A change of perspective for prevention?

Cancer prevention and early detection represent complementary, interdependent ways of reducing cancer burden.

Traditionally, cancer prevention has been divided into primary prevention, aiming to eliminate or reduce exposure to carcinogenic factors (for example, lifestyle modifications, vaccination, chemoprevention), and secondary prevention, focusing on identifying and managing early-stage lesions to prevent progression to invasive cancer.

A new framework

Cancer prophylaxis encompasses interventions that prevent the transition from normal to precancerous states in individuals without evidence of disease. Broadly applied strategies include vaccination (good examples here include HPV and HBV), lifestyle modifications, and carcinogen avoidance. Preventive treatments – including chemoprevention – also fall under this heading.

Population-wide measures like smoking bans have had among the most significant impacts on cancer risk reduction to date, emphasizing the importance of population strategies to impact broad public health. However, more recent developments in understanding risk and individualised strategies have led to precision prophylaxis approaches, such as risk-reducing surgery in individuals who have inherited a germline genetic variant that confers extremely high cancer risk. A risk-reducing oophorectomy in women who have inherited BRCA1 pathogenic variants is a classic case of this approach.

So, population strategies can be complemented by targeted precision prophylaxis strategies to meet the needs of individuals at different levels of cancer risk.

Cancer interception aims to halt the progression of abnormal cells and preneoplastic lesions before they become invasive tumours. This concept aligns with risk-adaptive screening and surveillance, analogous to cardiovascular risk monitoring which utilises cholesterol and blood pressure measurements.

Molecular markers increasingly inform early intervention, but a critical challenge remains in defining actionable thresholds for intervention. For example, monitoring premalignant conditions such as monoclonal gammopathy of undetermined significance (MGUS) requires precise biomarkers to distinguish indolent states from those progressing toward malignancy.

Cancer mitigation focuses on delaying or preventing progression from early-stage to advanced cancer, emphasizing early detection, active surveillance, and strategic intervention. Imaging, molecular diagnostics, and multi-cancer detection assays hold promise in refining this phase, though their clinical utility depends on demonstrating a meaningful impact on mortality.

For example, prostate cancer screening has value in some individuals who are at risk of developing lethal prostate tumours but may cause harm in men who harbour indolent tumours that don’t need treatment. Optimising active treatment vs active surveillance, treatment timing, and minimising overtreatment are key to balancing disease control with quality of life. Similar concerns exist with ductal carcinoma in situ and thyroid cancers. These issues represent some of the most important challenges in the field of cancer mitigation.

Continuum of control

This redefined framework highlights a continuum of cancer control, shifting from a binary model of prevention and detection to a risk-adaptive approach.

A core tenet of this framework is “equal care for equal risk” ensuring equitable access to prevention and early detection strategies. Disparities in cancer outcomes remain a persistent challenge, driven by variations in screening uptake, preventive interventions, and healthcare access. Addressing these disparities requires precision-based as well as population-wide strategies that align risk with intervention intensity.

By establishing a standardised lexicon for cancer prevention and early detection, our hope is this framework will foster greater coherence in research, policy, and clinical implementation. A refined, integrated approach to cancer control will enhance collaboration, improve risk stratification, and ultimately optimise the balance between intervention and overmedicalisation, leading to more effective and equitable cancer prevention strategies.