Condition category
Date applied
Date assigned
Last edited
Retrospectively registered
Overall trial status
Recruitment status
No longer recruiting
Publication status

Plain English Summary

Not provided at time of registration

Trial website

Contact information



Primary contact

Mr Mark Watson


Contact details

Norfolk and Norwich Health Care NHS Trust
Department of Gastroenterology
West Norwich Hospital
Bowthorpe Road
United Kingdom
+44 (0)1603 288111

Additional identifiers

EudraCT number number

Protocol/serial number

N0499010351; Watson HSR/06/97

Study information

Scientific title


Study hypothesis

CRC risk is affected by diet and by genetic polymorphisms leading to inter-individual variation in the metabolism of environmental carcinogens. Our first hypothesis is that these effects may combine to place certain individuals at greatly enhanced risk according to their diet. We shall examine how dietary factors known to affect CRC risk (including meats, fat, fruit and vegetables, cooking methods, dietary supplements and drugs) and genetic polymorphisms implicated in CRC (Glutathione S-transferase: GSTM1, GSTM3, GSTT1; N-acetyl transferase: NAT1, NAT2; and Cytochrome P450: CYP1A1, CYP2D6) combine to affect the prevalence of colorectal polyps, both adenomatous (the precursor lesion of CRC) and metaplastic.
Our second hypothesis is that diets associated with increased risk (high red meat, low vegetable and low fibre consumption) may affect DNA damage markers which may be elevated in people with colorectal adenomas.
We shall therefore examine the effect of diet on adduct rates (cross sectional) and adduct rates in people with and without colorectal adenomas. We shall examine malondialdehyde adduct rates in relation to anti-oxidant status and carboxymethyl adduct rates and k-ras mutation frequency in relation to meat consumption; and examine the effect of DNA repair enzyme (ATase) activity on any relationship found. In summary the aim of this population based study is to link dietary factors thought to be important in the genesis of colorectal polyps and cancer with genetic polymorphisms and DNA damage markers in rectal mucosa and in blood.

Ethics approval

Not provided at time of registration

Study design

Randomised controlled trial

Primary study design


Secondary study design

Randomised controlled trial

Trial setting

Not specified

Trial type

Not Specified

Patient information sheet

Not available in web format, please use the contact details below to request a patient information sheet


Colorectal cancer


The first arm involves volunteers common to both EPIC and Flexi-Scope studies. We shall study people with adenomatous polyps and matched controls only. The prospectively collected accurate dietary data collected within EPIC is favoured for analyses of diet and DNA damage markers. In those EPIC participants who have polyps (est. 100 adenomatous and 100 metaplastic) a peripheral blood sample will be taken for genotyping and malondialdehyde (MDA) adduct assay: and rectal biopsies for MDA and CBM adduct assay, ATase activity and k-ras mutation frequency. Polyp free age/sex/GP practice/race matched controls (est.100) will be identified for each subject with adenomatous polyps and the same samples collected.
The second arm involves non-EPIC participants (est. total 2000) and in these people dietary data will be collected by food frequency questionnaire compatible with that used within EPIC (and validated within EPIC).
We shall study people with adenomatous and metaplastic polyps and matched controls. This arm of the study will also be conducted in parallel in the Leeds and Portsmouth centres of the Flexi-Scope Trial permitting greater sample sizes and a diverse sample population. A peripheral blood sample will be taken from people with polyps (total 400 in Norwich, 200 adenomatous and 200 metaplastic) for genotyping. Matched polyp free controls will be identified for each person with adenomatous polyps (200).
Data from the Flexi-Scope trial is collected and processed on an EpiInfo (Version 6.0) database and data from this study will be incorporated within this. The food questionnaire will be scanned and processed within the Flexi-Scope Trial. DNA isolation will be performed by Mr Watson in Norwich. Genetic analysis and k-ras mutation frequency will be performed by Dr Alex Loktionov (MRC Dunn Clinical Nutrition Centre, Cambridge) using accepted techniques already running in that laboratory. DNA adduct assays will be performed by Dr Chiara Leuratti (MRC Toxicology Unit, Univ. of Leicester) by techniques established in that laboratory and adapted for colonic biopsies in a recent pilot study. DNA repair enzyme will be assayed by Dr Geoff Margison (Paterson Institute, Manchester) by accepted techniques currently running in that laboratory.
Rarely do two large multi-centre studies such as the EPIC study and the Flexi-Scope Trial overlap in terms of the population studied. This overlap affords us an opportunity to conduct this research which would be difficult and costly to recreate.

As of 10/08/09 the start and end dates of this trial were updated from 01/07/97 and 01/07/99 to 01/08/97 and 01/02/2000 respectively. The initial dates were generated at the time of registration.

Intervention type



Not Specified

Drug names

Primary outcome measure

We shall perform cross-sectional and case-control analyses of the effect of diet and genetic polymorphisms on the prevalence of adenomatous and metaplastic polyps. Genetic polymorphisms will be examined in isolation and paired combinations and in groups stratified according to diet. We shall examine the effect of diet on MDA adduct rates (concentrating on foods relating to anti-oxidant status) and CBM adduct rates and k-ras mutations (concentrating on meat consumption and cooking methods) by categorical variables; and MDA and CBM adducts and k-ras mutation frequency in people with adenomatous polyps and polyp free controls (case-control). We shall examine the affect of ATase activity on any relationship found and ATase activity in people with adenomatous polyps and polyp free controls (case control).
DNA will be stored for future analysis of as yet unrecognised polymorphisms which may be recognised as having a role in CRC. Samples taken from EPIC participants for adduct, ATase and k-ras measurement whose polyps are found to be metaplastic will be stored for possible future analysis: we shall investigate people with adenomatous polyps in the first instance as these are the precursors of colorectal cancer.

Secondary outcome measures

Not provided at time of registration

Overall trial start date


Overall trial end date


Reason abandoned (if study stopped)


Participant inclusion criteria

All people (male and female) randomised to the screening arm of the Flexi-scope Trial will be invited to participate in this study. General practioners are initially approached and if they agree to take part in the Flexi-Scope Trial all patients aged 55-64 are contacted by questionnaire to declare interest in that study.

Participant type


Age group




Target number of participants

Not provided at time of registration

Participant exclusion criteria

1. People unable to provide informed consent.
2. People with a history of colorectal cancer, adenomatous polyps or inflammatory bowel disease.
3. People with severe or terminal disease, with life expectancy of less than 5 years.
4. People with a recent history of sigmoidoscopy or colonoscopy (within 2 years).
5. People unfit for flexible sigmoidoscopy.

Recruitment start date


Recruitment end date



Countries of recruitment

United Kingdom

Trial participating centre

Norfolk and Norwich Health Care NHS Trust
United Kingdom

Sponsor information


NHS R&D Regional Programme Register - Department of Health (UK)

Sponsor details

The Department of Health
Richmond House
79 Whitehall
United Kingdom
+44 (0)20 7307 2622

Sponsor type




Funder type


Funder name

NHS Executive Eastern (UK) (ref: RCC56354)

Alternative name(s)

Funding Body Type

Funding Body Subtype


Results and Publications

Publication and dissemination plan

Not provided at time of registration

Intention to publish date

Participant level data

Not provided at time of registration

Basic results (scientific)

Publication list

1. 2002 results in

Publication citations

  1. Results

    Leuratti C, Watson MA, Deag EJ, Welch A, Singh R, Gottschalg E, Marnett LJ, Atkin W, Day NE, Shuker DE, Bingham SA, Detection of malondialdehyde DNA adducts in human colorectal mucosa: relationship with diet and the presence of adenomas., Cancer Epidemiol. Biomarkers Prev., 2002, 11, 3, 267-273.

Additional files

Editorial Notes