Diabetes, obesity and cancer:
At the start of this research program, we undertook a seminal piece of work (not cited more than 1500 times) through a key collaboration with Prof Matthias Egger's group at the University of Bern. We reported a systematic review and meta-analysis (224 cohort studies across 20 cancer types) using standardised approaches (Renehan et al, Lancet 2008) and quantified and ranked associations between body mass index (BMI) and cancer risk by gender. Using these data we then showed that, for 2008, approximately 124,000 new cancers in Europe are attributable to excess body weight. This forms the basis for cancer prevention in this field. A new collaboration (with Dr Isabelle Soerjomataram, IARC, Lyon) with the WCRF and IARC updated these data for the global burden of cancer attributed to excess body weight, published in Lancet Oncology in 2015.
Since 2008, we have shown in collaboration with Prof Michael Leitzmann University of Regensburg Germany that (i) increases in body weight during early adulthood increases risk of incident colorectal cancer in a gender-specific pattern (ii) increased waist circumstance is associated with increased risk of incident colorectal cancer in a gender-specific pattern and in collaboration with Prof Iain Buchan, Manchester (iii) changes in BMI over time (trends) in a population can be described in terms of 'latent classes' which differ by gender. All these observations point to the need for gender-specific and age-specific strategies to prevent obesity-related cancers.
We have written several papers on the biological mechanisms linking obesity and cancer risk.
Research from our group over the last 4 years have critically appraised the relationship between obesity and cancer outcome after the diagnosis of obesity related cancers. For example in collaboration with Dr Emma Crosbie Manchester, we have failed to demonstrate adverse associations between BMI and survival in 2 large cohorts of women diagnosed with endometrial cancer. This questions whether or not weight control strategies in cancer survivors can impact upon cancer mortality and recurrence in some cancer types.
Current research themes are in 2 areas (1) in collaboration with Prof Iain Buchan and Dr Matt Sperrin, we are teasing out the inter relationship between type 2 diabetes, BMI and cancer risk & outcome & (2) in collaboration with Prof Steve Williams Manchester, we are exploring new approaches through imaging to quantify ectopic body fat and how this relates to cancer risk and outcome.
Clinical studies in colorectal cancer and pelvic malignancies: I am lead for clinical research in Colorectal and Peritoneal Oncology Centre, the Christie. The workstreams reflect the clinical workload of this tertiary referral practice: management of anal cancer, outcome and quality of life following pelvic exenterative surgery, and after cytoreductive surgery for peritoneal surface malignancies.
We have extensively quantified the potential benefits of intensive follow-up after colorectal cancer, demonstrating that it is associated with improved survival. I am a member of the COLOFOL trial steering group, the largest trial in the world, in this field; due to publish results in 2017.