RJC, Wells M
Breast Cancer Campaign: Breast – Activity & Healthy Eating after Diagnosis BAHEAD
Status: Ongoing. A randomised comparison of 3 weight control programmes during adjuvant treatment for early breast
cancer
Funding: Breast Cancer Campaign
Investigators: Harvie M, Howell T, Campbell A (Co-investigator)
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Cancer as a Catalyst for Change? Predictors of changes in diet, alcohol, physical
activity and tobacco use after colorectal cancer diagnosis among patients and
their partners
Status: Ongoing
Funding: Chief Scientist Office
Investigators: Hubbard G, Morrison D, Campbell A (Co-investigator)
5 Year Follow Up of Breast Cancer Survivors in RCT
Status: Ongoing
Funding: Macmillan
Investigators: Mutrie N, Campbell A
III) Understanding Cancer Related Health Behaviours
Secondary Analysis of the Expenditure and Food Survey – comparison of
household and eating out with the Scottish dietary targets and by area of
residence
Status: Ongoing
Funding: Food Standards Agency Scotland
Investigators: Wrieden W, Anderson AS
Understanding food culture in Scotland and its comparison in an international
context: implications for policy development
Status: Complete
Funding: NHS Health Scotland
Investigators: McMillan T, Anderson AS, Dowler E
Can a gender-sensitised weight management programme delivered by Scottish
Premier League football clubs help men lose weight? A feasibility study for a
randomised controlled trial
Status: Complete
Funding: Chief Scientist Office
Investigators: Wyke S, Hunt K, Gray C, Anderson AS, Leishman J, Mutrie N, Treweek S
Football Fans in Training (FFIT): a randomised controlled trial of a gendersensitive weight loss and healthy living programme delivered to men aged 3565 by Scottish Premier League Football clubs
Status: Ongoing
Funding: NIHR Public Health Research Programme
Investigators: Wyke S, Hunt K, Gray C, Anderson AS, Mutrie N, Treweek S, Donnan P, White A, Fenwick E, Leishman J,
MacPhee S
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The Effect of Adherence to Adjuvant Endocrine Therapy on Breast Cancer
Outcomes
Status: Completed
Funding: MRC (Personal Fellowship) & Breast Cancer Research Scotland
Investigators: McCowan C, Thompson AM, Dewar JA, Donnan PT, Fahey T, Makubate B
Increasing duration of adjuvant endocrine therapy improves survival in women with breast cancer but the
impact of adherence to therapy on mortality and recurrence is unclear. Two linked studies investigated
whether women prescribed endocrine therapy after surgery for breast cancer adhered to their prescription
and whether adherence influenced survival. The first study looked solely at tamoxifen use between 1993 &
2002 and the second study also looked at aromatase inhibitor use over the period 1993-2008.
Methods
A retrospective cohort study of all women with incident breast cancer in the Tayside region of Scotland
between 1993 and 2002 was linked to encashed prescription records to calculate adherence to endocrine
therapy. A case note review was performed to ascertain breast cancer recurrence. Survival analysis was
used to determine the effect of adherence on all-cause mortality and recurrence.
Results
2080 patients formed the initial study cohort with 1633 (79%) prescribed tamoxifen. Longer duration was
associated with better survival, the hazard ratio for mortality for duration at 2.4 years was 0.85, 95% CI
0.83-0.87. Median adherence to tamoxifen was 93% (interquartile range 84-100%). Adherence <80% was
associated with poorer survival, hazard ratio 1.10, 95% CI 1.001-1.21. Persistence with tamoxifen was
modest with only 49% continuing therapy for 5 years of those followed up for 5 years or more.
The second study looked at 4,627 patients with 1530 (33%) deaths and 726 (16%) recurrences observed.
3,328 (72%) patients received endocrine therapy with median duration of use 3.24 years (inter-quartile
range = 1.41 - 5.07). 1,415 (43%) women were treated for at least 5 years or until death. Median
adherence to therapy remained high at 93% (IQR 73-100%), although 1,008 (30%) patients had low
adherence <80%.
In Conclusion
A significant proportion of women have low adherence to endocrine therapy and published work for
tamoxifen has shown they are at increased risk of death. Increased duration of endocrine therapy reduces
the risk of death, although over one in two women do not complete the recommended 5-year course of
treatment.
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IV) Screening and Early Detection
Bowel Screening Research Unit
Status: Ongoing
Funding: Chief Scientist Office (CSO)
Investigators: Steele RJC, Brewster D, Black R, Walker A, Weller D, Fraser C
Funded by a five year CSO programme grant, a screening research unit has been established within the
Scottish Bowel Screening Centre with four basic aims:1. To utilise data collected from the demonstration pilot of colorectal cancer screening carried out in
Scotland between 2000 2006 and the ongoing Scottish National Screening Programme to
investigate changes in mortality, geographical and socio-economic variation in uptake, and
programme performance across Scotland.
2. To develop rational management plans for screen detected cancers and polyp cancers.
3. To evaluate follow up strategies in screen detected adenomas.
4. To investigate the effect of the introduction of new screening technologies. Some of the screening
projects listed below are funded entirely by the CSO programme grant. Others are supported by
the screening research unit and others are independent of the screening research unit.
Results from the First Three Rounds of the Scottish Demonstration Pilot of
FOBT Screening for Colorectal Cancer
Status: Complete (See Publications)
Funding: Scottish Government Health Department
Investigators: Steele RJC, McClements PL, Libby G, Black R, Morton C, Birrell J, Mowat NEG, Wilson JA, Kenicer M, Carey
FA, Fraser GC
A demonstration pilot programme was conducted in three Scottish NHS Boards between 2000 and 2006.
Residents aged between 50-69 years, registered on the community health index, were included in the
study. In the first round the uptake was 55%, the positivity rate was 2.07% and the cancer detection rate
was 2.1 per thousand screened. In the second round these were 53.0%, 1.90% and 1.2 per thousand
respectively and in the third round 55.3%, 1.16% and 0.7 per thousand respectively. In the first round the
positive predictive value of the FOBT was 12.0% for cancer and 36.5% for adenoma; these fell to 7.0% and
30.3% in the second round and were maintained at 7.5% and 29.1% in the third round. The percentage of
screen detected cancers diagnosed at Dukes’ Stage A was 49.2% in the first round and 40.1% in the second
round and 36.3% in the third round. These results are compatible with those of previous randomised trials
done in research settings demonstrating that population based colorectal cancer screening is feasible in
Scotland and should lead to a comparable reduction in disease specific mortality.
15
Effect of Gender, Age and Deprivation on Key Performance Indicators in an
FOBT Based Colorectal Screening Programme
Status: Complete, presented at DDW 2009, Manuscript in preparation
Funding: Chief Scientist Office (CSO) programme
Investigators: Steele RJC, Kostourou I, McClements P, Watling C, Libby G, Weller D, Brewster D, Black R, Carey F,
Fraser C
The relevant populations from the Scottish demonstration pilot of FOBT Colorectal Screening were
subdivided into four age categories and into five deprivation categories according to the Scottish Index of
Multiple Deprivation (SIMD) and key performance indicators analysed within these groups. In all rounds,
uptake of the FOBT decreased with increasing deprivation and increased with age in both sexes, although
uptake in women was significantly higher than men in all SIMD and all age groups. In addition SIMD
category correlated negatively with uptake of colonoscopy and those with a positive FOBT although this
effect was stronger in men than in women. Positivity rates increased with increasing deprivation and age in
both sexes in all rounds although they were higher in men than in women for all SIMD and age categories.
Cancer and adenoma detection rates increased with age in both men and women were consistently higher
in men than in women in all age and SIMD categories but were not consistently related to deprivation. The
PPVs for cancer and adenoma increased with age and decreased with increasing deprivation in both sexes
in all rounds and were consistently higher in men than in women in all age and SIMD categories. In this
population based colorectal screening programme, age deprivation and gender had marked effects on key
performance indicators and this has implications for both the evaluation of screening programmes and for
strategies designed to reduce inequalities.
Clinico-pathological Characteristics and Outcome of Screen Detected Cancers
Status: Complete, presented at DDW 2009, Manuscript in preparation
Funding: Chief Scientist Office (CSO) programme
Investigators: Steele RJC, Libby G, Carey F
Analysis of screen detected cancers clearly demonstrates that these are diagnosed at a much earlier stage
than symptomatic cancers. There is a tendency for screening to under diagnose right-sided cancers and to
over diagnose rectal cancers but even within these categories, stage at diagnosis is more favourable in the
screen detected cohort. In addition to this, survival analysis demonstrates that screen detected cancers
have a more favourable prognosis stage for stage than symptomatic cancers indicating that there are
subtle differences between screen detected and symptomatic cancers that are not detected by
conventional staging techniques.
Interval Cancers and the “Certificate of Health” Effect
Status: Complete, presented at DDW 2009, Manuscript in preparation
Funding: Chief Scientist Office (CSO) programme
Investigators: Steele RJC, Libby G, McClements P, Carey F, Fraser C
An interval cancer is a cancer that is diagnosed after a negative screening test and apparently in the
Scottish Screening Programme approximately 30% of cancers that are diagnosed in the screen population
are interval cancers. There is a concern that these cancers may have a particularly poor prognosis as a false
negative test may persuade an individual to ignore symptoms. We have carried out a study in which the
stage of interval cancers has been compared to both screen detected cancers and symptomatic cancers
arising in non-screened health boards in Scotland. Although interval cancers present at a more advanced
stage than screen detected cancers they do not present at a more advanced stage than symptomatic
16
cancers in non-screened areas indicating that there is no significant certificate of health effect.
Prevalence and Incidence Screening
Status: Complete, presented at DDW 2009, Manuscript in preparation
Funding: Chief Scientist Office (CSO) programme
Investigators: Steele RJC, Libby G, Carey F, Fraser C
Prevalence screening is defined as the first screening episode for an individual whereas incidence screening
is screening that is carried out in subsequent tests. It is important to determine the relative efficacy of
prevalence and incidence screening as this provides the rationale for repeating invitations. In the Scottish
demonstration pilot we have demonstrated that although uptake of prevalence screening is only 55% in the
first round, follow up of this initial cohort demonstrates that prevalence screening goes up to 65% after
three rounds. Similarly, repeated invitations for incidence screening increases uptake. It is also interesting
to note that the proportion of individuals’ early stage disease declines from about 50% for prevalence
screening to around 35% for second incidence screening indicating that incidence screens may be detecting
cancers that had been missed on prevalence or previous incidence screens. The conclusion is that repeated
invitation for both prevalence and incidence screening is worthwhile.
Adenoma Follow-up
Status: In progress
Funding: NHS Tayside Endowment
Investigators: Kostourou I, Steele RJC, Libby G, Carey F
When an adenoma has been diagnosed and removed endoscopically, patients then enter an endoscopic
surveillance programme. The evidence underlying the optimum surveillance interval is however, lacking. In
this study all patients who have had a screen detected adenoma have been tracked and the results of any
subsequent colonoscopies have been recorded. In this way we expect to determine the efficacy of different
screening intervals and the data will inform a more rational endoscopic surveillance policy.
Effect of Colorectal Cancer Screening on Disease Specific Mortality
Status: In progress
Funding: Chief Scientist Office (CSO) programme
Investigators: Libby G, Brewster D, Steele RJC
Although the randomised trials of colorectal cancer screening have consistently demonstrated reductions in
disease specific mortality, it is not clear to what extent the national population based colorectal screening
programme will have. The Scottish demonstration pilot of colorectal cancer screening provides an ideal
opportunity to study this as, during the duration of the pilot, the rest of Scotland was not being screened.
We are therefore carrying out a case control study where all individuals offered screening in the pilot
health boards are being matched with individuals of similar age, gender and deprivation category in the
non-screened health boards in order to determine the effect of population screening on colorectal cancer
mortality.
17
Economic Impact of Screening
Status: In progress
Funding: Chief Scientist Office (CSO) programme
Investigators: Walker A, Libby G, Steele RJC
The true economic impact of screening is still uncertain. UK estimates of cost effectiveness have progressed
from those based on the MRC (Nottingham) randomised trial to an evaluation alongside the UK pilot
studies yet we do not have an estimate of “Real World” cost effectiveness. To achieve this, costs will be
obtained for the various interventions from the screening centre and NHS boards and calculating cost per
life-year saved overall and for different sub-groups defined by age, sex and deprivation. In addition
projections will be used to calculate the cost saving created by reducing the need for adjuvant treatment
and the treatment of advanced disease.
Faecal Immunological Testing
Status: Complete see publications
Funding: Chief Scientist Office (CSO) programme
Investigators: Fraser C, Carey F, Steele RJC
For many years faecal occult blood testing has utilised the guaiac test which in an indirect measure of
haemoglobin and therefore susceptible to dietary interference. In the initial pilot it was found that
approximately 50% of all colonoscopies carried out for a positive FOBT detected no neoplastic pathology.
For this reason a study was carried out in which individuals awaiting colonoscopy for a positive guaiac FOBT
were offered Faecal Immunological Testing (FIT). It was found that 60% of those with a positive guaiac FOBT
had a positive FIT. Of those with a negative FIT the yield of neoplastic pathology was negligible. It would
therefore appear that the colonoscopy requirement could be reduced by 30% without adversely affecting
the yield of pathology using a two tier reflex system whereby those who had a positive guaiac FOBT would
go on to have an FIT and only have a colonoscopy if the FIT was positive. This strategy has been introduced
into the national Scottish Bowel Screening Programme.
The Psychological Effect of Interval Cancers
Status: to commence 2010
Funding: Bowel Disease Research Foundation
Investigators: Miles A (UCL), Steele RJC
There is a concern that individuals who develop interval cancers may develop psychological morbidity. For
this reason a qualitative study based on semi-structured interviews is planned to assess individuals’
reactions to developing an interval cancer. This study will be run from the Health Behaviour Research
Centre, UCL, London but will be carried out in Tayside.
The Utility of DNA Mutations in Colorectal Cancer Screening
Status: Ongoing
Funding: Randox Limited
Investigators: Jenkinson F, Fraser C, Steele RJC
18
In recent years there has been great interest in detecting DNA mutations in the stool as a marker for early
colorectal cancer. Randox Limited has developed a chip which can be used to detect 36 different mutations
in four colorectal cancer associated genes. Currently we are engaged in a sensitivity study where this
technology is being used in patients with known colorectal cancer and in individuals who have recently had
a normal colonoscopy. Study is accumulating data after overcoming considerable technical difficulties.
The Utility of Proteomics in Colorectal Cancer Screening
Status: Ongoing
Funding: Tenovus
Investigators: Goodbrand S, Ferguson M, Steele RJC
In an attempt to find plasma proteins that may be consistently associated with the presence of colorectal
and neoplasia, a large scale proteomics screen is being carried out in collaboration with Professor Mike
Ferguson of Life Sciences. This involves advanced proteomics technology which utilises mass spectrometry.
When candidate proteins have been identified it is intended to develop simple assays for these proteins in
order to test them prospectively in a screening environment.
Investigate the Diagnosis of Colorectal Polyps using Optical Projection
Tomography
Status: Ongoing
Funding: MRC T
Investigators: Steele RJC, Weddell S, Carey F, Keogh R
Investigate the Utility of Quantitative Immunological Faecal Occult Blood
Testing in Symptomatic Patients
Status: Ongoing
Funding: Evelyn Ferris Mudie Charitable Trust
Investigators: Steele, RJC
Evaluate Faecal Immunological Testing as a First-line Colorectal Screening Test
in the Scottish Population
Status: Ongoing
Funding: NHS Tayside
Investigators: Steele RJC
19
2. CRiPS Publications 2007 - 2011 (original research)
Anderson AS, Caswell S, MacAskill S, Steele RJC, Wells M (2009) "It makes you feel so full of life" LiveWell, a feasibility
study of a personalised lifestyle programme for colorectal cancer survivors. Supportive Care in Cancer; 2009 18(4):
409-415
Anderson AS, Caswell S. Obesity management--an opportunity for cancer prevention. Surgeon. 2009 Oct;7(5):282-5.
Anderson AS, Caswell S. Obesity and Cancer risk: a weighty problem in the 21st century. The Biologist. 2008;55(2):1005.
Anderson AS. Nutrition interventions in women in low-income groups in the UK. Proc Nutr Soc. 2007 Feb;66(1):25-32.
Anderson A, Dewar J, Marshall D, Cummins S, Taylor M, Dawson J, Sparks L. The development of a healthy eating
indicator shopping basket tool (HEISB) for use in food access studies-identification of key food items. Public Health
Nutr; 2007 Dec; 10(12):1440-7.
Barton KL, Wrieden WL, Anderson AS. Validity and reliability of a short questionnaire for assessing the impact of
cooking skills interventions. J Hum Nutr Diet; 2011 (In Press)
Blaney J Lowe-Strong, Rankin A, Campbell J, Allen A, Gracey J. The Cancer Rehabilitation Journey: Barriers to and
facilitators of exercise among patients with cancer-related fatigue. Physical Therapy, 2010 90 (8): 1135-1147
Bray SE, Paulin FE, Fong SC, Baker L, Carey FA, Levison DA, Steele RJ, Kernohan NM. Gene expression in colorectal
neoplasia: modifications induced by tissue ischaemic time and tissue handling protocol. Histopathology. 2010 Jan;
56(2):240-50.
Brewster DH, Clark DI, Stockton DL, Munro AJ, Steele RJC. Characteristics of patients dying within 30 days of diagnosis
of breast or colorectal cancer in Scotland, 2003-2007. Br J Cancer 2011; 104: 60-67
Burke L, Jancey J, Howat P, Lee A, Kerr D, Shilton T, Hills A, Anderson A. Physical activity and nutrition program for
seniors (PANS): protocol of a randomized controlled trial. BMC Public Health. 2010; 10:751.
Campbell A, Mutrie N, Whyte F, Emslie C, Lee L, Ritchie D, McConnachie A, Kearney N. Short and long term physical
and psychological benefits of a 12 week supervised group exercise programme during treatment for early stage breast
cancer. EJC Supplements, 2007; 5 (4): 452-452 8151
Caswell S, Anderson AS, Steele RJC Diet and physical activity in patients with colorectal adenomas -directions for
intervention programmes. J Hum Nutr Diet; 2008 21(5): 494-501
Caswell S, Anderson AS Steele RJC Bowel health to better health” A minimal contact lifestyle intervention for people
at increased risk of colorectal cancer. Br J Nutr; 2009, 102: 1541-1546
Clarke P, Jack F, Carey FA, Steele RJC (2006) Medications with anticoagulant properties increase the likelihood of a
negative colonoscopy in faecal occult blood population screening. Colorectal Disease; 8: 389-392
Craigie AM, Matthews JNS, Rugg-Gunn AJ,Lake AA, Mathers JC, Adamson AJ. Raised adolescent body mass index
predicts the development of adiposity and a central distribution of body fat in adulthood: a longitudinal study.
Obesity Facts; 2009 2(3): 157-165.
Craigie AM, Caswell S, Paterson C, Treweek S, Belch JJ, Daly F, Rodger J, Thompson J, Kirk A, Ludbrook A, Stead M,
Wardle J, Steele RJ, Anderson AS.(2011) Study protocol for BeWEl: the impact of a BodyWEight and physical L activity
intervention on adults at risk of developing colorectal adenomas (2011) BMC Public Health. 2011 Mar 25;11(1):184
Craigie AM, Barton KL, MacLeod M, Williams B, van Teijlingen E, Belch JJ, Anderson AS : the Healthforce team. (2011)
20
A feasibility study of a personalised lifestyle programme (HealthForce) for individuals who have participated in
cardiovascular risk screening. Prev Med Mar 16 52(5): 387-389
Craigie AM, Macleod M, Barton, KL, Treweek S, Anderson AS and the WeighWell team (2011) Supporting postpartum
weight loss in women living in deprived communities - design implications for a randomised control trial. Eur J Clin
Nutr (in press)
Cummins S , Smith DM, Taylor M, Dawson JM, Marshall D, Sparks L Anderson AS (2010) Neighbourhood deprivation
and the price and availability of fruit and vegetables in Scotland
J Hum Nutr Diet 5:494-501
Cummins S, Smith DM, Taylor M, Dawson J, Marshall D, Sparks L, Anderson AS. Variations in fresh fruit and vegetable
quality by store type, urban-rural setting and neighbourhood deprivation in Scotland. Public Health Nutr. 2009 Feb
26:1-7.
Dawson JM, Marshall D, Taylor M, Cummins S, Sparks L, Anderson AS. Accessing Healthy Food: Availability and price of
a healthy food basket in Scotland. Marketing Management. 2008;24(9/10):893-913.
Donnelly CM, Lowe-Strong A, Rankin JP, Campbell A, Allen JM, Gracey JH. Physiotherapy management of cancerrelated fatigue: a survey of UK current practice. Supportive Care in Cancer, 2010 July, 18 (7):817-825
Emslie C, Whyte F, Campbell A, Mutrie N, Lee L, Ritchie D, Kearney N. “I wouldn’t have been interested in just sitting
round a table talking about cancer”; exploring the experiences of women with breast cancer in a group exercise trial.
Health Education Research 2007
Foster E, Adamson AJ, Anderson AS, Barton KL, Wrieden WL. Estimation of portion size in children's dietary
assessment: lessons learnt. Eur J Clin Nutr. 2009 Feb;63 Suppl 1:S45-9.
Foster E, Matthews JN, Lloyd J, Marshall L, Mathers JC, Nelson M, Barton KL, Wrieden WL, Cornelissen P, Harris J,
Adamson AJ. Children's estimates of food portion size: the development and evaluation of three portion size
assessment tools for use with children. Br J Nutr. 2008 Jan;99(1):175-84.
Foster E, O'Keeffe M, Matthews JN, Mathers JC, Nelson M, Barton KL, Wrieden WL, Adamson AJ. Children's estimates
of food portion size: the effect of timing of dietary interview on the accuracy of children's portion size estimates. Br J
Nutr. 2008 Jan;99(1):185-90.
Fraser CG, Matthew CM, Mowat NAG, Wilson JA, Carey FA, Steele RJC Evaluation of a card collection based faecal
immunochemical test in screening for colorectal cancer using a two-tier reflex approach. Gut; 2007, 56: 1415-1418
Fraser CG, Matthew CM, McKay K, Carey FA, Steele RJC Automated immunochemical quantitation of haemoglobin in
faeces collected on cards for screening for colorectal cancer. Gut; 2008, 57: 1256-1260
Fraser CG, McDonald PJ, Colford L, Irvine A, Kenicer M, Morton C, Birrell J, Steele RJC. Experience with a wipe guaiacbased FOBT as an alternative test in a bowel screening programme. J Med Screening 2010; 17: 211-213
Goodbrand SA, Steele RJ. An overview of colorectal cancer screening. Scott Med J. 2008 Nov;53(4):31-7.
Gray C, Anderson AS, Dalziel A, Hunt K, Leishman J, Wyke S. Addressing Male Obesity: An evaluation of a group-based
weight management intervention for Scottish men. Journal of Men's Health. 2009;6(1):70-81
Haleem MA, Barton KL, Borges G, Crozier A, Anderson AS. Increasing antioxidant intake from fruits and vegetables:
practical strategies for the Scottish population. J Hum Nutr Diet. 2008 Dec;21(6):539-46
Jenkinson F, Steele RJ. Colorectal cancer screening - Methodology. Surgeon. 2010 Jun;8(3):164-71
21
Kapur G, Windsor PM, McCowan C. The Effect of Aerobic Exercise on Treatment Related Acute Toxicity in Men
Receiving Radical External Beam Radiotherapy for Localised Prostate Cancer. EJCC 2010 19 (5): 643-647
Lake AA, Adamson AJ, Craigie AM, Rugg-Gunn AJ, Mathers JC. Tracking of Dietary Intake and Factors Associated with
Dietary Change from Early Adolescence to Adulthood: The ASH30 Study. Obesity Facts; 2009 2(3): 150-156
Lawrence JM, Devlin E, Macaskill S, Kelly M, Chinouya M, Raats MM, Barton KL, Wrieden WL, Shepherd R. Factors that
affect the food choices made by girls and young women, from minority ethnic groups, living in the UK. J Hum Nutr
Diet. 2007 Aug;20(4):311-9
Libby G, Bray, J, Champion J, Colford L, Birrell J, Gorman D, Crighton E, Fraser C, Steele RJC. Pre-notification increases
uptake of colorectal cancer screening in all demographic groups: a randomised controlled trial. J Med Screening 2011;
18: 24-29
Lorimer K , Gray CM, Hunt K, Wyke S, Anderson AS Benzeval M (2011) Response to written feedback of clinical
data within a longitudinal study: a qualitative study exploring the ethical implicationsBMC Medical Research
Methodology BMC Medical Research Methodology in press
Mackison D, Wrieden WL, Anderson AS. Making an informed choice in the catering environment: what do consumers
want to know? J Hum Nutr Diet. 2009 Dec;22(6):567-73.
Mackison D, Wrieden WL, Anderson AS. Validity and reliability testing of a short questionnaire developed to assess
consumers' use, understanding and perception of food labels. Eur J Clin Nutr. 2009 Nov 11.
Maynard MJ, Baker G, Rawlins E, Anderson A, Harding S. Developing obesity prevention interventions among minority
ethnic children in schools and places of worship: The DEAL (DiEt and Active Living) study. BMC Public Health.
2009;9:480
McCowan C, Shearer J, Donnan PT, Dewar JA, Crilly M, Thompson AM, Fahey T P. Cohort study examining tamoxifen
adherence and its relationship to mortality in women with breast cancer. BJC 2008 99 1763-68
McCowan C, Donnan PT, Dewar JA, Thompson AM, Fahey T P. Identifying suspected breast cancer: development and
validation of a clinical prediction rule. Br J Gen Prac 2010 61 327-328
Mutrie N, Campbell AM, Whyte F, McConnachie A, Emslie C, Lee L, Kearney N, Walker A, Ritchie D. What are the
benefits of a supervised group exercise programme for women undergoing treatment for early stage breast cancer?
A randomised controlled trial. British Medical Journal, 2007, 334: 517
Northwood EL, Elliott F, Forman D, Barrett JH, Wilkie MJ, Carey FA, Steele RJ, Wolf R, Bishop T, Smith G.
Polymorphisms in xenobiotic metabolizing enzymes and diet influence colorectal adenoma risk. Pharmacogenet
Genomics. 2010 May;20(5):315-26
Olde Bekkink M, McCowan C, Falk G, Teljeur C, Van de Laar F, Fahey T. Diagnostic accuracy systematic review of rectal
bleeding in combination with other symptoms, signs and tests in relation to colorectal cancer. BJC 2009 102 48-58
Orbell S, O’Sullivan I, Parker R, Steele RJC, Campbell C, Weller D Illness representations and coping following an
abnormal colorectal cancer screening result. Soc Sci Med 2008; 67: 1465-1474
Quyn AJ, Appleton PL, Carey FA, Steele RJ, Barker N, Clevers H, Ridgway RA, Sansom OJ, Nathke IS. Spindle orientation
bias in gut epithelial stem cell compartments is lost in precancerous tissue. Cell Stem Cell. 2010 Feb 5;6(2):175-81
Quirke P, Steele R, Monson J, Grieve R, Khanna S, Couture J, O'Callaghan C, Myint AS, Bessell E, Thompson LC, Parmar
M, Stephens RJ, Sebag-Montefiore D. Effect of the plane of surgery achieved on local recurrence in patients with
operable rectal cancer: a prospective study using data from the MRC CR07 and NCIC-CTG CO16 randomised clinical
trial. Lancet. 2009 Mar 7;373(9666):821-8
22
Roger J, Steele RJC Telephone assessment increases uptake of colonoscopy in a FOBT colorectal cancer screening
programme. J Med Screening; 2008 15: 105-107
Sebag-Montefiore D, Stephens RJ, Steele R, Monson J, Grieve R, Khanna S, Quirke P, Couture J, de Metz C, Myint AS,
Bessell E, Griffiths G, Thompson LC, Parmar M. Preoperative radiotherapy versus selective postoperative
chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): a multicentre, randomised trial.
Lancet. 2009 Mar 7;373(9666):811-20.
Smith G, Bounds R, Wolf H, Steele RJ, Carey FA, Wolf CR. Activating K-Ras mutations outwith 'hotspot' codons in
sporadic colorectal tumours - implications for personalised cancer medicine. Br J Cancer. 2010 Feb 16;102(4):693-703
Smith DM, Cummins S, Taylor M, Dawson J, Marshall D, Sparks L, Anderson AS. Neighbourhood food environment and
area deprivation: spatial accessibility to grocery stores selling fresh fruit and vegetables in urban and rural settings. Int
J Epidemiol. 2009 Feb;39(1):277-84.
Steele RJC (2006) Faecal occult blood test screening in the United Kingdom. Am J Gastroenterology; 101: 1-3
Steele RJC (2008) Colorectal cancer screening in Scotland. Z Gastroenterol; 46(S1): 33-35
Steele RJC, McClements PL, Libby G, Black R, Morton C, Birrell J, Mowat NAG, Wilson JA, Kenicer M, Carey FA, Fraser
CG (2009) Results from the first three rounds of the Scottish Demonstration Pilot of FOBT Screening for Colorectal
Cancer. Gut; 58: 530-535
Steele RJ, Kostourou I, McClements P, Watling C, Libby G, Weller D, Brewster DH, Black R, Carey FA, Fraser C. Effect of
repeated invitations on uptake of colorectal cancer screening using faecal occult blood testing: analysis of prevalence
and incidence screening. BMJ. 2010;341:c5531. Abridged print version : Br Med J 2010; 341: 977
Steele RJ, Kostourou I, McClements P, Watling C, Libby G, Weller D, Brewster DH, Black R, Carey FA, Fraser C. Effect of
gender, age and deprivation on key performance indicators in a FOBT-based colorectal screening programme. J Med
Screen. 2010 Jun;17(2):68-74.
Steele RJ. Colorectal cancer surgery: a specialty in evolution. Surgeon. 2010 Jun;8(3):125-6.
Stephens RJ, Thompson LC, Quirke P, Steele R, Grieve R, Couture J, Griffiths GO, Sebag-Montefiore D. Impact of shortcourse preoperative radiotherapy for rectal cancer on patients' quality of life: data from the Medical Research Council
CR07/National Cancer Institute of Canada Clinical Trials Group C016 randomized clinical trial. J Clin Oncol. 2010 Sep
20;28(27):4233-9
Thaha MA, Campbell KL, Kazmi SA, Irvine LA, Khalil A, Binnie NR, Hendry WS, Walker A, Staines HJ, Steele RJ.
Prospective randomised multi-centre trial comparing the clinical efficacy, safety and patient acceptability of circular
stapled anopexy with closed diathermy haemorrhoidectomy. Gut. 2009 May;58(5):668-78
Vossenaar M, Solomons N, Valdés-Ramos R, Anderson AS Evaluating concordance with the 1997 World Cancer
Research Fund/American Institute of Cancer Research cancer prevention guidelines- challenges for the research
community Nutrition Research Reviews 2008 21, 189-206
Vossenaar M, Solomons NW, Valdés-Ramos R Anderson AS Concordance with dietary and lifestyle population goals
for cancer prevention in Dutch, Scottish, Mexican and Guatemalan population samples Nutrition 2009 26(1): 40-52
Vossenaar M, Mayorga E, Soto-Méndez MJ, Medina-Monchez SB, Campos R, Anderson AS, Solomons NW (2009) The
positive deviance approach can be used to create culturally appropriate eating guides compatible with reduced cancer
risk. J Nutr 139(4): 755-762
Vossenaar M, Solomons NW, Valdes-Ramos R, Anderson AS. Evaluating concordance with the 1997 World Cancer
23
Research Fund/American Institute of Cancer Research cancer prevention guidelines: challenges for the research
community. Nutr Res Rev. 2008 Dec;21(2):189-206
West NP, Anderin C, Smith KJ, Holm T, Quirke P, Steele R. Multicentre experience with extralevator abdominoperineal
excision for low rectal cancer. Br J Surg. 2010 Apr;97(4):588-99
Weidlich S, Walsh K, Crowther D, Burczynski ME, Fuerstein G, Carey FA, Steele RJC, Wolf CR, Miele G, Smith G.
Pyrosequencing-based methods reveal marked inter-individual differences in oncogene mutation burden in human
colorectal tumours. Br J Cancer (in press)
Windsor PM, Potter J, McAdam K, McCowan C. Evaluation of a Fatigue Initiative: Information on Exercise for Patients
Receiving Cancer Treatment. Clin Oncol (R Coll Radiol). 2009 Feb 24
Wrieden WL, Anderson AS. Measurement of food and alcohol intake in relation to chronic liver disease. Stat Methods
Med Res. 2009 Jun;18(3):285-301
Wrieden WL, Anderson AS, Longbottom PJ, Valentine K, Stead M, Caraher M, Lang T, Gray B, Dowler E. The impact of a
community-based food skills intervention on cooking confidence, food preparation methods and dietary choices - an
exploratory trial. Public Health Nutr. 2007 Feb;10(2):203-11
Wrieden WL, Longbottom PJ, Adamson AJ, Ogston SA, Payne A, Haleem MA, Barton KL. Estimation of typical food
portion sizes for children of different ages in Great Britain. Br J Nutr. 2008 Jun;99(6):1344-53
24
3. Translating and Facilitating Research to Policy and Practice
Current Government Advisory work (including UK Departments of Health and
Research Councils)
Anderson AS
NCRI/MRC – National Prevention Research Initiative (NPRI), Deputy Chair, Scientific committee
UK Depts. of Health & Food Standards Agency Scientific Advisory Committee on Nutrition (SACN),
(Ministerial appointment), 2001 to 2011
NCRI Screening Prevention Colorectal cancer Sub Group, Member
Food Standards Agency, Expert advisor, research review panel (as part of international group)
NICE Public Health Initiatives Advisory Committee, Co-opted member
Scottish Government, Food Research Committee (REERAD), Expert Advisor
Scottish Government: Workstream Lead on Health and sustainability for National Food and Drink policy
(launched 2009), (Ministerial appointment)
Steele RJC
Director, Scottish Government Scottish Bowel Screening Programme
Chair of the Programme Board
Chair, UK Depts. of Health Colorectal Cancer Screening Executive Group
Chair, Colorectal Subgroup of NHS Quality Improvement Scotland
Chair, Colorectal Screening Subgroup of NHS Quality Improvement Scotland
Chair, Colorectal Cancer Guideline Group, Scottish Intercollegiate Guidelines Network
Member, Colorectal Clinical Studies Group of the National Cancer Research Institute (NCRI)
Chair, Screening and prevention subgroup of the National Cancer Research Institute (NCRI)
Member, NHS Advisory Group on Colorectal Cancer
Member, MRC College of Experts, Health Services and Public Health Research Board
Member, Data Monitoring Committee for SIGGAR
Chair, Colorectal Subgroup of the National Core Data Set Development Group (NCDDP)
Member, Panel of Peer Reviewers, National Institute for Health Research, Health Technology Assessment
Programme
Member, Health Services Research Committee, Chief Scientist Office, Scottish Executive Health Department
25
Advisory Work for NGOs and Other Agencies
Anderson AS
Healthway, Western Australia
Visiting Professor, Centre for Behavioural Research in Cancer Control, Division of Health Sciences
Curtin University, Perth, Western Australia (2007 Healthway Visiting Research Fellow)
Scottish Cancer Foundation (SCF)
Member, Board of Directors
-
Conference co-organiser and speaker: Cancer Prevention: Evidence to Action: Food,
Nutrition and Physical Activity. Royal College of Surgeons, Edinburgh (June, 2008)
-
Conference co-organiser and speaker: Enhancing Cancer Prevention in Scotland Royal College
of Physicians, Edinburgh, August 2009
-
Survey of Cancer prevention activities by cancer agencies in Scotland (August, 2009)
-
SCF supports The Scottish Cancer Prevention Network (SCPN). Inititiated in 2009 to assist
professionals and NGOs to communicate research evidence, information and education
approaches and support advocacy work for practical action related to cancer prevention and
early detection. Anderson and Steele were founding members.
UICC (International Union against Cancer)
- Observer – (On behalf of UICC) WCRF/AICR Review Food, Nutrtition, Physical Activity and the
prevention of Cancer (2005-2009)
Bowel Cancer UK
Member, expert advisory group
26
Steele RJC
Bowel Disease Research Foundation
Trustee
Bowel Cancer UK
Member, Advisory Committee.
Melville Trust
Member, Scientific Advisory Committee.
Scottish Cancer Foundation
Chair, Board of Directors
Invited speaker, The patient journey and how to avoid it.
Cancer Prevention: Evidence to Action: Food, Nutrition and Physical Activity, Edinburgh 2008
UICC Invited Speaker/workshop organiser
The Scottish National Colorectal Cancer Screening Programme - Lessons from the First Two Rounds
UICC World Cancer Congress 2006 (Washington 2006)
Cancer screening – an opportunity for prevention?
UICC World Cancer Congress 2008, Geneva 2008
WHO International Association for Cancer Research (IARC)
Member, Committee for Quality Assurance in Colorectal Screening
Australian, Republic of Ireland, Netherlands, Portuguese and Spanish Government Health
Departments
Advisor, colorectal screening
27
Selected International/National Invited presentations for Scientific
Professional Groups (since 2007)
Anderson AS
•
Recommendation for cancer prevention - theory to practice
th
8 National Nutrition and Health Conference, London Nov 2007
•
Energy balance - an opportunity for cancer reduction
Military Hospital, Muscat, Oman, Feb 2008
•
Legga Italiana Per La Lotta contro I Tumori (Italian Cancer League)
Food, nutrition and physical activity: the latest evidence for cancer prevention, invited
presentation, Rome 2008
•
Food, Nutrition and Physical activity and the prevention of cancer
British Dietetic Association national conference, Liverpool June 2008
•
Colorectal cancer: optimising screening and prevention
NCRI cancer Conference, Birmingham, Oct 2009
•
UNESCO
Nutrition interventions in low-income groups: Dearth of research on effective interventions. June
2009, Paris
•
CSIRO
Food and drink policy in Scotland, 2009, Adelaide, South Australia
•
College of Surgeons of Hong Kong
Cancer Prevention – Global solutions to a global problem, 2010, Hong Kong
•
World Cancer Research Fund International
Nutrition, Physical Activity and Cancer Prevention: Current Challenges, New Horizons Policy and
Practice in Scotland, 2010, London
•
UICC 6th World Cancer Congress
Screening – a missed opportunity for weight management, 2008, Geneva
•
European Gastro-Enterology Foundation
Colorectal cancer prevention: is lifestyle modification achievable? 2010, Barcelona
Steele RJC
•
Increasing uptake of colon cancer screening by invitation schemes
European Conference on Colon Cancer Prevention, Brussels 2007
•
Effective Screening for Rectal Cancer
Colorectal Cancer Congress, St Gallen, Switzerland, 2007
•
Bowel Screening Today: A UK Perspective
Meeting organised by the Scottish Bowel Screening Programme, Edinburgh 2008
•
Evidence from an established screening programme based on FOBT
28
Colorectal Cancer Screening Meeting. Norwegian Directorate of Health, Oslo 2008
•
Effective screening for colorectal cancer (Bo F Holmström Lecturer)
Colorectal Surgery Symposium and Workshop at the Karolinska Institute, Stockholm 2008
•
Colorectal Screening in the United Kingdom
Screening and Management of Colorectal Cancer in Europe. Meeting Organised by ICDA
(International Digestive Cancer Alliance), Prague 2008
•
Keynote Lecture - Colorectal Cancer Screening
Joint Scientific Meeting of the College of Surgeons of Hong Kong and the Royal College of Surgeons
of Edinburgh, Hong Kong 2008
•
How to improve participation and adherence in a colorectal cancer screening programme
Moving forward to Colorectal Cancer Screening in Spain, Santa Cruz de Tenerife 2008
•
Setting up a national colorectal cancer screening programme in the United Kingdom
Visit to the Centre for Cancer Screening and Prevention Research, National Cancer Centre, Tokyo,
Japan, 2009
•
Age and other influences on screening KPIs in Scotland
OMED Colorectal Cancer Screening Meeting, DDW, Chicago, 2009
•
Indications for elective surgery in Diverticular Disease, Impact of screening on rectal cancer
surgery
10th Colorectal Surgery Symposium and Workshop, Karolinska Instituet, Stockholm, Sweden, 2009
•
Implementation of colorectal cancer screening. Presentation of a successful experience
Discussion group on colorectal cancer screening organised by the Portuguese Health Department
and the Portuguese Gastrointestinal Cancer Association, Lisbon 2010
•
Interval cancers in population screening for colorectal cancer
European Multidisciplinary Colorectal Cancer Congress, Nice, France 2010
•
Evidence based colorectal cancer screening
United European Gastroenterology Week (UEGW) Cochrane Symposium, Barcelona, Spain 2010
•
Characteristics of interval cancers in the Scottish Colorectal Cancer Screening Programme
OMED Colorectal Cancer Screening meeting, DDW, Chicago, USA 2011
29
Publications for professional groups (excluding research findings)
Anderson AS (2004) Evidence based dietary behaviour strategies to reduce cancer risk in Sancho-Garnier, H,
Biedermaan A, Slama K, Anderson AS, Lynge E (Editors). Evidence-based Cancer Prevention Strategies for
NGOs A Handbook for Europe UICC, Geneva
Anderson AS (2004) Evaluating cancer prevention activities in Sancho-Garnier H, Biedermaan A, Slama K,
Anderson AS, Lynge E (Editors). Evidence-based Cancer Prevention Strategies for NGOs, A Handbook for
Europe UICC, Geneva
Anderson AS (2008) Obesity and cancer should not be ignored Scottish Primary Care 79 p14-15
Anderson AS & Caswell S (2008) Obesity and Cancer risk: a weighty problem in the 21st century. The
Biologist 55:2 100-105
Anderson AS & Caswell S. (2009) Obesity management – an opportunity for cancer prevention The Surgeon
(in press)
Goodbrand SA, Steele RJC. An overview of colorectal cancer screening. Scot Med J 2008; 53: 31-37
Henderson NA, Steele RJC. SELDI-TOF proteomic analysis and cancer detection. Surgeon 2005; 1: 383-390
Sancho-Garnier H, Biedermaan A, Slama K, Anderson AS, Lynge E (Editors) (2004) Evidence-based Cancer
Prevention Strategies for NGOs, A Handbook for Europe UICC, Geneva
Steele RJC. Implications of screening for colorectal cancer. Practice Nursing 2005: 16: 124-126
Slevin T, Anderson AS, Doyle C, Bull F, Pratt S, and Mohandas Mallath (2009) A Healthy, Active
Childhood.UICCGenevahttp://www.worldcancercampaign.org/templates/wcc/images/pdf/2009WCC_PDFs
/Scientific%20Report/scientific%20report.pdf
See Also:
Scottish Cancer Prevention Network Newsletter edited by Anderson AS, Steele SJC; 2010 Vol. 1-4, 2011 Vol.
5-6 http://www.sitemantra.co.uk/cancerpreventionscotland/index.php?page=newsletters
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4. Public Understanding of Science and Advocacy in support of cancer
prevention and early detection
Communications for General Public
Anderson AS Dispelling the myths about foods that fight cancer, invited presentation, Perth WA, July 2007
Organised by Cancer Council of Western Australia
st
Anderson AS Healthy eating in the 21 century, invited presentation Montrose, Sep 2007 Scottish Women’s
Rural Institute (national conference)
Anderson AS At last – Proof that we can all cut cancer risk. Invited article The Scotsman Nov 2007
Anderson AS Diet and cancer prevention, invited presentation, Dundee April, 2008 Café Science, Dundee
Steele RJC and Anderson AS Prevention of colo-rectal cancer, invited presentation, Dundee Jan 2008
Organised by British Association, Dundee
Steele RJC Bowel Cancer Screening in Scotland - stakeholder meetings Dundee, Elgin and Glasgow
5. CRiPS – Visits from International Scholars
Professor Graeme Young, Flinders Centre for Cancer Prevention and Control, Adelaide. Oct 2009
Dr Cliona Ni Mhurchu, Clinical Trials Research Unit, University of Auckland. June 2010
Professor Peter Howatt, Centre for Behavioural Research in Cancer Control, Perth, Auckland. April 2011
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CRiPS Contacts:
Annie Anderson
[email protected]
Mary Wells
[email protected]
Robert Steele
[email protected]
CRiPS Contact
Professor Annie S. Anderson
Division of Clinical and Population
Sciences and Education
Ninewells Hospital and Medical School
Dundee DD1 9SY
Tel: 01382 496442
[email protected]
An affiliate of the
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