Abstract
This editorial introduces the “Cancer Control” Special Collection featuring 14 peer-reviewed diverse studies from diverse geographical regions and thematic areas, including screening, HPV vaccination, cancer literacy, genetic and molecular innovations, and culturally tailored interventions. This collection highlights disparities in access, uptake, and awareness across populations emphasizing the urgent need for evidence-based strategies. It calls for integrated approaches in prevention, health education, policy reform, and technological advancements to reduce the global cancer burden, which continues to rise, especially in low- and middle-income countries.
Plain Language Summary
This is an editorial for a special topic on cancer burden and prevention. 14 articles summary are included in this editorial.
Cancer remains one of the leading causes of morbidity and mortality worldwide, imposing an immense burden on individuals, families, healthcare systems, and national economies.1-3 Despite advances in medicine, preventable and treatable cancers still lead to premature deaths in low-, middle-, and high-income countries alike.4,5 According to the World Health Organization (2020), many cancer-related deaths in both low-and high-income regions could be prevented through early detection and appropriate interventions. 5 Yet, as Zhou et al demonstrate, disparities persist—low- and middle-income countries (LMICs) bear a disproportionate burden due to limited access to screening, vaccine hesitancy, and late-stage diagnoses. 6 The Global Burden of Disease Study estimates that 44.4% of cancer deaths are linked to modifiable risk factors, including tobacco use, poor diet, and infections such as HPV[6]. In 2021, cancer accounted for approximately 14.6% of all global deaths and 8.8% of all disability-adjusted life years (DALYs). 6
Recent findings indicate that there is a shift in the burden of cancer towards low- and middle-income countries driven by factors such as aging populations, environmental exposures, and modifiable risk factors such as tobacco use, poor diet, physical inactivity, and infections.4,6 Moreover, there is an economic burden is increasing, exacerbated by the cost of treatment and health care services, lost productivity and long-term treatment.6,7
Strong public health systems are recommended to close gaps in knowledge, access, behaviour, and policy-especially when strategies are grounded in context-specific, evidence-based interventions.5,6,8
Highlights from the “Cancer Control” Special Collection
The Cancer Control journal recently published a thematic collection titled “Alleviating the Burden of Cancer through Prevention and Early Detection” (SAGE Publications, 2024). This collection comprises 14 peer-reviewed articles, covering a diverse range of topics, including cervical, breast, gastric and liver cancers; Human Papilloma Virus (HPV) vaccination, screening and genetic and molecular innovation; education, awareness and preventive measures; and efforts to address disparities in cancer care. The studies span various regions worldwide,-including Sub-Saharan Africa, Asia, the Middle East, Australia and the United States offering a broad examination of current challenges and innovative solutions.
Key Insights from the Collection
Cervical Cancer: Screening and Vaccination
1. Screening and Prevention in Sub-Saharan Africa
Research by Alie et al (2023) highlighted low cervical screening rates (23.4%) in sub-Saharan countries such as Kenya, Cameroon, Namibia, and Zimbabwe. Socio-economic factors such as younger age, rural residence, and limited health insurance coverage emerged as significant barriers. The study recommended that policymakers and healthcare professionals focus on improving screening rates and reduce the cervical cancer burden in the region. Targeting interventions were advised for younger women, rural residents, women with lower economic status, unemployed women, and those without health insurance. 9
In Ethiopia, Bogale et al (2024) found that over two-thirds of women living with HIV (WLHIV) had never undergone cervical cancer screening, despite being at higher risk. The study reported that more than 68% of HIV-positive women had never had a cervical examination, and over half had inadequate knowledge about cervical cancer. The study identified misinformation, embarrassment, and lack of perceived need as common barriers. Education level, income, and duration since HIV diagnosis were significant predictors of screening knowledge and practice. Integrating cancer education and screening into routine HIV care- as several African programs are beginning to do- offers a promising and pragmatic approach. 10
In the same collection, Effah et al (2024) described a program in Ghana that integrated cervical cancer screening into HIV clinics using mobile colposcopy and HPV DNA testing. The intervention led to improved screening uptake but revealed delays in treatment initiation. 11 The study highlighted both the potential and the limitations of mobile screening units, emphasising the need for a robust referral system.
2. Knowledge and Attitudes in the Middle East
Beyond Africa, a cross-sectional survey of women in the United Arab Emirates provided insights into the interplay between cancer literacy, health behaviours, and screening practices. Elbarazi et al. (2023) assessed cancer literacy among women in the United Arab Emirates and found that only 36.7% had adequate knowledge about breast cancer prevention, while just 5.3% were aware of cervical cancer prevention strategies. 12 Although most participants acknowledged the lifesaving potential of early detection, many held negative attitudes about screening, perceiving the procedures as unnecessary or painful. This was reflected in the low screening uptake: only 23% participants reported having ever undergone mammography, and 31.3% had received a Pap smear.
3. HPV Vaccination Uptake
Hundesa et al. (2024) reported that HPV vaccination coverage in Ethiopian secondary schools was only 31.65%, significantly influenced by factors such as parental education, rural residence, and household dynamics. 13 Similarly, Nguyen et al (2024) found in Vietnam that vaccine intention was strongly correlated with parental knowledge and attitudes, highlighting the importance of culturally tailored health communication. Vaccination uptake remained low, with only 55.9% of parents reported intending to vaccinate their children against HPV. 14 Positive attitudes and accurate knowledge of HPV and the vaccine were the strongest predictors of willingness to vaccinate, aligning with the Health Belief Model and Theory of Planned Behaviour. Both studies recommended that vaccination campaigns target adolescents, parents and caregiver with culturally relevant tailored messages that address specific values, perceived risk, and trust in the healthcare systems .
4. Disparities in Screening Access
A study of Nepali immigrant women in the United States (U.S), found that most had no knowledge of mammography or its purpose, despite living in a high-resource settings. 15 The study identified factors such as the lack of culturally appropriate information and language barriers as significant obstacles to accessing preventive services. However, since trust in primary care providers was found to be high, training these providers could serve as effective agents in increasing screening participation among underserved immigrant populations.
Likewise, in Australia, a study examining the relationship between colorectal cancer screening and mental and physical health found no evidence that colorectal cancer screening negatively affects mental or physical well-being. However, individuals with better overall health were slightly more likely to participate in screening. The study recommended promoting CRC screening among the general population noting that it is unlikely to harm psychological well-being and appears to be safe for individuals with various physical and mental health conditions. 16
5. Innovative Molecular and Genetic Research. a. DNA Damage and Breast Cancer
Lin et al (2024) explored the reduction of DNA abasic site in long-term breast cancer survivors in Taiwan, finding that these markers significantly declined post-treatment, The study suggests that biomarkers hold promise for recurrence monitoring and patient stratification.
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b. Gastric Cancer and Metastasis
Further upstream in the cancer development pathway, a study in China investigated metastasis markers in gastric cancer, highlighting potential molecular targets for early detection and treatment strategies. 18 These molecules may be promising as early detection markers or therapeutic targets-representing a step forward toward precision oncology.
6. Lifestyle and Behavioural Interventions a. Dietary Interventions
A study that piloted an mHealth behavioral intervention to improve adherence to dietary recommendations reported a successful reduction in processed food and sugary beverage intake. Factors such as household support and coach monitoring were found to be effective in enhancing outcomes. The study recommended a multifaceted approach to lifestyle modification.
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b. Liver Cancer in the MENA Region
Lakkis et al. (2024) identified rising liver cancer rates in the Middle East and North Africa (MENA) region attributed to poor control of infectious disease and obesity. Despite the availability of hepatitis B vaccination and antiviral therapies, the study highlighted inadequate surveillance systems and a lack of comprehensive epidemiological research in the region. It recommended a multifaceted strategy that includes vaccination, lifestyle interventions, improved cancer registries, and equitable access to care.
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c. Cancer Health Literacy
Staying in the same region, a study conducted in the United Arab Emirates (UAE) found that only 16.7% of residents demonstrated high cancer health literacy (CHL), with social media identified as a major source of information. 21 The authors strongly emphasised the need for culturally sensitive and evidence-based communication strategies.
Finally, in Japan, Yokoshima and Sugisaki (2024) explored the evolution of cancer awareness among Japanese students, finding improved knowledge but the persistent misinformation and myths. They recommended integrating accurate and engaging cancer education into school curricula to promote better preventive behaviours. 22
Conclusion
This editorial provided insights on global evidence on cancer prevention and early detection, highlighting diverse strategies—from education and behavioural change to molecular diagnostics and mobile screening. It is essential to embed prevention in routine care and tailor interventions to specific cultural and structural contexts. Addressing disparities, enhancing health literacy, and ensuring system-wide follow-up are critical to reducing the global burden of cancer. An interdisciplinary, community-driven, and data-informed approach will be central to closing the cancer prevention gap.
Translating Research into Action
Culturally tailored, evidence-based strategies to improve cancer prevention and control are urgently needed. Key priorities include expanding access to screening and vaccination, enhancing education to counter misconceptions, and leveraging technological and molecular advancements. Collaboration across healthcare systems, policymakers, and communities is essential to achieving meaningful reductions in cancer incidence and mortality.
