8/28/22, 7:53 PM Early Detection, Prevention, and Infections Branch (EPR) – IARC

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Early Detection, Prevention,
and Infections Branch (EPR)

About
In 2021, the Section of Infections and the
Section of Early Detection and Prevention
were merged to form the Early Detection,
Prevention, and Infections Branch (EPR).

The activities of EPR include a wide portfolio of

study designs, including etiology and natural
history, assessing the global burden, and
evaluating and modelling the impact of
interventions. A major theme is evaluating
interventions through the lens of
implementation science. Carcinogenic
infectious agents are particularly amenable to
cancer prevention (e.g. vaccines, diagnostic
tools, and therapies), and the burden of
infection-attributable cancers is
disproportionately high in low- and middle-
income countries (LMICs) (> 25% of all cancer
cases in certain global regions). Therefore, a
significant proportion of EPR’s prevention
research focuses on infection-related cancers.
EPR also supports capacity-building to
implement quality-assured programmes for
cancer prevention and early detection.

Specific aims

To transform knowledge about established

cancer causes and mechanisms, with a
focus on carcinogenic infections, into
evidence-based interventions that can
prevent cancer suffering and death.

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8/28/22, 7:53 PM Early Detection, Prevention, and Infections Branch (EPR) – IARC

p g

(https://iarc.who.int/) To evaluate strategies for cancer prevention IARC NEWSLETTER

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the cancer burden and improving survival )

and quality of life of patients after

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interventions in real health-care settings.

Major approaches/areas of activity

The interventions evaluated can be broadly

categorized into those relevant to: (i) primary
prevention of established modifiable
infectious risk factors (e.g. preventing human
papillomavirus [HPV] and hepatitis B virus
[HBV] infection through vaccination; testing
and treatment of Helicobacter pylori and
hepatitis C virus [HCV]); (ii) screening of
asymptomatic at-risk populations, for
cancer sites for which the current evidence
base is more established (cervical cancer,
breast cancer, colorectal cancer) or
experimental (e.g. gastric cancer, anal cancer,
oral cancer, lung cancer); and (iii) early
diagnosis of common cancer types in
symptomatic individuals, with a view to
shifting the stage distribution of tumours
detected towards a lower stage, and
improving survival and quality of life of
patients after treatment. The evaluation of
prevention, screening, and early diagnosis
focuses on the effectiveness in real health-
care settings and on understanding the
related implementation challenges.

Primary prevention of carcinogenic

infections

IARC is the global reference for estimates of

the burden of infection-attributable cancer.
This programme serves to raise awareness,
inform recommendations for preventive
action, prioritize resources, and monitor the
long-term impact of cancer prevention policies
that target infectious agents, on both the local
and global scales. Current EPR priorities to
improve these estimates include establishing
the population attributable burden of HIV to

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the population attributable burden of HIV to

(https://iarc.who.int/) cancer (e.g. cervical cancer, Kaposi sarcoma, IARC NEWSLETTER
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Epstein–Barr virus to non-Hodgkin lymphoma
and gastric carcinoma.
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World Health Organization (WHO) global

strategy to eliminate cervical cancer as a
public health problem, but it has had only
limited roll-out in LMICs to date. EPR is
engaged in evaluating the efficacy and
effectiveness of, as well as modelling the
impact of, HPV vaccination in different
implementation scenarios, most notably that
of a single dose of HPV vaccine. The evidence
will guide health policies and support national
authorities in implementing HPV vaccination
programmes, particularly in LMICs, in order to
reduce global disparities in cervical cancer.
Similarly, EPR and WHO are collaborating to
monitor the impact of the WHO target for
elimination of viral hepatitis on the burden of
liver cancer.

H. pylori is the most important infectious

cause of cancer worldwide. In anticipation of
results from ongoing research (the HELPER
trial), which is expected to establish the
efficacy of testing and treatment of H. pylori in
reducing gastric cancer incidence, EPR is
expanding research into the implementation
of such programmes in LMICs, both by
undertaking operational research in
programmatic settings in LMICs and by
leveraging expertise in modelling the natural
history of carcinogenic infections.

Screening of asymptomatic at-risk

populations

EPR is conducting a range of studies that

evaluate new technological inventions in
cancer screening and management of
premalignant conditions and assess their
suitability and applicability for
implementation, in particular in limited-
resource settings.

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To accelerate the introduction of HPV-based

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screening, in alignment with the WHO Cervical ( H T T P S : / / W W W. I A R C .W
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Cancer Elimination Initiative, the IARC
)
portfolio on cervical cancer screening
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includes: evaluation of novel HPV detection More

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oncoproteins, detection in urine using infrared

spectroscopy); techniques for triage of HPV-
positive women (e.g. the ESTAMPA study in
Latin America); artificial intelligence for
pattern recognition to detect cervical
precancer; HPV screen-and-treat programmes
in Africa, with a particular focus on women
living with HIV; and a randomized controlled
trial in Zambia on the efficacy, safety, and
cost–effectiveness of cervical thermal ablation.

Continued follow-up of a randomized

controlled trial to evaluate clinical breast
examination for breast cancer screening in
India will generate valuable evidence on the
efficacy of this test. EPR is a collaborator in a
study that combines H. pylori eradication with
endoscopic surveillance to reduce gastric
cancer mortality (the GISTAR study).

EPR is also conducting a range of studies to

understand the major barriers to accessing
quality-assured cancer screening, and to
evaluate interventions directed at multiple
levels (systems, providers, and clients) to
increase participation. The Cancer Screening
in Five Continents (CanScreen5) project
evaluates the coverage and quality of cancer
screening programmes globally.
Implementation research studies aim to
document the challenges that countries face
while introducing major changes in their
existing screening programmes (e.g.
transitioning from cytology-based to HPV-
based cervical cancer screening).

Early diagnosis of common cancer

types

To better understand the challenges in

implementing cancer early diagnosis and the
means to improve it, in particular in LMICs,

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EPR is evaluating barriers to accessing timely

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individuals, including measuring delays
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(access, systems, and treatment) across the
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appropriate solutions to minimize such

barriers and delays.

EPR is conducting studies that identify

relevant gaps in the health systems across the
cancer care continuum and suggest
contextualized and sustainable solutions.
Keeping pace with the advancement of
technology, EPR is assessing the applicability
of new technology: mobile technology to
educate the community, the use of mobile
phone-based applications for patient
navigation, and the web-based promotion of
telepathology and distance learning for
service providers.

Furthermore, through collaboration with

ministries of health in several countries
(priorities for LMICs), EPR assists them in
planning and implementing quality-assured
cancer control programmes, including training
of health professionals and researchers in the
field of cancer prevention.

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