Projects

Since 1980, the canton of Zurich has maintained an epidemiological cancer registry at the Institute of Pathology and Molecular Pathology of the University Hospital Zurich (UHZ) in close collaboration with the Epidemiology, Biostatistics and Prevention Institute (EBPI) of the University of Zurich. Since 2011, the registry has also collected data for the canton of Zug. With the introduction of the Cancer Registration Law in Switzerland (https://www.bag.admin.ch/bag/de/home/gesetze-und-bewilligungen/gesetzgebung/gesetzgebung-mensch-gesundheit/gesetzgebung-krebsregistrierung.html), the registry also started cancer registration in the cantons of Schaffhausen and Schwyz. The core task is to record, as far as possible, all new incidences of cancer cases among in the population of the cantons of Zurich, Zug, Schaffhausen and Schwyz . Thus, the cancer registry serves as an instrument to monitor the cancer burden among the population. This includes systematic and continuous collection of data, analysis, comparison and interpretation of data, and dissemination of the results through by means of reporting.
For more information and to participate please visit the project page.

Project lead: Sabine Rohrmann
Funding: Canton of Zurich; FOPH (via NICER); Cancer League Zurich

Switzerland is a small country by size, but offers much diversity with respect to nature and culture. Four languages and many more dialects are spoken in Switzerland. These language differences correspond to differences in culture, dietary habits, and lifestyle habits. Our diet and our lifestyle are clearly linked to the risk of chronic diseases such as cardiovascular disease, diabetes, and most cancers. In a previous Swiss study, lifestyles adhering to recommendations of the World Cancer Research Fund / American Institute of Cancer Research (WCRF/AICR) were associated with decreased cancer mortality, particularly among men. However, that study was not able to examine differences in following a cancer-protective lifestyle across the Swiss language regions, due to the lack of data providing uniform information for Swiss language regions.

The first Swiss National Nutrition Survey, menuCH, conducted in 2014 - 2015, closed this gap. menuCH is a national survey with an in-depth assessment of the participants’ diet covering all Swiss language regions. Not only does it assess participants’ diets, but it also measures lifestyle and sociodemographic characteristics. The project proposed here aims in the first step to examine the prevalence of a cancer-protective lifestyle in Switzerland, to determine differences between language regions and to assess determinants of following a cancer-protective lifestyle. In a second step, we will link the distribution of a cancer-protective lifestyle with mortality distribution in Switzerland using geospatial techniques. Third, we will examine changes in the behavior of the Swiss population with respect to a cancer-protective lifestyle over the last 25 years. To accomplish this goal, we will use data from the Swiss Health Surveys, which have a less detailed assessment of diet than menuCH, but are conducted every five years since 1992.

The Swiss Health Surveys will allow us for evaluating lifestyle changes over time. This project will therefore provide much-needed information for public health authorities to tailor their education campaigns to specific population groups and to develop targeted, evidence-based interventions with respect to diet and physical activity where they are most needed.

Project lead: Sabine Rohrmann
Funding: Krebsforschung Schweiz

The aim of this study is to develop a semi-quantitative, web-based food frequency questionnaire (eFFQ-CH), using the menuCH photo book and the framework of a food frequency questionnaire developed at ZHAW Wädenswil. The development work will be based on results of the menuCH survey, the first national, representative nutritional data of the Swiss population. This unique approach will deliver a web-based dietary assessment tool for an adult population in Switzerland with advantages over other existing tools. Following a multi-stage approach, we first aim to use menuCH results to guide the development of the new composite FFQ. In this process, we will also consider suggestions from experts in other language-regions in Switzerland. Based on these inputs, the FFQ will be optimized for structure, food items, photographs and other aspects of respondent usability. The tool will be implemented into a state-of-art content management platform, offering many advantages for research applications. A validation study will be conducted in the German- and in the French-speaking parts of Switzerland by comparing it against a 3-day food record.

Project lead: Sabine Rohrmann & Janice Sych (ZHAW, overall-lead)
Funding: BLV (Federal Food Safety and Veterinary Office)

Background: More and more people are increasingly interested in plant-based diets (i.e., diets rich in plant-based products that include little, if any, animal products). Apart from their potential health benefits, plant-based diets have been promoted as environmentally sustainable. However, the abundance of non-scientific information online about the health impact of plant-based diets, with its wide range of credibility, is confusing to the public and can, at times, paint plant-based diets in an unfavorable light. Recently, international experts of the influential EAT-Lancet Commission recommended a mostly plant-based, sustainable diet referred to as the ‘Planetary Health Diet’. Aims and Objectives: The current study aims to investigate if individuals adhering to the planetary health diet proposed by the EAT-Lancet Commission are at a lower risk for cancer. Additionally, we will investigate if cancer survivors who adhere to the planetary health diet have lower risk of premature death compared to cancer survivors who do not adhere to the planetary health diet. We predict that people (i.e., both cancer-free and cancer survivors) who closely follow the planetary health diet will have lower risk for cancer and will live longer than those who do not closely follow the planetary health diet. How It Will Be Done: For our analysis, we will use data from the United Kingdom (UK) Biobank study. The UK Biobank study contains detailed information from 500,000 people. It includes information about their general health, dietary habits, and lifestyle recorded between 2006 and 2010 from 22 centers throughout the UK. Study participants were followed over time. Newly diagnosed cancers, as well incidences of death, were recorded. This study is a unique resource for comprehensive and powerful analyses on the potential human health benefits of a mostly plant-based, environmentally sustainable diet. Having access to such a large dataset from a European population would allow us to determine the relationship between the planetary health diet with cancer risk and death – both overall, and for specific, common cancers (i.e., breast, colorectal, prostate). Potential Impact: The information available online about the health impact of plant-based diets, with its astounding range of credibility and scientific basis, is confusing to the public and can paint plant-based diets in an unfavorable light. An influential group of international nutrition experts recently recommended a mainly plant-based diet for its benefits to the environment and human health. This recommendation gained enormous reach in the media. However, the effects of this diet on health, and particularly cancer, have yet to be evaluated. The proposed work, using data from an existing European-based cohort, will result in high-quality evidence and peer-reviewed scientific publication(s) that will bring clarity to both the public and major stakeholders regarding the health impact of the planetary health diet on cancer risk and premature death.

Project lead: Sabine Rohrmann
Funding: World Cancer Research Fund International

More than 5,700 women in Switzerland are annually diagnosed with an invasive tumour of the breast. A non-invasive (in-situ) breast cancer (BCIS) is less common than invasive breast cancer. Although these tumours are not life-threatening per se, they still need to be treated because about 20 – 25% of patients with BCIS are subsequently diagnosed with an invasive breast cancer. However, not much is known about how many women are affected in Switzerland and which factors influence the risk of invasive cancer after having had BCIS. We will use data of the cancer registry in the canton of Zurich (dating back to 1980), to examine the frequency of BCIS and the change in frequency over time until 2014. For these BCIS patients, we will analyse how they were treated, whether treatment changed in the past 35 years and how this affects a woman’s future risk of an invasive breast cancer diagnosis, and finally survival. This project aims to provide a better understanding of the prevalence of BCIS, the risk of a subsequent invasive breast cancer, and the effect of specific treatments. This information may ultimately help clinicians in their decisions regarding treatment of BCIS and the need for closer surveillance of specific BCIS patients.

Project lead: Sabine Rohrmann
Funding: Cancer Research Switzerland

This project aims at assessing (1) potential effects of and trend in animal product consumption in the population, (2) controversies about health implications on animal products consumption, (3) based on (1) and (2): defining and discussing public health implications. The project is part of NOVAnimal, funded by a NRP69 grant.
More information about the results of this project can be found on this website: https://novanimal.ch/

Project lead: Sabine Rohrmann
Funding: Swiss National Science Foundation

Background: Breast cancer had an age-standardised incidence rate of 110.9 per 100,000 person-years in the female population in Switzerland in the period 2011-2015. About 7.43% of women who had been diagnosed with an initial primary breast cancer will have a second primary breast cancer within 10 years. Being able to predict a future second breast cancer for women with a first breast cancer using patient level data is a valuable tool for doctors. Early detection, already from the first breast cancer incidence can allow them to possibly prevent a second breast cancer event, detect it earlier or choose the most beneficial available treatment. Machine learning as well as deep learning algorithms are vastly applied to the field of medical health and sometimes they work as a support system to case-based reasoning to help doctors improve accuracy of diagnostic and prognostic decisions or to enhance the performance of Computer Aided Diagnosis (CAD) systems.
Aim: The aim of this project is to build a prediction model for second breast cancer for women who have had a primary breast cancer in the past. The model should be able to classify a women with a first breast cancer as a high or low risk for a second breast cancer.

Project lead: Sabine Rohrmann

Our eating habits have far-reaching consequences for our way of life: the ways in which food is produced, processed and consumed affects the environment, the economy and society as a whole. At the same time, many common illnesses are
linked to nutrition. For these reasons, sustainability and health will be important factors in future diets. The interdisciplinary research project analyses synergies and trade-offs between these two areas. It presents different scenarios and proposes strategies to make nutrition in Switzerland healthier and more sustainable.
For more information please visit the project page.

Project lead: Sabine Rohrmann
Funding: Swiss National Science Foundation

Cancer is the second leading cause of mortality and morbidity in Switzerland, with approximately 17,200 cancer deaths and more than 46,400 incident cases in 2019. Although the age-standardized mortality rates have been decreasing over the past few decades, the burden of cancer is predicted to increase due to demographic ageing. Many cancers caused by lifestyle risk factors are preventable, suggesting the potential of reducing the cancer burden by risk reduction. Quantifying the proportion of preventable cases related to risk factors (i.e., the population attributable fraction [PAF]), especially for those that are modifiable, can assist in identifying rising threats to population health and informing preventative strategies. Previous studies from the United States, the United Kingdom, Germany, Canada, and France have reported their country-specific attributable cancer case estimates. However, in Switzerland, such comprehensive cancer risk factor estimates remain unknown, leaving a void as authorities develop and update cancer control strategies.

The aim of this project is to estimate the fraction of cancer burden attributable to modifiable risk factors in adults in Switzerland. These risk factors include alcohol drinking; tobacco (cigarette) smoking; presence of body fatness reflected by body mass index and waist circumference; physical inactivity; red meat consumption; processed meat consumption; diet low in fruit; diet low in non-starchy vegetable; diet low in fibre; diet low in dairy products; coffee consumption. Additionally, as a multilingual country with regional heterogeneity, the exposure prevalence of risk factors in Switzerland is known to vary between the major three major language regions (German, French, and Italian). We also aim to provide estimates of the attributable fraction of cancer burden on both national and regional levels.

Project lead: Sabine Rohrmann

In 2014/2015, the first Swiss National Nutrition Survey, menuCH, was conducted in a sample of about 2000 participants. These participants provided detailed information about what they eat and drink. In our project, menuCH data from will be analysed in order to assess cultural differences between language regions of Switzerland with respect to consumption, dietary patterns, and associated lifestyle factors. Differences in consumption of meat and meat products; milk and dairy; and beverages, will be compared to nutritional recommendations and assessed for evidence-based benefits and risks. Data-driven dietary patterns of menuCH data will be generated, compared with established dietary patterns such as a Mediterranean Diet or the Healthy Eating Index, and related to regional prevalence/mortality of chronic non-communicable disease. Dietary information from Swiss Health Survey will be validated with corresponding menuCH data for food and beverage intake and by comparing associations between anthropometric parameters and dietary patterns with socioeconomic/demographic factors.

Project lead: Sabine Rohrmann

Alcohol consumption is part of the dietary and lifestyle habits of many countries and populations worldwide. However, the type and quantity of alcoholic beverages consumed, as well as the context of consumption (e.g. time and place), vary greatly between cultures and countries. Until now, estimates of alcohol consumption in Switzerland have been based on alcohol tax revenues reported as alcohol volumes for the main alcoholic beverages. These data show a decline in alcohol consumption from 9.2 l to 7.7 l per person per year from 1999 to 2018, but little is known about the overall context of alcohol consumption, drinking patterns, and associated cultural and sociodemographic factors in Switzerland. The impact of alcohol consumption on health most likely depends not only on the amount and type of beverages but also on the consumption pattern and context, e.g., whether alcohol is consumed with or without food. In Switzerland, differences in mortality from cardiovascular diseases and certain cancers between the French-speaking and German-speaking parts of the country follow fairly closely the cultural habits of alcohol consumption. The average alcohol consumption is therefore not sufficient to describe the rather complex relationship between alcohol consumption and diseases such as cardiovascular diseases or even cancer. The National Consumption Study menuCH offers for the first time the possibility of an in-depth study on alcohol consumption based on a representative population from three language regions.

Project lead: Sabine Rohrmann
Funding: BLV (Federal Food Safety and Veterinary Office)