Currently, researchers estimate that around 4 in 10 cancers are preventable. That’s because they’re linked to risk factors we can do something about, like tobacco, UV exposure and obesity. But these “modifiable” exposures aren’t the only things that might put someone at a high risk of cancer. What if there was also a way to protect people from the risk factors we can’t directly control?

In recent years, scientists studying cancer and cancer risk have begun to identify the early changes that happen in the body just as cancer cells begin to develop. Their discoveries are pushing the boundaries of cancer prevention much further. It’s now becoming possible to target the early changes that might lead to cancer, as well as the exposures that can sometimes trigger them.

This approach is called precision prevention. By helping stop pre-cancerous changes in people with a high risk of cancer, it could give us a way to stop significantly more than 4 in 10 cancers before they have a chance to start – ushering in a new era for disease prevention in the process.

But, for all its promise, precision prevention research still needs to be carefully developed. This new era will need a new generation of researchers trained, funded and supported to deliver it. If we get that right, with a system that specifically encourages and invests in precision prevention, the potential is there for a future where many more people can live free from the fear of cancer.

That’s why Cancer Research UK’s science policy team has been speaking to and learning from the researchers working to bring precision prevention into practice. Together, we’ve written a new policy paper that identifies the barriers that are holding precision prevention research back, explains how we can build momentum in this novel research field, and outlines what the UK Government needs to do to help precision prevention reach its potential.

Cancer Research UK researchers developed LungVax to help prevent lung cancer in people at high risk by teaching their immune system how to recognise and kill lung cells that are showing signs they may develop into cancer. It’s now moving into clinical trials.

“LungVax is our chance to do something to actively prevent lung cancer,” says Professor Sarah Blagden, one of the lead researchers behind LungVax. Lab tests have shown the vaccine can work, and now the upcoming phase 1 trial will determine the right dose to give people and examine any possible side effects. If the results are promising, future phases will test how effectively it prevents cancer in a larger group of high-risk people.

Projects like LungVax, which is the first lung cancer vaccine of its kind, clearly show the potential of precision prevention research and are an example of how the UK can lead the way globally. And yet our researchers have raised concerns about how the research community will continue to run such innovative trials in the future.

Building a foundation for a new generation of researchers

The first challenge for precision prevention research is how difficult it can be to become a precision prevention researcher. Currently, the UK’s research ecosystem isn’t set up for younger researchers to specialise in the field.

Professor Karen Brown, director of the Leicester Cancer Research Centre, knows that problem well. An established precision prevention researcher, she’s currently working on COLO-PREVENT, a trial investigating two common medicines (aspirin and metformin) and a food supplements (resveratrol, which commonly found in red grapes) could help prevent bowel polyps (tissue growths which can develop into cancer over time).

Brown says: “I’ve been working in the area for a long time, and I’ve had many clinical fellows that have worked with me, and then they get told: ‘Don’t go into prevention – there’s no career in it.’ So we lose research talent, as potential prevention researchers build their career in other fields.”

The idea that it’s difficult to succeed professionally in prevention research is linked to how much time this research can take. Unlike with new cancer treatments, there’s usually a long lag between testing a preventative intervention and finding out whether it’s worked. This is a challenge for early and mid-career researchers, who need to regularly publish results to secure future funding and develop their career.

Over recent years the number of clinician academics in the UK has declined. Even beyond precision prevention, working to reverse this trend (by, for example, giving more doctors the opportunities to take part in research) will help ensure that NHS patients continue to have access to the most cutting-edge technologies and that the UK remains at the forefront of life sciences research. Government funders supporting more clinician academics to step into precision prevention is therefore doubly beneficial.

“Precision prevention is really exciting,” says Blagden. “You’re developing interventions that you can see changing people’s futures. Clinician academics are in danger of extinction, but precision prevention research could rescue the discipline.” 

Creating the right conditions: research funding and regulation  

But the next generation of precision prevention researchers can’t drive forward progress in disease prevention if the wider research environment is against them.

Again, that starts with funding. When funders prioritise certain research types in their funding strategies, or offer funding in specific areas, they help spark new research ideas, leading to more potential projects.

“You can see what a difference the Cancer Research UK push towards biology-based prevention has made to applications,” Brown says. “Ultimately people will go where the funding is – we need more funding from the National Institute of Health Research (NIHR) and UK Research and Innovation (UKRI).”

These government research funders are particularly key because their resources and reach can help embed precision prevention work in the UK research environment, giving it the chance to grow sustainably.

Still, on its own, research funding doesn’t translate directly to cancers prevented. The UK’s health regulators also need to adapt to make sure they’re prepared to support a new era of prevention research.

Our researchers highlighted that the processes and standards of bodies like the Medicines and Healthcare Regulatory Authority (MHRA) are generally geared towards treatment. This creates barriers for all types of prevention research, but they’re especially acute in precision prevention studies. These trials can be especially complex to set up, and because the field is new, regulators might not be familiar with the nature of the studies and the patients involved.

Currently, the MHRA assesses issues around designing and delivering precision prevention studies on a case-by-case basis. Blagden explains that this means researchers have to play a “guessing game” before launching a study. “You have to go back and forth to MHRA to understand how to build the trial to generate the right evidence, so there’s no consistency,” she says.

We’re calling on the MHRA to engage with research funders, academics, and experts to develop guidance around precision prevention trial design that could put a stop to the guesswork and unblock research. Researchers also need to be given a direct line of communication with assessors at MHRA so they can seek advice on how best to develop their precision prevention research projects.

The MHRA’s Innovative Licencing and Access Pathway (ILAP) for new medicines shows how it can offer joined-up, consistent support for research teams. Now it’s time to apply that thinking to precision prevention studies, too.

“Something similar to the ILAP for precision prevention – a joined-up committee which sits at the start of the project and follows it through to offer that support – would be fantastic,” says Blagden.

Creating the right conditions to accelerate the growth of this novel field would pave the way to a future where disease prevention is more precise and impactful, and where fewer people hear the words “You have cancer”.