Red Meat and PRocessed Meat - World Health Organization

1 Red Meat and PRocessed Meat volume 114 Red Meat and PRocessed Meatiarc monographs on the evaluation of carcinogenic risks to humansRed Meat and PRocessed Meat volume 114this publication represents the views and expertopinions of an IaRc Working Group on theevaluation of carcinogenic Risks to Humans,which met in Lyon, 6 13 october 2015 LYON, FRANCE - 2018iarc monographs on the evaluation of carcinogenic risks to humansIARC MONOGRAPHSIn 1969, the International Agency for Research on Cancer (IARC) initiated a programme on the evaluation of the carcinogenic risk of chemicals to humans involving the production of critically evaluated monographs on individual chemicals. The programme was subsequently expanded to include evaluations of carcinogenic risks associated with exposures to complex mixtures, lifestyle factors and biological and physical agents, as well as those in specific occupations.

2 The objective of the programme is to elaborate and publish in the form of monographs critical reviews of data on carcinogenicity for agents to which humans are known to be exposed and on specific exposure situations; to evaluate these data in terms of human risk with the help of international working groups of experts in carcinogenesis and related fields; and to indicate where additional research efforts are needed. The lists of IARC evaluations are regularly updated and are available on the Internet at This programme has been supported since 1982 by Cooperative Agreement U01 CA33193 with the United States National Cancer Institute, Department of Health and Human Services.

3 Additional support has been provided since 1986 by the European Commission Directorate-General for Employment, Social Affairs, and Inclusion, initially by the Unit of Health , Safety and Hygiene at Work, and since 2014 by the European Union Programme for Employment and Social Innovation EaSI (2014 2020) (for further information please consult: ). Support has also been provided since 1992 by the United States National Institute of Environmental Health Sciences, Department of Health and Human Services. The contents of this volume are solely the responsibility of the Working Group and do not necessarily represent the official views of the United States National Cancer Institute, the United States National Institute of Environmental Health Sciences, the United States Department of Health and Human Services, or the European Commission.

4 Published by the International Agency for Research on Cancer, 150 cours Albert Thomas, 69372 Lyon Cedex 08, France International Agency for Research on Cancer, 2018 On-line publication, March 2018 Distributed by WHO Press, World Health Organization , 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; email: of the World Health Organization enjoy copyright protection in accordance with the provisions of Protocol 2 of the Universal Copyright Convention. All rights to the IARC Monographs are published online at To report an error, please contact: Co-funded by the European UnionThe International Agency for Research on Cancer welcomes requests for permission to reproduce or translate its publications, in part or in full.)

5 Requests for permission to reproduce or translate IARC publications whether for sale or for non-commercial distribution should be addressed to the IARC Communications Group at: The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city, or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. The mention of specific companies or of certain manufacturers products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned.

6 Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. The IARC Monographs Working Group alone is responsible for the views expressed in this publication. IARC Library Cataloguing in Publication DataRed meat and PRocessed meat / IARC Working Group on the Evaluation of Carcinogenic Risks to Humans (2015: Lyon, France) (IARC monographs on the evaluation of carcinogenic risks to humans ; volume 114)1. Carcinogens 2. Red Meat adverse effects 3. Food Additives adverse effects 4. Diet, Western adverse effects 5. Risk Factors I. International Agency for Research on Cancer II. SeriesISBN 978-92-832-0180-9 (NLM Classification: W1)ISSN 1017-1606 IIICONTENTSNOTE TO THE READER.

7 1 LIST OF PARTICIPANTS ..3 PREAMBLE ..9A. GENERAL PRINCIPLES AND PROCEDURES ..91. Background ..92. Objective and scope ..103. Selection of agents for review ..114. Data for the Monographs ..125. Meeting participants ..12B. SCIENTIFIC REVIEW AND EVALUATION ..141. Exposure data ..152. Studies of cancer in humans ..163. Studies of cancer in experimental animals ..204. Mechanistic and other relevant data ..235. Summary ..266. Evaluation and rationale ..27 References ..311 . EXPOSURE DATA .. Identification of the agents .. Red meat .. Offal .. PRocessed meat .. Meat composition .. Red meat .. PRocessed meat .. Changes in meat composition due to cooking methods ..43 IVIARC MONOGRAPHS - Exposure via food intake.

8 Data description .. Results .. Exposure assessment and biological markers .. Questionnaires .. Biological markers .. Regulations and guidelines .. Prevention of infectious disease .. Prevention of contamination ..89 References ..902 . CANCER IN HUMANS .. General issues regarding the epidemiology of cancer and consumption of red meat and PRocessed meat .. Exposure definition .. Sample size and the number of exposed cases .. Study design .. Exposure assessment tools .. Adjustment for potential confounding factors ..104 References .. Cancer of the colorectum .. Cohort studies .. Case control studies .. Meta-analyses ..138 References .. Cancer of the stomach .. Cohort studies .. Case control studies.

9 Meta-analyses ..248 References .. Cancer of the pancreas .. Cohort studies .. Case control studies .. Meta-analyses ..284 References .. Cancer of the prostate .. Cohort studies .. Case control studies ..300 References .. Cancer of the breast .. Cohort studies .. Case control studies ..322 References .. Cancer of the lung .. Cohort studies .. Case control studies .. Meta-analyses ..343 References .. Cancer of the oesophagus .. Cohort studies .. Case control studies .. Meta-analyses ..349 References .. Other cancers .. Non-Hodgkin lymphoma .. Cancer of the liver (hepatocellular carcinoma) .. Cancers of the gallbladder and biliary tract .. Cancer of the testis .. Cancer of the kidney.

10 Cancer of the bladder .. Cancer of the ovary .. Cancer of the endometrium .. Leukaemia .. Cancer of the brain .. Cancer of the breast in men ..380 References ..3803 . CANCER IN EXPERIMENTAL ANIMALS .. Mouse .. Red meat .. Red meat with known carcinogens .. Rat .. Red meat .. Red meat with known carcinogens .. Red meat and/or PRocessed meat with known carcinogens to give aberrant crypt foci and/or mucin-depleted foci .. Haem iron .. Overview of cancer bioassays for chemicals related to meat consumption .. Heterocyclic aromatic amines .. Polycyclic aromatic hydrocarbons .. N-Nitroso compounds .. Others ..418 References ..418 VIIARC MONOGRAPHS - 1144 . MECHANISTIC AND OTHER RELEVANT DATA.