The Project

The aim of the DISCERN project is to identify the causes of three poorly understood cancers in Europe – renal, pancreatic, and colorectal cancer – and to help explain the geographical distribution of these cancer types, including their high incidence in central and eastern Europe. This will be achieved by combining data from large-scale European biorepositories comprising population-based cohorts and tumour case series for each of the three cancer types. DISCERN will integrate state-of-the-art exposomics and proteomics techniques, as well as genomics technologies, to analyse both normal tissue and tumour tissue. The goal of DISCERN is to uncover novel causes for each of these three cancer types and to provide the critical evidence base required to develop new prevention strategies for these cancers in Europe.

Renal, pancreatic, and colorectal cancers were responsible for approximately one fifth of the estimated 2.7 million new cancer cases and one quarter of the 1.26 million cancer deaths in the European Union (EU) in 2020 (Figure 1). Because of demographic changes (such as population ageing and growth) and secular changes in the prevalence of risk factors, the global burden of cancer is predicted to increase by approximately 47% over the next 20 years, and pancreatic cancer is expected to become the third most common cause of cancer death in Europe by 2025. Despite improvements in cancer diagnosis and treatment, survival rates have not improved substantially for these three cancer types.

For unknown reasons, the highest rates of these three cancer types tend to occur in central Europe and the Baltic region. In particular, the highest incidence rates for renal cancer in the world for both men and women are observed in Czechia, Lithuania, and Estonia (Figure 2A). For pancreatic cancer, a similar cluster is seen in central Europe, and the highest incidence rates are observed in Hungary, Slovakia, and Czechia (Figure 2B). For colorectal cancer, the highest incidence rates are observed in Hungary and Slovakia, and parts of western Europe also have high incidence rates, particularly the Netherlands, Spain, Denmark, and Norway (Figure 2C).

DISCERN has five core objectives, which will be achieved through eight Work Packages:

  1. Establish a biorepository comprising extensive case series from across Europe with normal tissue and tumour tissue, as well as a consortium of European prospective cohorts with pre-diagnostic blood samples and extensive exposome data (lifestyle, environment, behavioural).
  2. Discover novel risk factors and causal pathways for renal, pancreatic, and colorectal cancers by assessing the exposome and proteome across prospective cohorts.
  3. Identify exogenous and endogenous factors that promote the growth of pre-initiated cells in normal tissues, and elucidate their cellular targets.
  4. Exploit human organoids and stem cell models to identify the biological mechanisms through which the identified cancer risk factors promote carcinogenesis.
  5. Disseminate these findings to citizens, patients, and relevant stakeholders to guide public health policy, with the long-term aim of reducing the burden of these lethal cancers in Europe.


Fig. 1. The burden of renal, pancreatic, and colorectal cancer in Europe in 2020. (A) Incidence and mortality. Source: GLOBOCAN 2020. (B) Net survival by stage at diagnosis. Source: Compiled from SEER, Johnson et al. (2021).

 

Fig. 2. Incidence rates of (A) renal, (B) pancreatic, and (C) colorectal cancers in 2020 in Europe (both sexes and all ages). The three countries with the highest incidence rates are highlighted by red, orange, and yellow arrows, respectively. Source: GLOBOCAN 2020.