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Novel method for reviewing
mechanistic evidence on diet,
nutrition (including body
composition), physical activity and
cancer
Sarah Lewis
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Conflict of interest: None
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Aim
To develop and publish methodology for
carrying out rigorous systematic reviews of
mechanistic studies.
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Why is this important?
Wealth of data on potential mechanisms
often not taken into account.
Methods for combining information from
human, animal and cell studies are lacking.
Need to identify gaps in the research.
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Milestones
Develop a method for searching for relevant
mechanisms
Develop a method for systematically reviewing
specific mechanisms
Test the methodology above using a case study
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Analytical approach
Large multi-disciplinary group
5 workshops -mixture of presentations with
discussion, small group exercises, round
table discussions
On going searches, and development of
methods, feedback to members of the team
Regular meetings between PIs and research
associates
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Stage 1-
Search for mechanisms
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Searching for studies
Incorporate an exhaustive list of mechanistic targets (intermediate phenotypes-eg hallmarks of cancer,
hormones etc)
Three sets of searches:
Exposure-Outcome (E → O)
Exposure-Intermediate phenotype (E → IP)
Intermediate phenotype and Outcome (IP →O)
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Why automate the search for mechanisms?
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Introducing TeMMPo: Text Mining for Mechanism
Prioritisation -Tom Gaunt
Identifies co-occurrence of MESH headings in
scientific publications to indicate papers that link
an intermediate mechanism to either an exposure
or an outcome.
https://www.temmpo.org.uk/
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Sankey plot
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EXPOSURES INTERMEDIATE
MECHANISMS OUTCOMES
Automated mechanism quantification and display
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Stage 2-Systematic review of
a specific mechanism
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Step 9: Synthesis of supporting evidence from in vitro and
xenograft models underpinning biological plausibility
Step 8: Integrate human and animal studies to develop an
evidence based conclusion
Step 7: Assess strength of overall body of evidence for human and
animal studies separately
Step 6: Synthesis of data from individual studies
Step 5: Assess the quality of individual studies
Step 4: Extract data
Step 3: Apply inclusion/exclusion criteria, including an
assessment of relevance
Step 2: Search for studies
Step 1: Specify research objectives
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Cell line and animal
studies where a tumour
is transplanted into the
animal model
Supportive evidence from
in vitro and xenograft
models underpinning
biological plausibility
Question 1 - Has the
cancer arisen in the
animal model rather
than being
transplanted into
the animal?.
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Wider potential impact
Apply this to WCRF systematic review of diet,
physical activity and cancer
Apply this to other systematic reviews of cancer
Apply this to research on other diseases
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Strengths
Allows identification of potential mechanisms
Quantity and quality of data on specific
mechanisms can be assessed
Data from human and animal studies can be
assessed together
Will help to identify gaps in the research
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Limitations
Time consuming
Requires a multi-disciplinary team
Can only review one mechanism at a time
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Current gaps / priorities
Ability to identify pathways rather than single
intermediates
Ability to identify mechanisms using completely
hypothesis free approaches
Further automation to speed up process (eg
using text mining for RoB)
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Future research Incorporate changes recommended by validation
studies
Marty Weijenberg -Gökhan Ertaylan and Eline van Roekel
Rudolf Kaaks- Renée T. Fortner, Audrey Jung, Charlotte Le Cornet
WCRF funded project -Diet and prostate cancer – mechanistic reviews of BMI and Vit D and PC
Integrative Cancer Epidemiology – ICEP funded by CRUK – ongoing mechanistic reviews and work on methodology – Julian Higgins
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The Team
PI- Dr Sarah Lewis –Genetic epidemiology
Co-PI- Prof Richard Martin –Epidemiology
Dr Mona Jeffreys- Cancer Epidemiology
Dr Mike Gardner – Animal biology/systematic reviews
Prof Jeff Holly- Molecular biology – IGF and cancer
Dr Claire Perks – Molecular biology
Dr Tom Gaunt – Bioinformatics
Prof Jonathan Sterne- Systematic review methodology
Professor Julian Higgins –Evidence synthesis
Prof Steve Thomas –Head and neck cancer surgeon
Dr Pauline Emmett - Nutritional epidemiology
Dr Kate Northstone – Nutritional Epidemiology
Cath Borwick – Librarian/ Search strategies
Sean Harrison- PhD student
Rosie Lennon-PhD student
Vanessa Tan- PhD student
University of Cambridge
Dr Suzanne Turner-
Animal models
WCRF
Prof Martin Wiseman
Dr Pangiota Mitrou
Dr Rachel Thompson
IARC
Dr Sabina Rinaldi-
Hormones and cancer
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