When we first started this study in 1990, we named it Health 2000 to highlight its future-facing aspect. Then 2000 went by, and so we renamed it Health 2020. Now that this once-futuristic date is our present, and the study is still going strong, we thought we’d take the opportunity to celebrate this milestone by telling the story of Health 2020’s evolution through its first 30 years.
How it started
Health 2020 was planned to be the flagship research platform for the newly formed Cancer Epidemiology Centre at Cancer Council Victoria in 1986. Dr Nigel Gray was keen that the research took advantage of the organisation’s long-term stewardship of the Victorian Cancer Registry.
When Health 2020 was conceived, its design was shaped by research that showed that post-world war 2 migrants from Southern Europe were less likely to be affected by certain cancers. We wanted to see whether this might be due to aspects of their diet and lifestyle, which were notably different to those of Australians of British descent. Health 2020 actively recruited migrants from Southern European migrant communities; nearly a quarter of Health 2020 participants were born in Italy or Greece.
Thus, Health 2020 was designed to investigate prospectively the roles of diet and lifestyle in causing cancer and other non-communicable diseases. It was developed in parallel with the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort at a time when diet and nutrition were considered important to cancer causation but there was little detailed information that would be adequate to inform prevention.
Our original research proposal encompassed a broad range of questions, with a strong focus on the influence of individual foods and food groups, macronutrients and micronutrients on the risk of cancer. To this end we also stored blood samples collected at baseline, to permit the analysis of dietary markers detectable in the blood, rather than relying on dietary questionnaire responses alone.
To enable research on heart disease and diabetes as well as cancer, we also took direct physical and clinical measurements of all participants.
How it changed
As we addressed our research questions over time, we adapted our data collection at each follow-up to refine our approach and better answer remaining questions. We also repeated blood sampling and physical measurements to be able to assess any effect of changes over time.
What we did not anticipate at the start of the study was the rapid growth in genomic technology and knowledge. Health 2020 blood samples, which we collected originally solely to measure dietary and other markers, became a highly valuable source of DNA to examine genetic risk factors for disease. This field of research has been our principal focus for the past 15 years.
What we found
Health 2020 has produced over 900 scientific publications (and counting!). The most influential papers have come from pooling data with other cohorts in international consortia. Examples include the finding that overweight and obesity are associated with increased risk of many cancers as well as death from any cause; and the identification of common genetic variants associated with risk of breast, bowel and prostate cancer.
Health 2020 continues to be a valuable resource, both for our own research as well as for collaborative studies with Australian and international research groups. Ongoing work led by Cancer Council Victoria researchers focusses on alcohol and other risk factors for stomach cancer (led by Dr Harindra Jayasekara – see also our 2017 newsletter), biological mechanisms underlying the effect of obesity on post-menopausal breast cancer (led by Professor Dallas English), and developing better prediction models for breast cancer risk (led by Associate Professor Robert MacInnis).
Looking ahead, Health 2020 has been joined by Cancer Council Victoria’s next large cohort study, the Australian Breakthrough Cancer (ABC) Study. The ABC Study started in 2014 as a comprehensive, high-quality resource for national and international research into how to prevent cancer and other diseases.
Milne RL et al. Cohort Profile: The Melbourne Collaborative Cohort Study (Health 2020). Int J Epidemiol. 2017 Dec 1;46(6):1757-1757i.