Over the past 6 decades, the International Agency for Research on Cancer (IARC) has played a pivotal role in global cancer research capacity building. This study presents a comprehensive evaluation of IARC's capacity-building initiatives with a mixed-methods approach. We integrated qualitative and quantitative data from institutional records, outcome surveys, and a career-tracking study of postdoctoral fellows. IARC's capacity-building portfolio includes fellowships, digital-learning platforms, a summer school, and global networks such as the Global Initiative for Cancer Registry development, the Cancer Screening in 5 Continents project, and the Biobank and Cohort Building Network. Since 1966, approximately 30 000 professionals from most countries in the world have benefited from those initiatives, with a majority from low- and middle-income countries. Among tracked IARC postdoctoral fellows, since 1966, 76.5% remained in academia, and 18.7% had a role in public health policy. Qualitative findings highlight the impact of IARC training on individual careers, institutional capacity, and global cancer control strategies. IARC's sustained investment in capacity-building has strengthened the cancer research workforce and institutional infrastructures while reducing inequalities in low- and middle-income countries. These efforts have advanced leadership, equity, and evidence-based cancer prevention. As global health challenges evolve, continued support remains essential to achieving equitable cancer control worldwide.

Background: Premature mortality from non-communicable diseases (NCDs), particularly cancer and cardiovascular disease (CVD), threatens population health, workforce participation, and economic sustainability across Europe. However, comparative evidence on their productivity costs across European regions remains limited. Objective: To estimate and compare the productivity costs of premature cancer and CVD mortality among working-age populations across Europe and assess regional inequalities. Methods: A quantitative, retrospective, cross-sectional comparative modelling study was conducted using secondary data from 30 European countries. Mortality data for adults aged 15–64 years were obtained from the World Health Organization Mortality Database, and labour market and economic data from Eurostat. A lifecycle simulation model incorporating age-specific earnings, employment rates, and labour force participation was developed to estimate productivity losses associated with premature mortality. Productivity costs were expressed in 2021 Euros and as a proportion of Gross Domestic Product (GDP). Results: Premature mortality from cancer and CVD generated productivity losses of €195.7 billion, equivalent to 1.24% of European GDP. Cancer accounted for €122.2 billion (62.5%) and CVD for €73.5 billion (37.5%). Productivity losses per death were slightly higher for CVD (€219,848; 95% CI 165,241–270,247) than cancer (€217,744; 95% CI 166,554–273,144). Central and Eastern Europe experienced the highest relative economic burden. Conclusions: Premature mortality from cancer and CVD imposes substantial and unequal productivity losses across Europe. Increasing investment in prevention and early detection, particularly in higher-burden Central and Eastern European countries, could reduce avoidable working-age mortality and support workforce sustainability and long-term economic resilience.

Background:Even though breast cancer (BC) is the most common female cancer worldwide, the role of tobacco, specifically chewing tobacco in the development of BC has not been widely studied. This study is aimed at assessing this association. Methods:A multicentre hospital-based case-control study was utilised. Two thousand five hundred fifty-three histopathologically confirmed BC cases, and 2239 visitor controls were included. Self-reported information was collected regarding tobacco consumption and other potential confounders. A logistic regression model was used to calculate odds ratio (OR) and its 95% confidence interval (CI), after adjusting for age, current residential region, education, various reproductive factors, BMI and history of benign breast lump. Attributable fraction (AF) and population attributable fraction (PAF) of BC due to chewing tobacco were also calculated. Results:An increased risk of BC was observed in women who ever used chewing tobacco (OR:1.19, 95% CI:1.00-1.41) as compared to those who never consumed tobacco (smoking and chewing), consistent across all subtypes of BC. A dose-response relation was observed for duration of tobacco chewing (OR>25 years: 1.38, 95% CI: 1.04-1.83). Women who initiated chewing tobacco at < 20 years, before their first full-term pregnancy (FFTP), had more risk. Observed association was consistent even after stratification on menopausal status. The AF of BC due to tobacco chewing in our study was calculated to be approximately 3%, whereas the PAF for India was about 2%. Conclusion:Our study suggests that chewing tobacco is associated with an increased risk of BC for all subtypes. This is particularly true when the duration of exposure is higher and exposure begins before FFTP. This highlights the need to target tobacco control policies to smokeless tobacco along with smoking, thus reducing the burden of BC to some extent.

Survival after metastatic breast cancer (MBC) has improved in high-income countries, yet international differences in outcomes and access to optimal care, particularly for recurrent disease remain unclear. We compared survival after recurrent MBC across four high-income countries, examining tumour subtype, treatment patterns and guideline adherence. Individual-level data were obtained from population-based cancer registries in Canada (British Columbia), Ireland, the Netherlands and the United States (Connecticut) for women who were diagnosed with stage I-III invasive breast cancer between 2005 and 2008 and developed distant metastatic recurrence between 2008 and 2010. Follow-up was from first recurrence until death, loss to follow-up or December 31, 2015. Kaplan-Meier methods were used to estimate overall survival, and age-standardised net survival (ASNS) at 1, 3 and 5 years after recurrence was estimated by registry and subtype. Among 2,735 women with recurrent MBC, treatment at initial diagnosis varied across registries. Median survival after recurrence ranged from 12 months in Ireland to 18 months in the United States (p=0.015). One-year ASNS ranged from 51.3% in Ireland to 63.6% in the United States and the Netherlands. Across countries, ASNS was highest for HR+/HER2− tumours and lowest for HR−/HER2− tumours. The Netherlands consistently showed the highest subtype-specific survival, while survival for HER2+ disease in Canada was closer to HR−/HER2− than HR+/HER2− disease. Differences narrowed over longer follow-up and in sensitivity analyses. Survival after recurrent MBC differed across these high-income countries. Improved harmonisation of recurrence data and timely implementation of evidence-based therapies may help reduce persistent international disparities.

Background:Brazil contributes to 41% of colorectal cancer (CRC) deaths in Latin America. CRC is the second most incident cancer among males and females in Brazil, with wide regional variation. We aimed to estimate the years of potential life lost (YPLL) and the productivity lost due to mortality from CRC by region, between 2001 and 2030. Methods:We estimated the indirect costs of mortality from CRC using the Human Capital Approach. Mortality data (2001-2016) were obtained from the national Mortality Information System. Economic data were obtained from the Continuous National Household Sample Survey. Productivity lost was calculated for those aged over 15. Results for 2016-2030 were estimated based on the observed data (2001-2015). Findings:We estimated 635,253 deaths from CRC between 2001 and 2030, corresponding to 12·6 million YPLL and Int$22·6 billion in productivity losses. From 2001-2005 (observed) to 2026-2030 (estimated), CRC deaths are expected to increase by 181% and 165% among males and females, respectively. The largest relative increases among males will be observed in the North region, with productivity losses increasing 9·7-fold. Among females, North and Northeast regions will experience the highest increases in productivity lost, 8·7 and 10·3-fold respectively. Interpretation:CRC productivity loss will increase substantially by 2030, primarily due to increasing incidence and mortality, as a consequence of the epidemiological transition and health services access, especially in the North and Northeast regions. Implementing primary prevention, screening, early diagnosis and ensuring timely access to treatment is essential to reduce the economic impact of CRC overall and reduce regional inequities. Funding:This study was funded by the MSD Independent Oncology Policy Grant Program.

This study explores variation in stage-specific survival in women diagnosed with breast cancer in transitioning countries. We obtained data of women diagnosed between 2008 and 2012 from 11 population-based cancer registries (PBCRs) in 10 countries, with follow-up until December 2014. Following stage data standardization and multiple imputation for missing data, we estimated age-standardized 1-, 3-, and 5-year net survival (ASNS) by stage and age group. Stage distribution varied significantly across jurisdictions. Puerto Rico had over 4 in 5 patients diagnosed with early stage (stage I/II), while India, Trivandrum, and Thailand, Khon Kaen had <3 in 5 diagnosed with early stage. Stage-specific ASNS was similar across early stages (stage I/II) but varied markedly for stage IV, where the highest 3-year ASNS (Puerto Rico: 43.2% 95% CI: 38.9%-47.6%) was 20 percentage points higher than the lowest 3-year ASNS (India, Trivandrum: 22.8% 95% CI: 10.2%-35.4%). ASNS for patients 60 years and older was generally lower than for patients younger than 60 years across all jurisdictions. Differences in ASNS were subtle in early stages but were especially pronounced for stage IV, where in Puerto Rico, 3-year ASNS for patients younger than 60 (49.0% 95% CI: 42.7%-55.2%) was over 13 percentage points higher than 3-year ASNS for patients 60 or older (35.4% 95% CI: 29.2%-41.7%). Disparities in breast cancer survival were partly explained by differences in early diagnosis and in care at late stages. Stage at diagnosis is an important indicator that should be collected by registries worldwide, particularly for late-stage disease and older patients.

Background: Incremental improvements in early detection, diagnosis and treatment of cancer have led to an increasing number of cancer survivors worldwide. Existing cancer prevalence statistics however have seldom focused on specific phase-of-care pathways essential to inform cancer survivors’ and healthcare needs. Methods: We estimated 5-year cancer prevalence in 186 countries in 2024 using available estimates of cancer incidence and survival by cancer type, time since diagnosis, sex for ages at diagnosis > 15 years. We defined three clinically distinct phases of care: (a) the initial phase of treatment; (b) the phase from initial treatment to end-of-life care where patients are followed-up; and (c) the “end-of-life” phase. These were calculated by first partitioning the 1-year survival to either treatment (if the patient was alive), or end-of-life (if the patient died). For the remaining four years, we then assigned cases to the follow-up phase if they were alive, or end-of-life, if they died from cancer or other causes. Results: The 5-year prevalence was estimated to be approximately 52.4 million, indicating 1% of the global adult population were living within five years of a diagnosis in 2024. Around 22.9% (12/52 million) of prevalent cases were in diagnosis and treatment, 65.5% (34/52 million) in follow-up and 11.6% (6/52 million) were at the end-of-life phases. Female breast, colorectal and prostate cancers were the most prevalent cancer types contributing 43% (23/52 million) of the total prevalent cases, with almost three-quarters of the prevalent cases in the follow-up phase. On the other hand, lung cancer, the fourth most prevalent cancer, had a larger proportion of prevalent cases (4.1 million) in the end-of-life phase (32%, 1.3/4.1 million). Cancer prevalence as a proportion was higher in very high versus low Human Development Index (HDI) countries (2,608 vs. 417 survivors per 100,000 respectively), yet the proportion in the end-of-life phase was higher among low HDI countries (8% vs. 12% of all prevalent cases in very high vs low HDI, respectively). Interpretation: Among the 52 million cancer survivors estimated in 2024, there are substantial variations in cancer survivorship at different phases of care, driven by distinct cancer profiles coupled with survival disparities. This study highlights the need for equitable access to early detection, timely diagnosis and comprehensive care to improve survival and quality of life cancer survivors worldwide.

PURPOSECancer imposes substantial economic burden through indirect costs associated with labor outcomes and productivity loss. This systematic review and meta-analysis quantifies labor and productivity outcomes among patients with cancer and survivors to inform economic evaluations and policy development.METHODSWe systematically searched PubMed, EconLit, and Web of Science databases in June 2025 using cancer, productivity loss, and labor outcomes terminology. Peer-reviewed studies reporting eight outcomes were included. Following screening of 6,239 abstracts and full-text review of 358 articles, 144 studies from 27 countries met inclusion criteria for meta-analysis.RESULTSThe available evidence skews strongly toward formal employment situations in high-income, Western countries. We estimate a 25% productivity loss due to absenteeism (95% CI, 18 to 32) and a 23% productivity loss due to presenteeism (95% CI, 21 to 26); working hours are reduced by 19% (95% CI, 14 to 24); the return-to-work rate is 47% (95% CI, 39 to 54) with a median time of 239 days for full return; the overall job loss rate is 9% (95% CI, 8 to 11; 35% for advanced cancer; 95% CI, 22 to 48); the unemployment rate is 29% (95% CI, 22 to 36); the long-term disability/pension use is 11% (95% CI, 0 to 22); and the early retirement rate is 14% (95% CI, 8 to 20). For each reported outcome, cancer's productivity costs are observed to be more severe among women than men.CONCLUSIONThis represents the largest comprehensive meta-analysis of cancer-related labor outcomes to date. Estimated labor and productivity consequences are in line with previous research, but outcomes varied significantly by gender, cancer stage, geographic region, and time since diagnosis. Subgroup analysis provides nuanced insight into how these factors influence labor and productivity outcomes. These evidence-based estimates provide critical inputs for economic evaluations and support development of policies to maintain professional productivity among patients with cancer and survivors.

This study estimates population-based cancer survival for selected cancers in Türkiye over a 10-year period and investigates differences across provinces. We utilised data for patients diagnosed with five most common cancers (lung, breast, colorectum, prostate and thyroid) from eight population-based cancer registries (PBCRs) in Türkiye (Antalya, Bursa, Edirne, Erzurum, Eskisehir, Izmir, Samsun and Trabzon) in 2008-2012 and 2013-2017. We estimated 5-year age-standardised relative survival (ASRS) by age, sex and extent of disease. Five-year ASRS for the leading cancers in Türkiye increased by 1.4 to 4.6 percentage points between subsequent 5-year periods, in particular for breast, prostate and colorectal cancers. Thyroid cancer consistently showed the highest 5-year ASRS, exceeding 89%, while lung cancer had the lowest 5-year ASRS, with Edirne reporting the lowest survival at approximately 10% in both periods. Improvement in 5-year ASRS was greatest in the older age group (≥ 65 years) except for lung cancer (0.6 percentage point increase in ≥ 65 years vs. 3.2 percentage points for < 65 years). Antalya and Trabzon showed the greatest 5-year ASRS and the largest survival gains over time across most cancers, while survival improvements in Erzurum were limited. In 2013-2017, 5-year ASRS for localised cancers were > 95% for breast cancer in 7 out of 8 PBCRs, and > 75% for colorectal cancer in all PBCRs. While survival for the most common cancers in Türkiye has improved, likely due to advances in the availability of and access to cancer treatment, further efforts are needed to address regional disparities and inform policy decisions across the provinces in Türkiye.

Background:Alcohol is a major preventable risk factor for cancer, causally linked to seven types of cancer. Yet the potential cancer-preventive impact of population-level alcohol control policies remains unquantified; this study provides the first such estimates for the European Union (EU). Methods:We conducted a modelling analysis for 27 EU countries to estimate changes in alcohol consumption and alcohol-attributable cancer incidence. Four policy scenarios were examined, based on real-world studies from high-income economies reviewed in the International Agency for Research on Cancer Handbooks of Cancer Prevention Volume 20B: increased alcohol excise taxation, a Sunday alcohol sales ban, a national alcohol marketing ban, and an integrated alcohol policy implemented in Lithuania Relative changes in recorded alcohol consumption were applied to 2012 exposure data to estimate cancer incidence in 2022, assuming a 10-year latency period. Alcohol-attributable fractions were calculated for seven causally related cancers by country, sex, and age, with uncertainty quantified using Monte Carlo-like simulation. Findings:In 2022, an estimated 146,194 cancer cases (16.1% across seven causally related sites) in the EU were attributable to alcohol. All policy scenarios would have reduced cancer incidence across the EU. The integrated policy scenario would avert 9220 cases (95% UI: 8568-9833; 6.5% of alcohol-attributable cases). Increased taxation would avert 8387 cases (95% UI: 7954-8 862, 5.9%), a Sunday sales ban 5491 cases (95% UI: 5365-5 618, 3.8%), and a marketing ban 6434 cases (95% UI: 5899-6 973, 4.5%). The largest absolute reductions were for female breast, and oesophageal cancers. Interpretation:Implementation of major alcohol policies could prevent thousands of cancer cases in the EU. Population-level alcohol policies represent an underused tool for cancer prevention and should be integrated within EU and national cancer control frameworks. Funding:EU4Health Programme (SANTE/2022/SI2.883729); French National Cancer Institute (INCa_19160).

Cancer is a leading and growing cause of morbidity and mortality worldwide, with an estimated 20 million new cases and 9.7 million deaths in 2022 and projections of substantially greater burden over coming decades. A large fraction of this burden is preventable through interventions directed at established modifiable risk factors, including tobacco, excess body weight, alcohol, ultraviolet and occupational exposures, and oncogenic infections such as human papillomavirus (HPV) and hepatitis B virus. Yet, primary prevention remains underutilized relative to its demonstrated impact. In this chapter, derived from presentations at the 2026 ASCO Annual Meeting Education Session on global cancer prevention, we synthesize the contemporary global burden of preventable cancers quantified through population attributable fractions; summarize progress and remaining challenges in eliminating cervical cancer through HPV vaccination, screening, and treatment of precancerous lesions; and examine evidence-based approaches to cancer control in Africa, where the preventable fraction is particularly high. We conclude with priority actions spanning policy, financing, workforce development, and research that are needed to translate the existing prevention evidence base into measurable reductions in cancer incidence and mortality, particularly in settings of greatest need.

Cancer remains a leading cause of morbidity globally, largely attributable to modifiable risks. We estimated the 2022 global and national cancer burden attributable to 30 such factors, including tobacco smoking, alcohol consumption, high body mass index, insufficient physical activity, smokeless tobacco and areca nut, suboptimal breastfeeding, air pollution, ultraviolet radiation, 9 infectious agents and 13 occupational exposures, to inform prevention efforts. Using GLOBOCAN data for 36 cancer sites in 185 countries, we applied prevalence data from around 2012 to reflect exposure-cancer latency and estimated Levin-based or Miettinen-based population-attributable fractions (PAFs) or direct estimates where applicable. Combined PAFs accounting for overlapping exposures were derived by cancer, sex, country and region. In 2022, an estimated 7.1 million of 18.7 million new cancer cases (37.8%) were attributable to 30 modifiable risk factors-2.7 million (29.7%) in women and 4.3 million (45.4%) in men. The proportion of preventable cancers ranged from 24.6% to 38.2% in women and from 28.1% to 57.2% in men across regions. Smoking (15.1%), infections (10.2%) and alcohol consumption (3.2%) were the leading contributors to cancer burden. Lung, stomach and cervical cancers represented nearly half of preventable cancers. Strengthening efforts to reduce modifiable exposures remains central to global cancer prevention.

BACKGROUND:Accurate information on childhood cancer survival is essential for improving health systems. Survival is believed to be low in low-resource countries, but population-based survival estimates are scant. We aim to provide reliable and comparable survival estimates in these settings. METHODS:We included 16 821 patients from 47 population-based cancer registries in 23 countries in Africa, Latin America and the Caribbean, and Asia. We used the Cancer Survival in Countries in Transition project data (children aged younger than 15 years, diagnosed 2008-2012, followed until 2014) and data from Rwanda (2013-2017, followed until 2022). We estimated 1-year, 3-year, and 5-year observed survival using the Kaplan-Meier method, by diagnostic group, country, region, Human Development Index, income, and sex. RESULTS:Survival was higher in registries included from the Caribbean (namely, Puerto Rico [United States], Martinique [France]) and Central America (Costa Rica), Asia, and the Middle East and North Africa compared with those included from South America and sub-Saharan Africa. Survival correlated with the Human Development Index. For leukemia, 3-year survival varied from 30.4% (95% confidence interval [CI] = 12.4% to 50.6%) in Kenya to 89.5% (95% CI = 83.8% to 93.2%) in Puerto Rico; for central nervous system tumors from 32.0% (95% CI = 13.9% to 51.8%) in Algeria to 79.3% (95% CI = 69.1% to 86.5%) in Puerto Rico. The findings should be interpreted with care, as registry coverage varies and may not reflect national and regional survival. CONCLUSION:The variability of the population-based survival estimates across predominantly low- and middle-income countries highlights gaps in cancer registration, access to care, and quality of care. This study provides benchmark data for the World Health Organization Global Initiative for Childhood Cancer generated by population-based cancer registries, which should be supported in all countries.

Abstract Population-based cancer registries (PBCR) provide insight on the burden of cancer in a specific population, by systematically recording data on new (pre-)malignancies within a specific region, area, or treatment setting (e.g. hospital-based care). The burden of cancer at the population level is described by reporting on incidence, treatment modalities and timing, mortality, survival, and prevalence. Mortality data are often obtained through national or regional death registries. PBCRs play a vital role in cancer surveillance and research into the causes of cancer, by providing data on patterns and trends, and by different types of epidemiologic studies. They comprise an essential element in the planning and monitoring of cancer control strategies for a population, through identifying priorities in public health. Increasingly, PBCRs in developed countries have begun to gather additional data on stage, treatments, molecular profiles, and outcomes (e.g. recurrences), enabling the performance of research on quality of care, guideline adherence, quality of life, and outcomes.

Cancer has become the second leading cause of death, the global cancer burden is rapidly increasing, and there are marked disparities between and within countries worldwide. Population-based cancer registries systematically collect data on cancer patients in defined populations, which play a crucial role in planning and assessing cancer prevention and control strategies. While the development of cancer registration has been marked by increasing standardization of definitions and methods and the electronic processing of data, the advent of artificial intelligence (AI) offers opportunities to further reduce the labor-intensive nature of registry operations, particularly where registry resources are scarce. These include enabling the processing of large datasets, extracting complex or unstructured data patterns to support cancer registration data abstraction, and facilitating data quality and control. The analysis and dissemination of registry data are also increasingly integrating AI methodologies. This paper provides a comprehensive overview of the application of AI in cancer registration. We investigate the challenges associated with integrating AI into existing cancer registry structures, with a particular emphasis on network and computational constraints, uneven resource allocation, and potential biases and limitations within AI systems. We propose a forward-looking AI-enhanced framework for cancer registration, highlighting AI’s potential to optimize efficiency in cancer registration and the use of registry data for cancer control and cancer research.