Home | Online Resources | UB Catalog | Campus Libraries | About UB Libraries | Forms | Search | Help

NATIONAL INSTITUTES OF HEALTH
National Cancer Institute
Division of Cancer Prevention

New Directions for Nutritional Research at the National Cancer Institute:
Report of the Nutrition Implementation Group November 1999, Executive Summary

Executive Summary
Prevention must be a principal component of our Nation's strategy to reduce the burden of cancer among Americans. Both the scientific community and the general public have become aware of the benefits of wise lifestyle choices in reducing cancer risk. Avoidance of smoking certainly is recognized widely as a lifestyle choice that reduces the risk of lung cancer. A convincing body of epidemiologic evidence and corroborating experimental studies indicate that, apart from smoking, dietary factors are most consistently associated with variations in cancer incidence. A landmark report by Doll and Peto (1981) estimated that dietary factors are associated with about one-third of all cancers. In general, vegetables and fruits, dietary fiber, and certain micronutrients appear to be protective against cancer, whereas fat, excessive calories, and alcohol seem to increase cancer risk. The specific effects of these dietary factors on cancer development, however, likely vary by cancer site and type. Because diet is a lifestyle choice that can be controlled by individuals, it is a logical focal point for cancer prevention strategies.

Based on the large body of available evidence, the existence of a clear link between nutrition and cancer is not in question, but arriving at a clear definition of the causal and mechanistic relationships between specific dietary constituents and cancers at various organ sites has proved to be more elusive. It is recognized that diet-related factors, such as amount and type of dietary fat intake, amount and variety of vegetables and fruits consumed, level of alcohol consumption, total energy intake, level of physical activity, and obesity, are part of an intricate and inseparable interaction of lifestyle choices that can contribute to cancer risk. However, we presently have no quantitative information on the optimal intakes of dietary energy, specific nutrients, or levels of physical activity and/or body weight for cancer prevention. These diet-related factors, working together with other environmental exposures within a given genotype, contribute to the particular cancer risk profile of an individual. At present, a readily integrated approach for linking diet and its constituents and genotype to arrive at a reliable determination of cancer risk does not exist. Until this goal is achieved, the development and conduct of strategies and studies aimed at reducing cancer risk can be based only on current but inadequate knowledge. Thus, it is critical that research continues to expand the knowledge base relevant to nutrition and cancer risk and to enhance our understanding of the mechanistic basis for the diet and cancer relationship.

Beginning in the early 1980s, efforts in diet and cancer research at the National Cancer Institute (NCI), pursued through both extramural and intramural mechanisms, have grown significantly. In recent years, the Division of Cancer Prevention (DCP) has consistently supported approximately one-third of the total nutrition-related projects funded by the NCI. These projects have included studies of basic mechanisms-of-action of dietary constituents, methodology development, assessment of biomarkers, human metabolic studies, clinical trials of both dietary modification and the chemopreventive potential of individual nutrients, and population-based studies.

The Nutrition Implementation Group (NutrIG), which includes 22 leading scientists from the NCI, other federal agencies, and the extramural community, was given the mandate to advise the NCI, through the DCP, regarding the character and conduct of an invigorated, leading-edge nutrition/cancer research effort. Tthat is, how should the NCI encourage the broader involvement of the nutritional science community and simultaneously strengthen nutritional sciences to achieve more depth in the study of nutrition-cancer relationships? Further, what mechanisms can be established to incorporate molecular genetics and cell biology more extensively into this important area of biology and public health? The NutrIG was charged with developing recommendations for implementation of this effort. The report of the NCI Cancer Prevention Program Review Group (CPPRG) was used by the NutrIG as the initial basis for discussion.

Two major meetings of the NutrIG were held on August 26, 1998, and February 19, 1999, during which the NutrIG identified seven recommendations that addressed the general area of strengthening ties to basic nutritional science, broadening extramural research so as to foster translational research (i.e., bridging basic science to public benefit), and providing opportunities for training and career development.

This report includes an Executive Summary to provide an overview of the NutrIG's recommendations. The full report provides a more detailed rationale for the recommendations. The overlap between the Executive Summary and the full report is intentional, because each is designed to meet the needs of different readers. Based, in part, on our understanding of the multi-disciplinary character of nutritional science, as described in the main body of the report, the NutrIG's recommendations for strengthening the nutritional sciences research effort in the NCI Cancer Prevention Research Program are summarized below. The committee recognized that nutrition-related research also was under way in other divisions of the NCI, particularly within the Division of Cancer Control and Population Sciences (DCCPS) in the areas of epidemiology, behavioral, and dietary assessment methodology. However, those areas are not specifically emphasized in this report.

RECOMMENDATIONS

1 Create a trans-NCI Coordinating Committee 1 on Nutrition and Cancer led by the Division of Cancer Prevention.

At present, about 25 percent of the National Institutes of Health (NIH) nutrition research budget is allocated to the NCI. However, the administrative conduct of nutrition research at the NCI is being coordinated at various locations across the Institute. There is a need  to better coordinate and integrate nutrition-related research efforts across NCI Divisions to avoid unnecessary duplication of efforts, to use resources most effectively, and to better exploit the advantages of synergy that can be created when researchers with different views and problem-solving approaches tackle a common research issue. Creating a matrix among Divisions, focused on nutritional science, would strengthen the scientific foundation for this area. To provide leadership and stewardship, a trans-NCI Coordinating Committee on Nutrition and Cancer with a strong management mandate should be created at an early opportunity. This Committee would communicate with the NCI Director and serve in developing and enhancing the investigation of nutrition in cancer causation and prevention as well as function as an information and communication channel with other agencies.

2 Establish a number of programs of excellence in nutritional science and cancer prevention, including several at existing cancer centers. Allow an ample period to develop interdisciplinary Request for Application (RFA) responses.

The goal is to develop strong, mechanistic-based interdisciplinary programs of excellence in nutritional science and cancer prevention through RFA mechanisms. Cancer centers should be encouraged to develop interdisciplinary nutrition research programs that are strongly grounded in modern nutritional science and linked to molecular and cellular biology. Center directors should have the authority to recruit scientists from various disciplines, to form interactive groups that can develop sound nutrition-focused research agendas, and to apply for funding. Several cancer centers across the country might be designated as programs of excellence in molecular and nutritional oncology research as a way to expand this research field. Vigorous efforts also should be made to link cancer centers with existing centers of excellence of nutrition, particularly those at agricultural universities that have strong basic nutritional and food science research programs.

3 Provide developmental funds to encourage nutritional science-related pilot projects in existing cancer centers.

Future research in nutritional science and cancer prevention must emphasize the relationship between nutritional science and basic science. Areas of research focus might include: clinical-metabolic research, validated biomarkers of dietary exposure, functional interactions among dietary constituents, mechanisms of nutrient action, nutrient/gene interactions, and dietary/ environmental factor interactions. This list is not intended to be all-encompassing.

4 Hold interdisciplinary workshops linking basic areas of biology and nutritional sciences with cancer etiology and pathogenesis.

To advance the field of nutritional sciences and cancer prevention, it will be necessary to bring nutrition scientists more rapidly into the mainstream of genetics, as well as molecular and cellular biology. In addition, it will be necessary to secure an increased interest by molecular and cellular scientists in the nutritional sciences. Interdisciplinary workshops on basic science issues such as signal transduction, DNA methylation, and genetic polymorphisms-with a focus on the ties between these basic science issues and the molecular and cellular aspects of the nutritional sciences-could help enhance the appreciation of the scientific community for the importance of the essential links between basic science and nutritional research. These workshops would include planning sessions to outline the followup aims and approaches to be taken.

5 Enhance training and career development in the nutritional sciences aspects of cancer research.

A sufficient intellectual resource is a key component of any successful scientific endeavor. It is necessary to enhance university education and training in the nutritional sciences at several levels-that is, for undergraduates, graduate students, and medical students. The infrastructure for education and training opportunities should cut across schools of science, medicine, and public health as well as across relevant links with schools of agriculture, where many strong nutrition research programs currently reside. Various mechanisms for funding training should be considered. For example, NCI/DCP training grants could be awarded to basic scientists who are in translational fields or whose work is prevention-related. Also, cancer centers could be encouraged to develop nutrition research programs using both institutional awards and K07 individual awards as funding mechanisms. Finally, mechanisms should be put in place to encourage extramural scholars to spend sabbaticals and other research time on the NIH campus.

6 Assure an appropriate mix of reviewers for diet and cancer research grant applications.

Nutritional science and cancer research involves a far more complex vision of relevant areas of investigations that can be accommodated by the current peer-review system. It is very important that peer reviewers have both the expertise and the interest in nutritional science, which is not currently the case. Because many of the research approaches in diet and cancer prevention will, by necessity, be multidisciplinary in nature, it is recommended that a unique study review section be established at the NIH/NCI to evaluate and promote cancer prevention research that incorporates nutritional science as a key area of interest. Establishing and maintaining an appropriate mix of peer reviewers for applications that link the nutritional sciences to cancer prevention will be key to obtaining funding of relevant research in this area.

7 Invite nutritional scientists to join the NCI Board of Scientific Advisors (BSA).

The NCI's BSA, the body that reviews/approves proposed RFAs by NCI Divisions, must include nutrition scientists with an adequate understanding of basic science and cancer prevention research. At present, there is a lack of such scientists on the Board. The current NCI BSA should be expanded to include individuals with this expertise, who would be available to serve on a subcommittee of the BSA, formed specifically to advise the DCP.

For the complete Implementation report, see http://dcp.nci.nih.gov

NATIONAL CANCER INSTITUTE
NIH Publications No. 00-4759 March 2000
T401

Top of Page