Associations between degree of food processing and colorectal cancer risk in a large-scale European cohort
Corresponding Author
Aline Al Nahas
Nutrition and Metabolism Branch, International Agency for Research on Cancer/World Health Organization, Lyon, France
Correspondence
Aline Al Nahas, Nutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, 69007, France.
Email: [email protected]
Contribution: Conceptualization, Formal analysis, Investigation, Methodology, Software, Visualization, Writing - original draft, Writing - review & editing
Search for more papers by this authorSahar Yammine Ghantous
INSERM, INRAE, CNAM, Centre for Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Université Sorbonne Paris Nord and Université Paris Cité, Bobigny, France
Contribution: Writing - review & editing
Search for more papers by this authorFernanda Morales Berstein
MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
Contribution: Software, Writing - review & editing
Search for more papers by this authorEmine Koc Cakmak
Department of Epidemiology and Biostatistics, School of Public Health, MCR Centre for Environment and Health, Imperial College London, London, UK
Contribution: Visualization, Writing - review & editing
Search for more papers by this authorCarine Biessy
Nutrition and Metabolism Branch, International Agency for Research on Cancer/World Health Organization, Lyon, France
Contribution: Software
Search for more papers by this authorGenevieve Nicolas
Nutrition and Metabolism Branch, International Agency for Research on Cancer/World Health Organization, Lyon, France
Contribution: Visualization, Writing - review & editing
Search for more papers by this authorNathalie Kliemann
Centro de Pesquisas Oncológicas (CEPON), Santa Catarina, Brazil
Contribution: Writing - review & editing
Search for more papers by this authorJessica Blanco Lopez
Nutrition and Metabolism Branch, International Agency for Research on Cancer/World Health Organization, Lyon, France
Contribution: Writing - review & editing
Search for more papers by this authorInarie Jacobs
Nutrition and Metabolism Branch, International Agency for Research on Cancer/World Health Organization, Lyon, France
Contribution: Writing - review & editing
Search for more papers by this authorEsther M. Gonzalez-Gil
Nutrition and Metabolism Branch, International Agency for Research on Cancer/World Health Organization, Lyon, France
Contribution: Writing - review & editing
Search for more papers by this authorManon Cairat
Paris-Saclay University, UVSQ, Inserm, Gustave Roussy, CESP, Villejuif, France
Contribution: Writing - review & editing
Search for more papers by this authorMaria Gabriela Matias Pinho
Copernicus Institute of Sustainable Development, Department Environmental Sciences, Utrecht University, Utrecht, the Netherlands
Amsterdam UMC Location Vrije Universiteit Amsterdam, Epidemiology and Data Science, Amsterdam, the Netherlands
Contribution: Writing - review & editing
Search for more papers by this authorRenata Bertazzi Levy
Department of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil
Center for Epidemiological Research in Nutrition and Health, Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
Contribution: Funding acquisition, Resources, Writing - review & editing
Search for more papers by this authorFernanda Rauber
Department of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil
Center for Epidemiological Research in Nutrition and Health, Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
Contribution: Writing - review & editing
Search for more papers by this authorEszter P. Vamos
Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
Contribution: Funding acquisition, Resources, Writing - review & editing
Search for more papers by this authorKiara Chang
Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
Contribution: Writing - review & editing
Search for more papers by this authorChristopher Millett
Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
Contribution: Funding acquisition, Resources, Writing - review & editing
Search for more papers by this authorMathilde Touvier
INSERM, INRAE, CNAM, Centre for Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Université Sorbonne Paris Nord and Université Paris Cité, Bobigny, France
Contribution: Writing - review & editing
Search for more papers by this authorEmmanuelle Kesse-Guyot
INSERM, INRAE, CNAM, Centre for Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Université Sorbonne Paris Nord and Université Paris Cité, Bobigny, France
Contribution: Writing - review & editing
Search for more papers by this authorGianluca Severi
Paris-Saclay University, UVSQ, Inserm, Gustave Roussy, CESP, Villejuif, France
Department of Statistics, Computer Science, Applications “G. Parenti”, University of Florence, Florence, Italy
Contribution: Writing - review & editing
Search for more papers by this authorChloé Marques
Paris-Saclay University, UVSQ, Inserm, Gustave Roussy, CESP, Villejuif, France
Contribution: Writing - review & editing
Search for more papers by this authorMariem Hajji
Paris-Saclay University, UVSQ, Inserm, Gustave Roussy, CESP, Villejuif, France
Contribution: Writing - review & editing
Search for more papers by this authorAlessandra Macciotta
Department of Clinical and Biological Sciences, University of Turin, Orbassano, Italy
Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
Contribution: Writing - review & editing
Search for more papers by this authorGiovanna Masala
Clinical Epidemiology Unit, Institute for Cancer Research, Prevention, and Clinical Network (ISPRO), Florence, Italy
Contribution: Writing - review & editing
Search for more papers by this authorMario Fordellone
Medical Statistics Unit, University of Campania Luigi Vanvitelli, Naples, Italy
Contribution: Writing - review & editing
Search for more papers by this authorClaudia Agnoli
Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
Contribution: Writing - review & editing
Search for more papers by this authorPilar Amiano
Ministry of Health of the Basque Government, Sub Directorate for Public Health and Addictions of Gipuzkoa, San Sebastian, Spain
BioGipuzkoa (BioDonostia) Health Research Institute, Epidemiology of Chronic and Communicable Diseases Group, San Sebastián, Spain
Contribution: Writing - review & editing
Search for more papers by this authorMarcela Guevara
Instituto de Salud Pública y Laboral de Navarra, Pamplona, Spain
Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
Contribution: Writing - review & editing
Search for more papers by this authorAnne Tjønneland
Danish Cancer Institute, Diet, Cancer and Health, Copenhagen, Denmark
Department of Public Health, University of Copenhagen, Copenhagen, Denmark
Contribution: Writing - review & editing
Search for more papers by this authorCecilie Kyrø
Danish Cancer Institute, Diet, Cancer and Health, Copenhagen, Denmark
Contribution: Writing - review & editing
Search for more papers by this authorJeroen W. G. Derksen
Department of Epidemiology and Health Economics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
Contribution: Writing - review & editing
Search for more papers by this authorKarel C. Smit
Department of Epidemiology and Health Economics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
Contribution: Writing - review & editing
Search for more papers by this authorMatthias B. Schulze
Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany
Contribution: Writing - review & editing
Search for more papers by this authorFranziska Jannasch
Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
Contribution: Writing - review & editing
Search for more papers by this authorRudolf Kaaks
Division of Cancer Epidemiology (C020), German Cancer Research Center (DKFZ), Heidelberg, Germany
Contribution: Writing - review & editing
Search for more papers by this authorVerena Katzke
Division of Cancer Epidemiology (C020), German Cancer Research Center (DKFZ), Heidelberg, Germany
Contribution: Writing - review & editing
Search for more papers by this authorTonje Braaten
Department of Community Medicine, UIT The Arctic University of Norway, Tromsø, Norway
Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
Contribution: Writing - review & editing
Search for more papers by this authorMagritt Brustad
Department of Community Medicine, UIT The Arctic University of Norway, Tromsø, Norway
The Public Dental Health Service Competence Centre of Northern Norway, Tromsø, Norway
Contribution: Writing - review & editing
Search for more papers by this authorGuri Skeie
Nutrition and Metabolism Branch, International Agency for Research on Cancer/World Health Organization, Lyon, France
Department of Community Medicine, UIT The Arctic University of Norway, Tromsø, Norway
Contribution: Writing - review & editing
Search for more papers by this authorRhea Harewood
Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
Contribution: Writing - review & editing
Search for more papers by this authorAlicia Heath
Cancer Epidemiology and Prevention Research Unit, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
Contribution: Writing - review & editing
Search for more papers by this authorPaolo Vineis
Department of Epidemiology and Biostatistics, School of Public Health, MCR Centre for Environment and Health, Imperial College London, London, UK
Italian Institute for Genomic Medicine (IIGM), Turin, Italy
Contribution: Writing - review & editing
Search for more papers by this authorElisabete Weiderpass
Nutrition and Metabolism Branch, International Agency for Research on Cancer/World Health Organization, Lyon, France
Contribution: Writing - review & editing
Search for more papers by this authorPietro Ferrari
Nutrition and Metabolism Branch, International Agency for Research on Cancer/World Health Organization, Lyon, France
Contribution: Writing - review & editing
Search for more papers by this authorMarc J. Gunter
Nutrition and Metabolism Branch, International Agency for Research on Cancer/World Health Organization, Lyon, France
Cancer Epidemiology and Prevention Research Unit, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
Contribution: Conceptualization, Funding acquisition, Methodology, Resources, Supervision, Validation, Writing - review & editing
Search for more papers by this authorInge Huybrechts
Nutrition and Metabolism Branch, International Agency for Research on Cancer/World Health Organization, Lyon, France
Contribution: Conceptualization, Funding acquisition, Methodology, Resources, Supervision, Validation, Writing - review & editing
Search for more papers by this authorCorresponding Author
Aline Al Nahas
Nutrition and Metabolism Branch, International Agency for Research on Cancer/World Health Organization, Lyon, France
Correspondence
Aline Al Nahas, Nutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, 69007, France.
Email: [email protected]
Contribution: Conceptualization, Formal analysis, Investigation, Methodology, Software, Visualization, Writing - original draft, Writing - review & editing
Search for more papers by this authorSahar Yammine Ghantous
INSERM, INRAE, CNAM, Centre for Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Université Sorbonne Paris Nord and Université Paris Cité, Bobigny, France
Contribution: Writing - review & editing
Search for more papers by this authorFernanda Morales Berstein
MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
Contribution: Software, Writing - review & editing
Search for more papers by this authorEmine Koc Cakmak
Department of Epidemiology and Biostatistics, School of Public Health, MCR Centre for Environment and Health, Imperial College London, London, UK
Contribution: Visualization, Writing - review & editing
Search for more papers by this authorCarine Biessy
Nutrition and Metabolism Branch, International Agency for Research on Cancer/World Health Organization, Lyon, France
Contribution: Software
Search for more papers by this authorGenevieve Nicolas
Nutrition and Metabolism Branch, International Agency for Research on Cancer/World Health Organization, Lyon, France
Contribution: Visualization, Writing - review & editing
Search for more papers by this authorNathalie Kliemann
Centro de Pesquisas Oncológicas (CEPON), Santa Catarina, Brazil
Contribution: Writing - review & editing
Search for more papers by this authorJessica Blanco Lopez
Nutrition and Metabolism Branch, International Agency for Research on Cancer/World Health Organization, Lyon, France
Contribution: Writing - review & editing
Search for more papers by this authorInarie Jacobs
Nutrition and Metabolism Branch, International Agency for Research on Cancer/World Health Organization, Lyon, France
Contribution: Writing - review & editing
Search for more papers by this authorEsther M. Gonzalez-Gil
Nutrition and Metabolism Branch, International Agency for Research on Cancer/World Health Organization, Lyon, France
Contribution: Writing - review & editing
Search for more papers by this authorManon Cairat
Paris-Saclay University, UVSQ, Inserm, Gustave Roussy, CESP, Villejuif, France
Contribution: Writing - review & editing
Search for more papers by this authorMaria Gabriela Matias Pinho
Copernicus Institute of Sustainable Development, Department Environmental Sciences, Utrecht University, Utrecht, the Netherlands
Amsterdam UMC Location Vrije Universiteit Amsterdam, Epidemiology and Data Science, Amsterdam, the Netherlands
Contribution: Writing - review & editing
Search for more papers by this authorRenata Bertazzi Levy
Department of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil
Center for Epidemiological Research in Nutrition and Health, Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
Contribution: Funding acquisition, Resources, Writing - review & editing
Search for more papers by this authorFernanda Rauber
Department of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil
Center for Epidemiological Research in Nutrition and Health, Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
Contribution: Writing - review & editing
Search for more papers by this authorEszter P. Vamos
Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
Contribution: Funding acquisition, Resources, Writing - review & editing
Search for more papers by this authorKiara Chang
Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
Contribution: Writing - review & editing
Search for more papers by this authorChristopher Millett
Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
Contribution: Funding acquisition, Resources, Writing - review & editing
Search for more papers by this authorMathilde Touvier
INSERM, INRAE, CNAM, Centre for Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Université Sorbonne Paris Nord and Université Paris Cité, Bobigny, France
Contribution: Writing - review & editing
Search for more papers by this authorEmmanuelle Kesse-Guyot
INSERM, INRAE, CNAM, Centre for Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Université Sorbonne Paris Nord and Université Paris Cité, Bobigny, France
Contribution: Writing - review & editing
Search for more papers by this authorGianluca Severi
Paris-Saclay University, UVSQ, Inserm, Gustave Roussy, CESP, Villejuif, France
Department of Statistics, Computer Science, Applications “G. Parenti”, University of Florence, Florence, Italy
Contribution: Writing - review & editing
Search for more papers by this authorChloé Marques
Paris-Saclay University, UVSQ, Inserm, Gustave Roussy, CESP, Villejuif, France
Contribution: Writing - review & editing
Search for more papers by this authorMariem Hajji
Paris-Saclay University, UVSQ, Inserm, Gustave Roussy, CESP, Villejuif, France
Contribution: Writing - review & editing
Search for more papers by this authorAlessandra Macciotta
Department of Clinical and Biological Sciences, University of Turin, Orbassano, Italy
Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
Contribution: Writing - review & editing
Search for more papers by this authorGiovanna Masala
Clinical Epidemiology Unit, Institute for Cancer Research, Prevention, and Clinical Network (ISPRO), Florence, Italy
Contribution: Writing - review & editing
Search for more papers by this authorMario Fordellone
Medical Statistics Unit, University of Campania Luigi Vanvitelli, Naples, Italy
Contribution: Writing - review & editing
Search for more papers by this authorClaudia Agnoli
Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
Contribution: Writing - review & editing
Search for more papers by this authorPilar Amiano
Ministry of Health of the Basque Government, Sub Directorate for Public Health and Addictions of Gipuzkoa, San Sebastian, Spain
BioGipuzkoa (BioDonostia) Health Research Institute, Epidemiology of Chronic and Communicable Diseases Group, San Sebastián, Spain
Contribution: Writing - review & editing
Search for more papers by this authorMarcela Guevara
Instituto de Salud Pública y Laboral de Navarra, Pamplona, Spain
Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
Contribution: Writing - review & editing
Search for more papers by this authorAnne Tjønneland
Danish Cancer Institute, Diet, Cancer and Health, Copenhagen, Denmark
Department of Public Health, University of Copenhagen, Copenhagen, Denmark
Contribution: Writing - review & editing
Search for more papers by this authorCecilie Kyrø
Danish Cancer Institute, Diet, Cancer and Health, Copenhagen, Denmark
Contribution: Writing - review & editing
Search for more papers by this authorJeroen W. G. Derksen
Department of Epidemiology and Health Economics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
Contribution: Writing - review & editing
Search for more papers by this authorKarel C. Smit
Department of Epidemiology and Health Economics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
Contribution: Writing - review & editing
Search for more papers by this authorMatthias B. Schulze
Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany
Contribution: Writing - review & editing
Search for more papers by this authorFranziska Jannasch
Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
Contribution: Writing - review & editing
Search for more papers by this authorRudolf Kaaks
Division of Cancer Epidemiology (C020), German Cancer Research Center (DKFZ), Heidelberg, Germany
Contribution: Writing - review & editing
Search for more papers by this authorVerena Katzke
Division of Cancer Epidemiology (C020), German Cancer Research Center (DKFZ), Heidelberg, Germany
Contribution: Writing - review & editing
Search for more papers by this authorTonje Braaten
Department of Community Medicine, UIT The Arctic University of Norway, Tromsø, Norway
Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
Contribution: Writing - review & editing
Search for more papers by this authorMagritt Brustad
Department of Community Medicine, UIT The Arctic University of Norway, Tromsø, Norway
The Public Dental Health Service Competence Centre of Northern Norway, Tromsø, Norway
Contribution: Writing - review & editing
Search for more papers by this authorGuri Skeie
Nutrition and Metabolism Branch, International Agency for Research on Cancer/World Health Organization, Lyon, France
Department of Community Medicine, UIT The Arctic University of Norway, Tromsø, Norway
Contribution: Writing - review & editing
Search for more papers by this authorRhea Harewood
Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
Contribution: Writing - review & editing
Search for more papers by this authorAlicia Heath
Cancer Epidemiology and Prevention Research Unit, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
Contribution: Writing - review & editing
Search for more papers by this authorPaolo Vineis
Department of Epidemiology and Biostatistics, School of Public Health, MCR Centre for Environment and Health, Imperial College London, London, UK
Italian Institute for Genomic Medicine (IIGM), Turin, Italy
Contribution: Writing - review & editing
Search for more papers by this authorElisabete Weiderpass
Nutrition and Metabolism Branch, International Agency for Research on Cancer/World Health Organization, Lyon, France
Contribution: Writing - review & editing
Search for more papers by this authorPietro Ferrari
Nutrition and Metabolism Branch, International Agency for Research on Cancer/World Health Organization, Lyon, France
Contribution: Writing - review & editing
Search for more papers by this authorMarc J. Gunter
Nutrition and Metabolism Branch, International Agency for Research on Cancer/World Health Organization, Lyon, France
Cancer Epidemiology and Prevention Research Unit, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
Contribution: Conceptualization, Funding acquisition, Methodology, Resources, Supervision, Validation, Writing - review & editing
Search for more papers by this authorInge Huybrechts
Nutrition and Metabolism Branch, International Agency for Research on Cancer/World Health Organization, Lyon, France
Contribution: Conceptualization, Funding acquisition, Methodology, Resources, Supervision, Validation, Writing - review & editing
Search for more papers by this authorMarc J. Gunter and Inge Huybrechts are considered as joint senior authors.
[Correction added on 01 March 2025, after first online publication: The affiliation of Franziska Jannasch has been updated.]
Abstract
Industrial food processing has been linked to various health outcomes including cancer. To examine associations between the degree of food processing and risk of colorectal cancer (CRC) and its sub-sites, data from the European Prospective Investigation into Cancer (EPIC) including 6155 incident CRC cases (n = 450,111 participants), were analyzed. Dietary intakes were assessed using baseline food frequency questionnaires. Foods were classified into culinary ingredients, unprocessed, processed (PFs), and ultra-processed foods (UPFs) according to the Nova classification. Cox proportional hazards models, adjusted for established CRC risk factors, were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) associated with a 10% increase in proportion of consumption (%g/d) of each Nova group. Substitution analysis examined the effect of replacing UPFs and PFs with unprocessed foods on CRC risk. A 10% increase in proportion of UPFs was associated with 6% higher CRC risk (95% CI:1.02–1.10). A positive association was also found between PFs and CRC risk (HR per 10% increase: 1.10 [95% CI, 1.05–1.15]). Conversely, unprocessed food consumption was inversely associated with CRC risk (HR per 10% increase: 0.93[95% CI, 0.90–0.95]). Substitution of 10% of the overall proportion of the diet comprising UPFs or PFs with 10% unprocessed foods was associated with a decreased risk of CRC (HRUPFs: 0.94 [95% CI, 0.90–0.97]; HRPFs: 0.90 [95% CI, 0.86–0.94]). In conclusion, UPF was positively associated with CRC risk while diets richer in unprocessed foods were associated with lower CRC risk. Further studies are needed to understand the mechanisms by which food processing affects CRC risk.
Graphical Abstract
What's new?
The role of food processing in influencing colorectal cancer development is uncertain. Associations between food processing and colorectal cancer risk were investigated in the EPIC cohort including 6155 cases. Overall, consumption of ultra-processed foods (UPFs) and processed foods were positively associated with colorectal cancer risk, while unprocessed foods were associated with lower risk. These findings support the potential of replacing processed foods by minimally processed foods for colorectal cancer prevention.
CONFLICT OF INTEREST STATEMENT
The authors declare no conflict of interests.
Open Research
DATA AVAILABILITY STATEMENT
For information on how to apply for gaining access to EPIC data and/or biospecimens, please follow the instructions at https://epic.iarc.fr/access/. Further information is available from the corresponding author upon request.
Supporting Information
| Filename | Description |
|---|---|
| ijc35361-sup-0001-Supinfo.pdfPDF document, 15 MB | DATA S1. Supporting information. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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