# Cancer prevention roadmap: tobacco control and vaccines → biomarker-guided chemoprevention → interception in carriers

Source: https://onco.cc/roadmaps/prevention-roadmap/  
OnCo record `prevention-roadmap` (Roadmap). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

About four in ten cancers could be prevented with tools that already exist: vaccines against the viruses that cause them, tobacco and alcohol control, weight, aspirin for the right people, and finding the families who carry a high-risk gene. The roadmap is mostly about deployment, with interception vaccines as the long-range bet.

## Summary

Prevention has the strongest evidence and the weakest deployment in oncology. Tobacco control has prevented more cancer deaths than any drug. Hepatitis B vaccination cut liver cancer in the countries that adopted it early, and HPV vaccination is eliminating cervical cancer where coverage is high; a single dose proved almost fully protective (KEN SHE, 2021) and the WHO endorsed one-dose schedules, which makes elimination affordable everywhere. Germline testing finds the BRCA and Lynch carriers who benefit from risk-reducing surgery, aspirin and intensive screening. Tamoxifen prevents breast cancer in high-risk women.

The present decade is adding precision to prevention: aspirin after bowel cancer surgery works in tumours with PIK3CA mutations (ALASCCA) and is being tested in four cancers in Add-Aspirin, while ASPREE showed it does not help everyone; low-dose tamoxifen keeps the benefit with fewer side-effects; salpingectomy during any pelvic operation prevents ovarian cancer; polygenic scores could set when screening starts; population germline screening would find the carriers who do not know. GLP-1 agonists and bariatric surgery may prevent obesity-related cancers and need a randomised trial to prove it.

The frontier is interception: vaccinating people who carry a high-risk gene against the cancers they are likely to develop, with the Lynch syndrome frameshift vaccine as the first candidate for a randomised trial. The pace is set by the adoption gap, by funding that follows treatment rather than prevention, and by the politics of alcohol, tobacco and food.

## Fields

- Kind: Roadmap
- Last checked: 2026-09-10

## Sources

- WHO cervical cancer elimination initiative: https://www.who.int/initiatives/cervical-cancer-elimination-initiative
- KEN SHE single-dose HPV vaccine trial (NEJM Evidence 2022): https://doi.org/10.1056/EVIDoa2100056
- ALASCCA: aspirin in PIK3CA-mutated colorectal cancer (NEJM 2025): https://www.nejm.org/doi/full/10.1056/NEJMoa2504650

## Connected records

- collections: [UK Biobank](https://onco.cc/collections/uk-biobank/)
- roadmaps: [Diet, exercise and lifestyle roadmap: causes established → interventions that disappointed → exercise proven as treatment](https://onco.cc/roadmaps/nutrition-lifestyle-roadmap/), [Early detection roadmap: organ screening → blood tests for many cancers](https://onco.cc/roadmaps/early-detection-roadmap/), [Gallbladder cancer roadmap: from a chance finding at gallstone surgery to a disease with its own trials](https://onco.cc/roadmaps/gallbladder-cancer-roadmap/), [Global access and affordability roadmap: essential medicines and generics → biosimilars and frugal trials → reliance, pooling and homegrown innovation](https://onco.cc/roadmaps/global-access-roadmap/), [Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch](https://onco.cc/roadmaps/lung-cancer-evidence-roadmap/), [Paths to cures: interception, eradication, control](https://onco.cc/roadmaps/cure-paths/)
- ideas: [A bone drug to prevent breast cancer in BRCA1 carriers](https://onco.cc/ideas/idea-prev-brca1-denosumab-prevention/), [A frameshift neoantigen vaccine for Lynch syndrome carriers as the first preventive cancer vaccine approval](https://onco.cc/ideas/idea-moon-lynch-vaccine-phase3/), [A randomised trial of a shared-antigen vaccine to prevent Lynch syndrome cancers](https://onco.cc/ideas/idea-prev-lynch-frameshift-vaccine-rct/), [A trial of GLP-1 weight-loss drugs with cancer as the primary outcome](https://onco.cc/ideas/idea-prev-glp1-cancer-prevention-rct/), [Automatic germline testing for every cancer type where it changes care](https://onco.cc/ideas/idea-prev-reflex-germline-testing/), [Build polygenic scores that work in every ancestry before deploying any](https://onco.cc/ideas/idea-prev-prs-ancestry-portability-standard/), [Cancer interception vaccines for high-risk carriers](https://onco.cc/ideas/idea-interception-vaccines/), [Cancer warnings on alcohol labels, evaluated as a natural experiment](https://onco.cc/ideas/idea-prev-alcohol-cancer-warning-labels/), [Catch-up HPV vaccination for men to prevent throat cancer](https://onco.cc/ideas/idea-prev-hpv-male-catchup-oropharynx/), [Community pharmacies as one-stop cancer prevention hubs](https://onco.cc/ideas/idea-prev-pharmacy-prevention-hub/), [Community-tailored HPV vaccine confidence campaigns with school-based delivery](https://onco.cc/ideas/idea-moon-hpv-vaccine-confidence/), [Eliminate infection-caused cancers: HPV, hepatitis B and C, H. pylori and EBV](https://onco.cc/ideas/idea-moon-eliminate-infection-cancers/), [Family-based H. pylori test-and-treat to prevent stomach cancer](https://onco.cc/ideas/idea-prev-hpylori-family-test-and-treat/), [Find out what is driving early-onset bowel cancer, starting with colibactin, before extending screening any further](https://onco.cc/ideas/idea-crc-early-onset-cause-hunt/), [Get biomarker-directed aspirin after colorectal surgery into labels and guidelines](https://onco.cc/ideas/idea-reg-aspirin-pik3ca-implementation/), [Get every Lynch syndrome carrier onto the right dose of aspirin](https://onco.cc/ideas/idea-prev-lynch-aspirin-implementation/), [Let clinics contact relatives directly when a cancer gene is found](https://onco.cc/ideas/idea-prev-cascade-direct-contact-relatives/), [Low-dose tamoxifen for high-risk women, prescribed by pharmacists and nurses](https://onco.cc/ideas/idea-prev-low-dose-tamoxifen-uptake/), [Mandatory radon testing when homes are sold, with subsidised mitigation](https://onco.cc/ideas/idea-prev-radon-testing-at-property-sale/), [Offer everyone at 30 a test for the cancer genes that matter](https://onco.cc/ideas/idea-prev-population-germline-screening-at-30/), [One master trial for cancer prevention drugs across many precancers](https://onco.cc/ideas/idea-prev-chemoprevention-master-protocol/), [Population germline screening for hereditary cancer genes with cascade testing](https://onco.cc/ideas/idea-moon-population-germline-screening/), [Post every woman an HPV self-test kit instead of asking her to book a smear](https://onco.cc/ideas/idea-prev-hpv-self-sampling-mailed-default/), [Put cytisine, a cheap plant-based quit-smoking pill, on every essential medicines list](https://onco.cc/ideas/idea-prev-cytisine-essential-medicine/), [Regulators accept shrinking of precancer as the endpoint for prevention drug approval](https://onco.cc/ideas/idea-prev-precursor-endpoints-for-approval/), [Remove the fallopian tubes during any pelvic surgery once childbearing is finished](https://onco.cc/ideas/idea-prev-opportunistic-salpingectomy-default/), [Single-dose HPV vaccination plus HPV self-sampling to reach WHO elimination in low-income countries](https://onco.cc/ideas/idea-single-dose-hpv-self-sampling-elimination/), [Smoke-free generation laws with a built-in evaluation across countries](https://onco.cc/ideas/idea-prev-smokefree-generation-evaluation/), [Social impact bonds for cancer prevention, repaid from avoided treatment costs](https://onco.cc/ideas/idea-fund-social-impact-bonds-prevention/), [Switch every country to single-dose HPV vaccination and add catch-up to age 26](https://onco.cc/ideas/idea-prev-hpv-single-dose-switch-catchup/), [Treat everyone with chronic hepatitis B to prevent liver cancer](https://onco.cc/ideas/idea-prev-hbv-treat-all-hcc/), [Treat lung cancer in never-smokers as its own disease, with its own detection programme](https://onco.cc/ideas/idea-lung-never-smoker-disease-its-own-programme/), [Use a polygenic risk score to set when screening starts](https://onco.cc/ideas/idea-prev-prs-screening-start-age/)
- cancers: [Lung cancer (all types)](https://onco.cc/cancers/lung-cancer/)
- fronts: [Prevention & Risk](https://onco.cc/fronts/prevention/)
- technologies: [Alcohol reduction, pricing and cancer warning labels](https://onco.cc/technologies/alcohol-reduction-labelling/), [Aspirin for cancer prevention and adjuvant therapy](https://onco.cc/technologies/aspirin-cancer-prevention/), [Bariatric surgery and cancer incidence](https://onco.cc/technologies/bariatric-surgery-cancer-incidence/), [Cancer interception vaccines](https://onco.cc/technologies/interception-vaccination/), [Chemoprevention & risk-reducing surgery](https://onco.cc/technologies/chemoprevention/), [Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood)](https://onco.cc/technologies/colorectal-screening/), [Germline (hereditary) testing](https://onco.cc/technologies/germline-testing/), [GLP-1 receptor agonists and obesity-related cancer risk](https://onco.cc/technologies/glp1-agonists-cancer-risk/), [HCC surveillance in cirrhosis (ultrasound + AFP)](https://onco.cc/technologies/hcc-surveillance/), [HPV & HBV vaccination](https://onco.cc/technologies/hpv-vaccine/), [HPV DNA testing and self-sampling](https://onco.cc/technologies/hpv-testing/), [Low-dose CT lung screening](https://onco.cc/technologies/low-dose-ct-screening/), [Off-the-shelf cancer vaccines](https://onco.cc/technologies/shared-antigen-vaccine/), [Polygenic risk scores for cancer](https://onco.cc/technologies/polygenic-risk-scores/), [Risk-reducing and opportunistic salpingectomy](https://onco.cc/technologies/risk-reducing-salpingectomy/), [Smoking cessation in cancer patients](https://onco.cc/technologies/smoking-cessation-after-diagnosis/), [Thermal ablation and cryotherapy for cervical precancer](https://onco.cc/technologies/precancer-ablation/)
- drugs: [CERVAVAC (quadrivalent HPV vaccine, India)](https://onco.cc/drugs/cervavac/), [Nonavalent HPV vaccine](https://onco.cc/drugs/gardasil-9/), [Tamoxifen](https://onco.cc/drugs/tamoxifen/)
- companies: [Myriad Genetics](https://onco.cc/companies/myriad-genetics/), [Serum Institute of India](https://onco.cc/companies/serum-institute-of-india/)
- institutions: [ICMR-National Institute of Cancer Prevention and Research](https://onco.cc/institutions/icmr-nicpr/), [International Agency for Research on Cancer (IARC / WHO)](https://onco.cc/institutions/iarc/), [World Health Organization Cancer Programme](https://onco.cc/institutions/who/)
- terms: [Obesity-related cancers (IARC list of 13)](https://onco.cc/terms/obesity-related-cancers/), [Risk factor](https://onco.cc/terms/risk-factor/)
- trials: [Add-Aspirin](https://onco.cc/trials/add-aspirin/), [ALASCCA](https://onco.cc/trials/alascca/), [ASPREE (ASPirin in Reducing Events in the Elderly)](https://onco.cc/trials/aspree/), [IARC India HPV vaccine dose study (one, two or three doses)](https://onco.cc/trials/iarc-india-hpv-dose-study/), [KEN SHE (single-dose HPV vaccine)](https://onco.cc/trials/ken-she/), [NLST & NELSON (low-dose CT screening)](https://onco.cc/trials/nlst-nelson/), [NordICC (Nordic-European Initiative on Colorectal Cancer)](https://onco.cc/trials/nordicc/), [Osmanabad cervical screening trial (HPV testing vs cytology vs VIA)](https://onco.cc/trials/osmanabad-hpv-screening/)
- bottlenecks: [Funding follows fashion, not burden](https://onco.cc/bottlenecks/b-funding-allocation/), [Incentives reward me-too drugs and marginal gains](https://onco.cc/bottlenecks/b-incentive-misalignment/), [Inherited risk is mostly unidentified](https://onco.cc/bottlenecks/b-hereditary-risk/), [Most of the world has almost no cancer care](https://onco.cc/bottlenecks/b-global-access/), [Overdiagnosis and false alarms](https://onco.cc/bottlenecks/b-overdiagnosis/), [Prevention we already have is not deployed](https://onco.cc/bottlenecks/b-prevention-adoption/)
- key papers: [Effects of a combination of beta carotene and vitamin A on lung cancer and cardiovascular disease](https://onco.cc/key-papers/paper-caret-beta-carotene-retinol-lung-cancer-nejm-1996/), [Efficacy of single-dose HPV vaccination among young African women](https://onco.cc/key-papers/paper-barnabas-nejm-evid/), [Smoking, smoking cessation, and lung cancer in the UK since 1950: combination of national statistics with two case-control studies](https://onco.cc/key-papers/paper-peto-smoking-cessation-lung-cancer-uk-bmj-2000/), [The mortality of doctors in relation to their smoking habits; a preliminary report](https://onco.cc/key-papers/paper-doll-hill-mortality-of-doctors-smoking-bmj-1954/), [Tobacco smoking as a possible etiologic factor in bronchiogenic carcinoma; a study of 684 proved cases](https://onco.cc/key-papers/paper-wynder-graham-tobacco-bronchiogenic-carcinoma-jama-1950/)

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