{"entity":{"id":"b-prevention-adoption","kind":"bottleneck","name":"Prevention we already have is not deployed","aka":[],"tldr":"Around four in ten cancers are preventable with tools we already own: vaccines, tobacco control, weight, alcohol, sun and infection control.","summary":"About 40% of cancer cases and nearly half of cancer deaths in high-income countries are attributable to modifiable risk factors, tobacco above all, followed by excess body weight, alcohol, infections, diet, inactivity and ultraviolet exposure. Proven interventions exist for most of them: HPV vaccination (a single dose is now WHO-endorsed) can eliminate cervical cancer as a public health problem; hepatitis B vaccination and hepatitis C treatment prevent liver cancer; Helicobacter pylori eradication reduces gastric cancer; tobacco taxation, plain packaging and smoke-free laws are the most cost-effective measures in all of medicine; aspirin halves colorectal cancer in Lynch syndrome carriers. Yet global HPV coverage remains well below target, tobacco still kills more than eight million people a year, and prevention receives a small share of cancer research and health spending. The bottleneck is political, financial and organisational rather than scientific.","asOf":"2026-09-08","links":[{"label":"Islami et al., Proportion of cancer attributable to modifiable risk factors (CA 2018)","url":"https://doi.org/10.3322/caac.21440"},{"label":"WHO Cervical Cancer Elimination Initiative","url":"https://www.who.int/initiatives/cervical-cancer-elimination-initiative"},{"label":"Bruni et al., HPV vaccination coverage estimates 2010-2019 (Lancet Global Health 2021)","url":"https://doi.org/10.1016/S2214-109X(21)00347-3"},{"label":"WHO Framework Convention on Tobacco Control","url":"https://fctc.who.int/"}],"tags":[],"related":["idea-single-dose-hpv-self-sampling-elimination","globocan","idea-prev-therapeutic-hpv-vaccine-cin","idea-prev-hbv-treat-all-hcc","idea-prev-hcv-test-treat-surveillance-linkage","idea-prev-hpylori-family-test-and-treat","idea-prev-hpylori-stool-resistance-guided","idea-prev-hpylori-childhood-vaccine","idea-prev-very-low-nicotine-mandate","idea-prev-cytisine-essential-medicine","idea-prev-minimum-unit-pricing-cancer-endpoints","idea-prev-opportunistic-salpingectomy-default","idea-prev-commercial-sunbed-ban","idea-prev-radon-testing-at-property-sale","idea-prev-pay-for-prevention-outcomes","idea-prev-precursor-endpoints-for-approval","idea-prev-ebv-vaccine","idea-moon-eliminate-infection-cancers"],"cancers":["cervical","hcc","gastric","nsclc","head-and-neck","esophageal","colorectal","melanoma"],"sections":["prevention"],"technologies":["hpv-vaccine","chemoprevention","hpv-testing","precancer-ablation"],"targets":[],"drugs":["gardasil-9"],"companies":["merck"],"institutions":["iarc","cruk","nci"],"pathways":[],"terms":["hbv-hcv","hpv-p16","lynch-syndrome","cin-hsil"],"trials":["ken-she"],"people":[],"bottlenecks":[],"keyPapers":["paper-islami-ca-cancer-j-clin"],"journals":[],"dependsOn":[],"notes":[],"stage":"prevention-detection","severity":"critical","metrics":[{"label":"Share of US cancer cases and deaths attributable to potentially modifiable risk factors (2014)","value":"42% of cases, 45% of deaths","source":"Islami et al., CA 2018","url":"https://doi.org/10.3322/caac.21440"},{"label":"Girls worldwide fully vaccinated against HPV by 2019","value":"~15%","source":"Bruni et al., Lancet Global Health 2021","url":"https://doi.org/10.1016/S2214-109X(21)00347-3"},{"label":"Deaths caused by tobacco each year worldwide","value":"More than 8 million","source":"WHO fact sheet, Tobacco","url":"https://www.who.int/news-room/fact-sheets/detail/tobacco"},{"label":"Reduction in colorectal cancer with daily aspirin in Lynch syndrome carriers at 10 years (CAPP2, per-protocol)","value":"HR 0.56","source":"Burn et al., Lancet 2020","url":"https://doi.org/10.1016/S0140-6736(20)30366-4"}],"causes":["Prevention benefits accrue decades later and to no identifiable individual, so it attracts less political and commercial investment than treatment.","Tobacco, alcohol and food industries lobby against effective regulation.","Vaccine hesitancy and misinformation depress HPV and hepatitis B coverage.","Health systems and research funders are organised around treatment of disease rather than population health.","Prevention interventions have no patent, so no sponsor pays for their trials or promotion."],"currentEfforts":["The WHO Cervical Cancer Elimination Initiative sets 90-70-90 targets (vaccination, screening, treatment) for 2030, and WHO endorsed single-dose HPV schedules in 2022.","Gavi finances HPV vaccine introduction in low-income countries, with a target of vaccinating 86 million girls by 2025.","The WHO Framework Convention on Tobacco Control and MPOWER measures (taxation, smoke-free laws, plain packaging) are implemented in most countries to varying degrees.","CAPP2 and CAPP3 define aspirin chemoprevention in Lynch syndrome, and NICE recommends aspirin for carriers.","Population H. pylori screen-and-treat programmes in Taiwan, Japan and Korea are reducing gastric cancer incidence.","IARC Monographs and the IARC World Cancer Report provide the evidence base for carcinogen regulation."],"successLooksLike":"Global HPV vaccination coverage exceeds 90% of girls, adult smoking prevalence falls below 5% in high-income countries and is declining everywhere, and age-standardised incidence of cervical, liver, gastric and tobacco-related cancers falls measurably in registry data."},"route":"/bottlenecks/b-prevention-adoption/","neighbours":{"idea":[{"id":"idea-fund-prevention-moonshot","kind":"idea","name":"A delivery-science moonshot for prevention we already own","route":"/ideas/idea-fund-prevention-moonshot/"},{"id":"idea-nl-exercise-dose-finding","kind":"idea","name":"A dose-finding trial for exercise after cancer","route":"/ideas/idea-nl-exercise-dose-finding/"},{"id":"idea-moon-lynch-vaccine-phase3","kind":"idea","name":"A frameshift neoantigen vaccine for Lynch syndrome carriers as the first preventive cancer vaccine 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