{"id":"prevention-roadmap","name":"Cancer prevention roadmap: tobacco control and vaccines → biomarker-guided chemoprevention → interception in carriers","route":"/roadmaps/prevention-roadmap/","eras":[{"era":"1950-2000","title":"Tobacco, hepatitis B and the first chemoprevention","description":"The link between smoking and lung cancer, established in the 1950s, produced the taxes, advertising bans and smoke-free laws that have prevented more cancer deaths than any treatment. Universal infant hepatitis B vaccination, begun in Taiwan in the 1980s, cut liver cancer in the vaccinated generation. Helicobacter pylori was identified as the cause of most stomach cancer. Tamoxifen was shown to prevent breast cancer in high-risk women in 1998, the first drug proven to stop a cancer before it starts.","status":"historic","refs":[{"id":"risk-factor","kind":"term","name":"Risk factor","route":"/terms/risk-factor/","tldr":"Anything that raises the chance of developing a cancer: smoking, alcohol, obesity, sunlight, certain infections, inherited genes, age. Around 40% of cancers in high-income countries are attributable to modifiable factors, so having a risk factor does not mean getting cancer, and the majority of cancers cannot be pinned on a modifiable one."},{"id":"hpv-vaccine","kind":"technology","name":"HPV & HBV vaccination","route":"/technologies/hpv-vaccine/","status":"standard-of-care","tldr":"Vaccines that prevent the viral infections behind cervical, throat, anal, and liver cancers. The most effective anti-cancer intervention ever created."},{"id":"chemoprevention","kind":"technology","name":"Chemoprevention & risk-reducing surgery","route":"/technologies/chemoprevention/","status":"standard-of-care","tldr":"Drugs or surgery for people at high inherited risk, before any cancer appears."},{"id":"tamoxifen","kind":"drug","name":"Tamoxifen","route":"/drugs/tamoxifen/","status":"approved","tldr":"The original targeted cancer drug (1977): a pill that blocks oestrogen's effect on breast cancer and halves recurrence, still essential for premenopausal women."},{"id":"iarc","kind":"institution","name":"International Agency for Research on Cancer (IARC / WHO)","route":"/institutions/iarc/","tldr":"IARC is the WHO's cancer agency, responsible for global cancer statistics (GLOBOCAN), carcinogen classification, and prevention research."},{"id":"smoking-cessation-after-diagnosis","kind":"technology","name":"Smoking cessation in cancer patients","route":"/technologies/smoking-cessation-after-diagnosis/","status":"established","tldr":"Stopping smoking after a cancer diagnosis improves survival, reduces treatment complications and second cancers, and is the single most effective supportive intervention that oncology services still routinely fail to deliver."}],"trials":[],"papers":[]},{"era":"2006-2020","title":"HPV vaccines, hereditary testing and the elimination goal","description":"The first HPV vaccine (2006) and the nine-valent version that prevents about nine in ten cervical cancers turned an infection into a preventable one; HPV DNA testing replaced the smear and one round of it in rural India cut cervical cancer deaths (Osmanabad). Germline testing made BRCA and Lynch carriers findable, and risk-reducing surgery, aspirin (CAPP2) and intensive surveillance gave them options. In 2020 the WHO adopted a strategy to eliminate cervical cancer as a public health problem: vaccinate, screen, treat.","status":"historic","refs":[{"id":"gardasil-9","kind":"drug","name":"Nonavalent HPV vaccine","route":"/drugs/gardasil-9/","status":"approved","tldr":"A vaccine against nine HPV types that prevents about 90% of cervical cancers, and now works with a single dose."},{"id":"hpv-testing","kind":"technology","name":"HPV DNA testing and self-sampling","route":"/technologies/hpv-testing/","status":"standard-of-care","tldr":"A swab tested for the virus that causes cervical cancer, more accurate than the Pap smear and doable at home."},{"id":"osmanabad-hpv-screening","kind":"trial","name":"Osmanabad cervical screening trial (HPV testing vs cytology vs VIA)","route":"/trials/osmanabad-hpv-screening/","status":"positive","tldr":"One round of HPV testing in rural Indian villages halved deaths from cervical cancer within eight years, while a Pap smear or a visual check did not, which is why HPV tests are now the world's preferred screen."},{"id":"precancer-ablation","kind":"technology","name":"Thermal ablation and cryotherapy for cervical precancer","route":"/technologies/precancer-ablation/","status":"standard-of-care","tldr":"Destroying precancerous cervical cells with a heated or frozen probe in under a minute, the tool that makes screen-and-treat possible where there are no surgeons."},{"id":"germline-testing","kind":"technology","name":"Germline (hereditary) testing","route":"/technologies/germline-testing/","status":"standard-of-care","tldr":"A test of the DNA you were born with, to find inherited risk genes such as BRCA or Lynch syndrome."},{"id":"myriad-genetics","kind":"company","name":"Myriad Genetics","route":"/companies/myriad-genetics/","tldr":"The company that made BRCA testing a business, now selling hereditary panels and the myChoice, EndoPredict and Prolaris tumour tests."},{"id":"risk-reducing-salpingectomy","kind":"technology","name":"Risk-reducing and opportunistic salpingectomy","route":"/technologies/risk-reducing-salpingectomy/","status":"established","tldr":"Removing the fallopian tubes, where most ovarian cancer starts, during other pelvic surgery or in women at inherited risk."},{"id":"aspirin-cancer-prevention","kind":"technology","name":"Aspirin for cancer prevention and adjuvant therapy","route":"/technologies/aspirin-cancer-prevention/","status":"phase-3","tldr":"Daily low-dose aspirin lowers bowel cancer risk in people with Lynch syndrome and appears to cut recurrence in bowel cancers with a particular mutation. In healthy older people it caused more harm than good."},{"id":"who","kind":"institution","name":"World Health Organization Cancer Programme","route":"/institutions/who/","tldr":"The UN health agency that sets global cancer policy: the cervical cancer elimination strategy, the essential medicines list, the childhood cancer initiative and the classification of tumours."},{"id":"hcc-surveillance","kind":"technology","name":"HCC surveillance in cirrhosis (ultrasound + AFP)","route":"/technologies/hcc-surveillance/","status":"standard-of-care","tldr":"People with cirrhosis or chronic hepatitis B get a liver ultrasound and a blood test every six months so cancer is caught while it is still curable."},{"id":"colorectal-screening","kind":"technology","name":"Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood)","route":"/technologies/colorectal-screening/","status":"standard-of-care","tldr":"Finding and removing polyps before they become cancer. Colonoscopy prevents cancer; stool and blood tests catch it early and get more people screened."},{"id":"nordicc","kind":"trial","name":"NordICC (Nordic-European Initiative on Colorectal Cancer)","route":"/trials/nordicc/","status":"mixed","tldr":"The first randomised trial of colonoscopy screening: being invited cut the risk of bowel cancer by about a fifth, but fewer than half of those invited attended, so the effect on deaths was small."}],"trials":[{"id":"osmanabad-hpv-screening","name":"Osmanabad cervical screening trial (HPV testing vs cytology vs VIA)","route":"/trials/osmanabad-hpv-screening/","outcomes":[{"endpoint":"Cervical cancer deaths","primary":true,"unit":"deaths","arms":[{"name":"HPV testing","n":34126,"value":34},{"name":"Control","n":31488,"value":64}],"hr":0.52,"ci":[0.33,0.83],"source":"https://doi.org/10.1056/NEJMoa0808516"}],"setting":"Cluster-randomised trial in 52 villages of Osmanabad district, Maharashtra: one round of HPV DNA testing, cytology, visual inspection with acetic acid, or usual care in women aged 30-59","enrolled":131746,"enrolledBasis":"registry"},{"id":"nordicc","name":"NordICC (Nordic-European Initiative on Colorectal Cancer)","route":"/trials/nordicc/","outcomes":[{"endpoint":"Colorectal cancer incidence at 10 years (intention to screen)","primary":true,"unit":"%","arms":[{"name":"Invited to colonoscopy","value":0.98},{"name":"Usual care","value":1.2}],"hr":0.82,"ci":[0.7,0.93],"source":"https://doi.org/10.1056/NEJMoa2208375"},{"endpoint":"Colorectal cancer death at 10 years","unit":"%","arms":[{"name":"Invited to colonoscopy","value":0.28},{"name":"Usual care","value":0.31}],"hr":0.9,"ci":[0.64,1.16],"source":"https://doi.org/10.1056/NEJMoa2208375"}],"setting":"Population-based randomised trial of invitation to a single screening colonoscopy versus no invitation in Poland, Norway and Sweden, adults aged 55 to 64","enrolled":84585,"enrolledNote":"ClinicalTrials.gov lists 95,000 participants (actual); the NEJM 2022 analysis covers the 84,585 participants in Poland, Norway and Sweden with follow-up data (28,220 invited, 56,365 usual care).","enrolledBasis":"analysed"}],"papers":[]},{"era":"2021-2026","title":"One dose, self-sampling and vaccines made where they are needed","description":"KEN SHE showed in 2021 that a single dose of HPV vaccine is almost fully protective against the two most dangerous types, confirming what an interrupted Indian trial had suggested; the WHO endorsed one-dose schedules in 2022, halving the cost of elimination. India's Serum Institute launched its own vaccine, Cervavac. Self-collected HPV swabs and same-day thermal ablation of precancer are letting nurses run cervical programmes without colposcopy. Catch-up vaccination for men, to prevent the throat cancers that now outnumber cervical cancers in some countries, is the next policy step.","status":"current","refs":[{"id":"ken-she","kind":"trial","name":"KEN SHE (single-dose HPV vaccine)","route":"/trials/ken-she/","status":"positive","tldr":"One shot of HPV vaccine was 97.5% effective against the two most dangerous HPV types, making it realistic to vaccinate the whole world."},{"id":"iarc-india-hpv-dose-study","kind":"trial","name":"IARC India HPV vaccine dose study (one, two or three doses)","route":"/trials/iarc-india-hpv-dose-study/","status":"positive","tldr":"When an Indian vaccine trial was halted midway, thousands of girls had had only one shot; following them for ten years showed one dose protected as well as three, changing the world's vaccination policy."},{"id":"cervavac","kind":"drug","name":"CERVAVAC (quadrivalent HPV vaccine, India)","route":"/drugs/cervavac/","status":"approved","tldr":"India's first home-made HPV vaccine, protecting against the two virus types that cause most cervical cancers and the two that cause genital warts, at a price meant for a national programme."},{"id":"serum-institute-of-india","kind":"company","name":"Serum Institute of India","route":"/companies/serum-institute-of-india/","tldr":"The world's largest vaccine maker by doses, which developed CERVAVAC, India's first home-made HPV vaccine, so that cervical cancer prevention no longer depends on imported shots."},{"id":"hpv-testing","kind":"technology","name":"HPV DNA testing and self-sampling","route":"/technologies/hpv-testing/","status":"standard-of-care","tldr":"A swab tested for the virus that causes cervical cancer, more accurate than the Pap smear and doable at home."},{"id":"precancer-ablation","kind":"technology","name":"Thermal ablation and cryotherapy for cervical precancer","route":"/technologies/precancer-ablation/","status":"standard-of-care","tldr":"Destroying precancerous cervical cells with a heated or frozen probe in under a minute, the tool that makes screen-and-treat possible where there are no surgeons."},{"id":"idea-prev-hpv-single-dose-switch-catchup","kind":"idea","name":"Switch every country to single-dose HPV vaccination and add catch-up to age 26","route":"/ideas/idea-prev-hpv-single-dose-switch-catchup/","tldr":"One dose of HPV vaccine protects as well as two or three. Halving the doses frees supply to vaccinate far more girls, boys and young adults."},{"id":"idea-prev-hpv-self-sampling-mailed-default","kind":"idea","name":"Post every woman an HPV self-test kit instead of asking her to book a smear","route":"/ideas/idea-prev-hpv-self-sampling-mailed-default/","tldr":"Women who never book a smear test are missed by invitation-based screening. Posting an HPV self-sampling kit as the default invitation, as the Netherlands and Australia do, reaches them, and PCR-based self-samples match clinician samples for detecting high-grade precancer."},{"id":"idea-single-dose-hpv-self-sampling-elimination","kind":"idea","name":"Single-dose HPV vaccination plus HPV self-sampling to reach WHO elimination in low-income countries","route":"/ideas/idea-single-dose-hpv-self-sampling-elimination/","tldr":"One shot for girls and a mail-in swab for women could hit the WHO 90-70-90 targets at a fraction of the cost of the traditional three-dose, clinic-based model."},{"id":"idea-prev-hpv-male-catchup-oropharynx","kind":"idea","name":"Catch-up HPV vaccination for men to prevent throat cancer","route":"/ideas/idea-prev-hpv-male-catchup-oropharynx/","tldr":"HPV throat cancer now exceeds cervical cancer in some countries and mostly affects men, who were not vaccinated. Vaccinating men up to 45 could reduce it."},{"id":"idea-moon-hpv-vaccine-confidence","kind":"idea","name":"Community-tailored HPV vaccine confidence campaigns with school-based delivery","route":"/ideas/idea-moon-hpv-vaccine-confidence/","tldr":"The HPV vaccine prevents most cervical cancer, but false safety claims have cut uptake in several countries. Rebuild confidence locally and deliver the vaccine in schools."}],"trials":[{"id":"ken-she","name":"KEN SHE (single-dose HPV vaccine)","route":"/trials/ken-she/","outcomes":[{"endpoint":"Vaccine efficacy against persistent HPV16/18 infection","primary":true,"unit":"%","arms":[{"name":"Single dose nonavalent HPV","value":97.5}],"source":"https://www.cdc.gov/acip/downloads/slides-2025-04-15-16/03-Barnabas-HPV-508.pdf"}],"setting":"Kenyan women aged 15-20: single dose of bivalent or nonavalent HPV vaccine vs meningococcal control, endpoint persistent HPV16/18 infection","enrolled":2275,"enrolledBasis":"registry"},{"id":"iarc-india-hpv-dose-study","name":"IARC India HPV vaccine dose study (one, two or three doses)","route":"/trials/iarc-india-hpv-dose-study/","outcomes":[{"endpoint":"Vaccine efficacy against persistent HPV 16/18 infection","primary":true,"unit":"%","arms":[{"name":"One dose","n":4949,"value":95.4,"note":"95% CI 85.0-99.9"},{"name":"Two doses","n":4980,"value":93.1,"note":"95% CI 77.3-99.8"},{"name":"Three doses","n":4348,"value":93.3,"note":"95% CI 77.5-99.7"}],"source":"https://doi.org/10.1016/S1470-2045(21)00453-8"}],"setting":"Girls aged 10-18 in India randomised to two or three doses of quadrivalent HPV vaccine; after a 2010 suspension of recruitment, cohorts who had received one, two or three doses were followed for a decade","enrolled":17729,"enrolledBasis":"registry"}],"papers":[]},{"era":"2022-2027","title":"Aspirin and tamoxifen for the right people","description":"ASPREE showed that daily aspirin does not help healthy older people and can harm them; ALASCCA showed that three years of low-dose aspirin roughly halves recurrence in bowel cancers carrying PIK3CA mutations; Add-Aspirin is testing it in 11,000 patients across four cancers. The lesson is that chemoprevention needs a biomarker or a defined high-risk group. Low-dose tamoxifen keeps the preventive benefit with fewer side-effects and could be prescribed by pharmacists and nurses; removing the fallopian tubes during any pelvic operation, once childbearing is finished, prevents most ovarian cancers at no extra operation.","status":"current","refs":[{"id":"aspree","kind":"trial","name":"ASPREE (ASPirin in Reducing Events in the Elderly)","route":"/trials/aspree/","status":"negative","tldr":"In healthy older people, daily low-dose aspirin did not extend disability-free life and, unexpectedly, was linked with more cancer deaths. It changed guidelines against routine aspirin in the elderly."},{"id":"alascca","kind":"trial","name":"ALASCCA","route":"/trials/alascca/","status":"positive","tldr":"A Nordic trial showing that three years of low-dose aspirin roughly halves recurrence in bowel cancers carrying a particular set of mutations, a biomarker-directed use of a drug that costs pennies."},{"id":"add-aspirin","kind":"trial","name":"Add-Aspirin","route":"/trials/add-aspirin/","status":"active","tldr":"Add-Aspirin is an 11,000-patient trial across four common cancers in the UK, Ireland and India asking whether cheap daily aspirin after curative treatment stops cancer coming back."},{"id":"aspirin-cancer-prevention","kind":"technology","name":"Aspirin for cancer prevention and adjuvant therapy","route":"/technologies/aspirin-cancer-prevention/","status":"phase-3","tldr":"Daily low-dose aspirin lowers bowel cancer risk in people with Lynch syndrome and appears to cut recurrence in bowel cancers with a particular mutation. In healthy older people it caused more harm than good."},{"id":"idea-reg-aspirin-pik3ca-implementation","kind":"idea","name":"Get biomarker-directed aspirin after colorectal surgery into labels and guidelines","route":"/ideas/idea-reg-aspirin-pik3ca-implementation/","tldr":"A Swedish trial found that cheap aspirin roughly halved recurrence in colorectal cancer patients with a particular tumour mutation. Nobody is going to market it, so health systems must adopt it deliberately."},{"id":"idea-prev-lynch-aspirin-implementation","kind":"idea","name":"Get every Lynch syndrome carrier onto the right dose of aspirin","route":"/ideas/idea-prev-lynch-aspirin-implementation/","tldr":"Aspirin roughly halves bowel cancer in Lynch syndrome, and a dose trial is defining how little is needed. Most carriers are still not prescribed it; the task is to fix prescribing."},{"id":"idea-prev-low-dose-tamoxifen-uptake","kind":"idea","name":"Low-dose tamoxifen for high-risk women, prescribed by pharmacists and nurses","route":"/ideas/idea-prev-low-dose-tamoxifen-uptake/","tldr":"A 5 mg tamoxifen dose halves breast cancer recurrence after precancer with far fewer side effects than the full dose. Almost nobody is prescribed it. Change who can prescribe."},{"id":"risk-reducing-salpingectomy","kind":"technology","name":"Risk-reducing and opportunistic salpingectomy","route":"/technologies/risk-reducing-salpingectomy/","status":"established","tldr":"Removing the fallopian tubes, where most ovarian cancer starts, during other pelvic surgery or in women at inherited risk."},{"id":"idea-prev-opportunistic-salpingectomy-default","kind":"idea","name":"Remove the fallopian tubes during any pelvic surgery once childbearing is finished","route":"/ideas/idea-prev-opportunistic-salpingectomy-default/","tldr":"Most ovarian cancers start in the fallopian tubes. Removing the tubes at hysterectomy, or instead of tying them, as British Columbia has done, appears to prevent ovarian cancer."}],"trials":[{"id":"aspree","name":"ASPREE (ASPirin in Reducing Events in the Elderly)","route":"/trials/aspree/","outcomes":[{"endpoint":"Death from cancer","unit":"events","arms":[{"name":"Aspirin","n":9525,"value":295},{"name":"Placebo","n":9589,"value":227}],"hr":1.31,"ci":[1.1,1.56],"source":"https://doi.org/10.1056/NEJMoa1803955"}],"setting":"Community-dwelling adults aged 70+ (65+ for US Black and Hispanic participants) without cardiovascular disease, dementia or disability: aspirin 100 mg/day vs placebo","enrolled":19114,"enrolledBasis":"registry"},{"id":"alascca","name":"ALASCCA","route":"/trials/alascca/","outcomes":[{"endpoint":"Time to recurrence at 3 years, group A (PIK3CA exon 9/20)","primary":true,"unit":"%","arms":[{"name":"Aspirin","value":7.7},{"name":"Placebo","value":14.1}],"hr":0.49,"ci":[0.24,0.98],"source":"https://doi.org/10.1056/NEJMoa2504650"},{"endpoint":"Time to recurrence at 3 years, group B (other PI3K-pathway alterations)","unit":"%","arms":[{"name":"Aspirin","value":7.7},{"name":"Placebo","value":16.8}],"hr":0.42,"ci":[0.21,0.83],"source":"https://doi.org/10.1056/NEJMoa2504650"}],"setting":"Resected stage I-III rectal or stage II-III colon cancer with somatic PIK3CA (exon 9/20) or other PI3K-pathway alterations: aspirin 160 mg/day for 3 years vs placebo","enrolled":626,"enrolledBasis":"registry"}],"papers":[]},{"era":"2025-2030","title":"Weight, alcohol, tobacco and infection at population scale","description":"People on GLP-1 agonists have lower rates of obesity-related cancers in observational data and bariatric surgery patients develop fewer cancers; a randomised trial with cancer as the primary outcome is the most important prevention study this decade could run. Smoke-free generation laws are being enacted and need built-in evaluation; cytisine, a cheap plant-based quit-smoking pill, belongs on every essential medicines list; cancer warning labels on alcohol are a natural experiment waiting to be measured. Treating everyone with chronic hepatitis B, curing hepatitis C and family-based H. pylori test-and-treat would remove most of the remaining infection-caused cancers.","status":"emerging","refs":[{"id":"glp1-agonists-cancer-risk","kind":"technology","name":"GLP-1 receptor agonists and obesity-related cancer risk","route":"/technologies/glp1-agonists-cancer-risk/","status":"emerging","tldr":"GLP-1 agonists, the new weight-loss injections, lower weight by 15-20%. Early observational data suggest fewer obesity-related cancers in people who take them, but no trial has yet tested cancer as an outcome."},{"id":"bariatric-surgery-cancer-incidence","kind":"technology","name":"Bariatric surgery and cancer incidence","route":"/technologies/bariatric-surgery-cancer-incidence/","status":"established","tldr":"People with severe obesity who have weight-loss surgery develop about a third fewer cancers over the following decade, especially womb and other hormone-related cancers, than similar people who do not."},{"id":"obesity-related-cancers","kind":"term","name":"Obesity-related cancers (IARC list of 13)","route":"/terms/obesity-related-cancers/","tldr":"Excess body fat is an established cause of thirteen cancers on the IARC list, including womb, oesophagus, kidney, liver, bowel, pancreas and postmenopausal breast cancer. It accounts for roughly 4 to 8% of cancers in high-income countries, second only to smoking among preventable causes, and bariatric surgery cohorts suggest the risk is partly reversible."},{"id":"idea-prev-glp1-cancer-prevention-rct","kind":"idea","name":"A trial of GLP-1 weight-loss drugs with cancer as the primary outcome","route":"/ideas/idea-prev-glp1-cancer-prevention-rct/","tldr":"Obesity raises the risk of 13 cancers, and GLP-1 weight-loss drugs are already in routine use for diabetes and obesity. Observational data hint that they cut obesity-related cancers but confounding is severe, so a randomised trial in adults aged 50 to 70 with a BMI of 30 or more should make cancer the primary outcome."},{"id":"idea-prev-smokefree-generation-evaluation","kind":"idea","name":"Smoke-free generation laws with a built-in evaluation across countries","route":"/ideas/idea-prev-smokefree-generation-evaluation/","tldr":"Banning tobacco sales to anyone born after a set year, as the UK is doing, could end smoking within a generation. Adopting countries should coordinate evaluation so the evidence is undeniable."},{"id":"idea-prev-cytisine-essential-medicine","kind":"idea","name":"Put cytisine, a cheap plant-based quit-smoking pill, on every essential medicines list","route":"/ideas/idea-prev-cytisine-essential-medicine/","tldr":"Cytisine costs a few dollars per course and works about as well as varenicline, but is unavailable in most countries. Global approval and procurement would make quitting affordable."},{"id":"alcohol-reduction-labelling","kind":"technology","name":"Alcohol reduction, pricing and cancer warning labels","route":"/technologies/alcohol-reduction-labelling/","status":"established","tldr":"Alcohol causes at least seven cancers and there is no safe threshold. Price, availability and cancer warning labels are the tools that work; most people still do not know alcohol causes cancer."},{"id":"idea-prev-alcohol-cancer-warning-labels","kind":"idea","name":"Cancer warnings on alcohol labels, evaluated as a natural experiment","route":"/ideas/idea-prev-alcohol-cancer-warning-labels/","tldr":"Most people do not know alcohol causes seven cancers. Ireland is putting cancer warnings on bottles; other countries should follow and measure the effect on drinking."},{"id":"idea-prev-hbv-treat-all-hcc","kind":"idea","name":"Treat everyone with chronic hepatitis B to prevent liver cancer","route":"/ideas/idea-prev-hbv-treat-all-hcc/","tldr":"Hepatitis B causes most liver cancer worldwide, and generic tenofovir suppresses it for under 30 dollars a year. Treating everyone infected, not just those with liver damage, as WHO's 2024 guidelines allow, would cut liver cancer incidence because viral load predicts it and antivirals reduce it in cirrhotics."},{"id":"idea-prev-hpylori-family-test-and-treat","kind":"idea","name":"Family-based H. pylori test-and-treat to prevent stomach cancer","route":"/ideas/idea-prev-hpylori-family-test-and-treat/","tldr":"Stomach cancer is largely caused by a bacterium that spreads in households. Testing and treating whole families, not individuals, would stop reinfection and prevent cancer."},{"id":"idea-moon-eliminate-infection-cancers","kind":"idea","name":"Eliminate infection-caused cancers: HPV, hepatitis B and C, H. pylori and EBV","route":"/ideas/idea-moon-eliminate-infection-cancers/","tldr":"About one in eight cancers is caused by an infection we can vaccinate against, cure or eradicate. A concerted global programme could make those cancers rare within a generation."},{"id":"idea-prev-radon-testing-at-property-sale","kind":"idea","name":"Mandatory radon testing when homes are sold, with subsidised mitigation","route":"/ideas/idea-prev-radon-testing-at-property-sale/","tldr":"Radon gas from the ground is the second biggest cause of lung cancer. Testing every home at sale and paying for fixes in high-radon areas would prevent thousands of cases."}],"trials":[],"papers":[]},{"era":"2026-2032","title":"Inherited risk found before the cancer","description":"Most people who carry a high-risk cancer gene find out when they or a relative get cancer. The proposals: reflex germline testing for every cancer where it changes care, letting clinics contact relatives directly when a gene is found, offering everyone at 30 a test for the genes that matter, and polygenic risk scores that set when screening starts, built to work in every ancestry before they are deployed anywhere. UK Biobank is the cohort where most of these scores are being validated.","status":"emerging","refs":[{"id":"germline-testing","kind":"technology","name":"Germline (hereditary) testing","route":"/technologies/germline-testing/","status":"standard-of-care","tldr":"A test of the DNA you were born with, to find inherited risk genes such as BRCA or Lynch syndrome."},{"id":"b-hereditary-risk","kind":"bottleneck","name":"Inherited risk is mostly unidentified","route":"/bottlenecks/b-hereditary-risk/","tldr":"Most people who carry a high-risk cancer gene do not know it until they or a relative gets cancer."},{"id":"idea-prev-reflex-germline-testing","kind":"idea","name":"Automatic germline testing for every cancer type where it changes care","route":"/ideas/idea-prev-reflex-germline-testing/","tldr":"Anyone with ovarian, pancreatic, metastatic prostate or mismatch-repair-deficient colorectal cancer should be tested for inherited mutations, yet testing rates fall well short. Making it an automatic, opt-out laboratory step triggered by pathology, as reflex mismatch-repair testing already is, would close the gap."},{"id":"idea-prev-cascade-direct-contact-relatives","kind":"idea","name":"Let clinics contact relatives directly when a cancer gene is found","route":"/ideas/idea-prev-cascade-direct-contact-relatives/","tldr":"When someone tests positive for a BRCA or Lynch mutation, relatives are told only if the patient passes the message on. Most do not. Letting clinics contact relatives directly, with consent, could double testing."},{"id":"idea-prev-population-germline-screening-at-30","kind":"idea","name":"Offer everyone at 30 a test for the cancer genes that matter","route":"/ideas/idea-prev-population-germline-screening-at-30/","tldr":"Most people with BRCA or Lynch mutations do not know until they get cancer. Testing everyone once for a short list of high-impact genes would find them in time to prevent it."},{"id":"idea-moon-population-germline-screening","kind":"idea","name":"Population germline screening for hereditary cancer genes with cascade testing","route":"/ideas/idea-moon-population-germline-screening/","tldr":"Most people carrying a high-risk cancer gene do not know it until someone in the family gets cancer. Offer testing to all adults so carriers can be protected before that happens."},{"id":"polygenic-risk-scores","kind":"technology","name":"Polygenic risk scores for cancer","route":"/technologies/polygenic-risk-scores/","status":"emerging","tldr":"A score built from hundreds of common gene variants that says whether your inherited risk of a cancer is higher or lower than average, now being tested as a way to decide who is screened and how often."},{"id":"idea-prev-prs-screening-start-age","kind":"idea","name":"Use a polygenic risk score to set when screening starts","route":"/ideas/idea-prev-prs-screening-start-age/","tldr":"Common gene variants shift a person's cancer risk several-fold. A one-time genetic score could tell each person when to start breast, bowel or prostate screening."},{"id":"idea-prev-prs-ancestry-portability-standard","kind":"idea","name":"Build polygenic scores that work in every ancestry before deploying any","route":"/ideas/idea-prev-prs-ancestry-portability-standard/","tldr":"Genetic risk scores were built mostly on Europeans and work worse in others. Funding non-European cohorts and setting a portability standard would prevent screening that widens inequality."},{"id":"uk-biobank","kind":"collection","name":"UK Biobank","route":"/collections/uk-biobank/","tldr":"UK Biobank is the richest population cohort for linking genes, blood and imaging to who later develops cancer."}],"trials":[],"papers":[]},{"era":"2030+","title":"Interception: vaccinating people who do not yet have cancer","description":"Lynch syndrome tumours share frameshift neoantigens, which makes a shared vaccine possible; a randomised prevention trial in carriers would be the first preventive cancer vaccine that is not against a virus. A bone drug (denosumab) may prevent BRCA1 breast cancers by hitting the cells they grow from. A master protocol for chemoprevention across many precancers, and regulators accepting shrinkage of precancer as an endpoint, would make prevention drugs developable at all. The bar is high: healthy people accept risk today for a probabilistic benefit years later.","status":"speculative","refs":[{"id":"interception-vaccination","kind":"technology","name":"Cancer interception vaccines","route":"/technologies/interception-vaccination/","status":"phase-2","tldr":"Cancer interception vaccines immunise people who do not yet have cancer but carry a high inherited risk, such as Lynch syndrome carriers, against the antigens their future tumour is predicted to express, so memory T cells remove transformed cells early. Because healthy people accept risk for a probabilistic benefit, the safety bar is far higher and trials take years."},{"id":"shared-antigen-vaccine","kind":"technology","name":"Off-the-shelf cancer vaccines","route":"/technologies/shared-antigen-vaccine/","status":"phase-3","tldr":"Off-the-shelf cancer vaccines target antigens shared across patients, such as mutant KRAS or HER2 peptides, so they are made in advance rather than per person. Sipuleucel-T is still the only approved therapeutic cancer vaccine in the US; tolerance to self-antigens and weak past results hold them back."},{"id":"idea-interception-vaccines","kind":"idea","name":"Cancer interception vaccines for high-risk carriers","route":"/ideas/idea-interception-vaccines/","tldr":"Vaccinate people with BRCA or Lynch mutations against the antigens their future cancers will express, before any cancer exists."},{"id":"idea-prev-lynch-frameshift-vaccine-rct","kind":"idea","name":"A randomised trial of a shared-antigen vaccine to prevent Lynch syndrome cancers","route":"/ideas/idea-prev-lynch-frameshift-vaccine-rct/","tldr":"Lynch syndrome tumours share predictable mutations the immune system can target. A vaccine in early trials could be tested to see if it prevents polyps and cancers in carriers."},{"id":"idea-moon-lynch-vaccine-phase3","kind":"idea","name":"A frameshift neoantigen vaccine for Lynch syndrome carriers as the first preventive cancer vaccine approval","route":"/ideas/idea-moon-lynch-vaccine-phase3/","tldr":"People with Lynch syndrome have a very high lifetime cancer risk from a predictable set of mutations. Vaccinate them against those shared mutations before cancer appears."},{"id":"idea-prev-brca1-denosumab-prevention","kind":"idea","name":"A bone drug to prevent breast cancer in BRCA1 carriers","route":"/ideas/idea-prev-brca1-denosumab-prevention/","tldr":"BRCA1 breast cancers seem to grow from cells driven by the RANK signal. Denosumab blocks it and is already used for bone. A trial is testing whether it prevents these cancers."},{"id":"idea-prev-chemoprevention-master-protocol","kind":"idea","name":"One master trial for cancer prevention drugs across many precancers","route":"/ideas/idea-prev-chemoprevention-master-protocol/","tldr":"Prevention drug trials run separately in each precancer and are slow. One master protocol with shared infrastructure across Barrett's oesophagus, oral leukoplakia, lung nodules and pancreatic cysts, using regression as an intermediate endpoint and adding or dropping arms adaptively, would test several drugs at once."},{"id":"idea-prev-precursor-endpoints-for-approval","kind":"idea","name":"Regulators accept shrinking of precancer as the endpoint for prevention drug approval","route":"/ideas/idea-prev-precursor-endpoints-for-approval/","tldr":"Few companies develop cancer prevention drugs because trials take decades. If regulators accepted validated precancer endpoints, as they do cholesterol for heart disease, industry would return."},{"id":"cure-paths","kind":"roadmap","name":"Paths to cures: interception, eradication, control","route":"/roadmaps/cure-paths/","tldr":"Three different ways a cancer stops killing someone: stop it before it starts, remove every last cell, or hold it in check for life. Each needs different technology."}],"trials":[],"papers":[]},{"era":"What sets the pace","title":"Deployment, funding and politics","description":"Around four in ten cancers are preventable with tools we already own, and the gap is deployment, not discovery. Prevention has no product to sell, so funding follows treatment; the commercial determinants of alcohol, tobacco and food are politically defended; and screening brings overdiagnosis that has to be managed rather than ignored. Community pharmacies as prevention hubs and social impact bonds repaid from avoided treatment costs are two ways to pay for what is already proven.","status":"current","refs":[{"id":"b-prevention-adoption","kind":"bottleneck","name":"Prevention we already have is not deployed","route":"/bottlenecks/b-prevention-adoption/","tldr":"Around four in ten cancers are preventable with tools we already own: vaccines, tobacco control, weight, alcohol, sun and infection control."},{"id":"b-funding-allocation","kind":"bottleneck","name":"Funding follows fashion, not burden","route":"/bottlenecks/b-funding-allocation/","tldr":"Research money follows visibility, not burden: breast, prostate and leukaemia receive far more funding per death or year of life lost than lung, pancreatic, liver, oesophageal, gastric, bladder and uterine cancers, and metastasis research gets an estimated 5% of funding despite causing most deaths. Advocacy strength and peer review that rewards mechanism explain the skew."},{"id":"b-incentive-misalignment","kind":"bottleneck","name":"Incentives reward me-too drugs and marginal gains","route":"/bottlenecks/b-incentive-misalignment/","tldr":"The system pays the same for a drug that adds two months as for a cure, so companies race to copy rather than to cure."},{"id":"b-global-access","kind":"bottleneck","name":"Most of the world has almost no cancer care","route":"/bottlenecks/b-global-access/","tldr":"Seven in ten cancer deaths happen in low- and middle-income countries, where radiotherapy, pathology, surgery and drugs are scarce."},{"id":"b-overdiagnosis","kind":"bottleneck","name":"Overdiagnosis and false alarms","route":"/bottlenecks/b-overdiagnosis/","tldr":"Finding more cancer is not the same as saving lives. Screening also finds cancers that would never have hurt anyone, and treats them."},{"id":"idea-prev-pharmacy-prevention-hub","kind":"idea","name":"Community pharmacies as one-stop cancer prevention hubs","route":"/ideas/idea-prev-pharmacy-prevention-hub/","tldr":"Pharmacies are everywhere and open late. They could give HPV vaccines, hand out bowel test kits, run stop-smoking clinics and offer HPV self-sampling under one roof."},{"id":"idea-fund-social-impact-bonds-prevention","kind":"idea","name":"Social impact bonds for cancer prevention, repaid from avoided treatment costs","route":"/ideas/idea-fund-social-impact-bonds-prevention/","tldr":"Investors would fund vaccination and screening campaigns up front and be repaid by health systems only if the campaigns hit verified targets, turning future savings into money for prevention now."},{"id":"icmr-nicpr","kind":"institution","name":"ICMR-National Institute of Cancer Prevention and Research","route":"/institutions/icmr-nicpr/","tldr":"ICMR's cancer prevention institute near Delhi, focused on the cancers India can prevent: cervical cancer through HPV screening and vaccination, and oral cancer through tobacco control."}],"trials":[],"papers":[]}],"watch":[]}