Schubauer-Berigan MK, Madia F, Kunzmann AT
… +10 more, Benbrahim-Tallaa L, de Conti A, Facchin C, Pasqual E, Wedekind R, Deng X, Suonio E, Viegas S, Mattock H, Weiderpass E
J Natl Cancer Inst Monogr
· 2026 Apr · PMID 42008728
·
Full text
For 54 years, the Monographs program of the International Agency for Research on Cancer has evaluated the carcinogenicity of agents suspected of causing cancer in humans, classifying them into categories according to str...For 54 years, the Monographs program of the International Agency for Research on Cancer has evaluated the carcinogenicity of agents suspected of causing cancer in humans, classifying them into categories according to strength of the scientific evidence. More than 15 years ago, all Group 1 agents (carcinogenic to humans, the highest strength-of-evidence category) were re-evaluated. Since then, 24 additional agents have been classified for the first time in Group 1. Here, we summarize the evidence for the 135 Group 1 agents, emphasizing those recently classified and providing a synthetic overview of the evidence that contributed to the classification. All but two of these newly identified Group 1 agents were found to have sufficient evidence for one or more cancer types in humans, most commonly cancers of lung, hematolymphoid tissue, skin, and urinary bladder. Perfluorooctanoic acid and "dioxin-like" polychlorinated biphenyls were classified in Group 1 with less than sufficient evidence for cancer in humans. For nearly all Group 1 agents, there was also sufficient evidence for cancer in experimental animals, strong mechanistic evidence, or both, illustrating the robust biological plausibility of Group 1 classifications. This survey of the known human carcinogens confirms that there are few established preventable causes for 3 of the 4 most common cancer types (breast, prostate, and colorectum) and for reproductive cancers in both women and men. Over the last 15 years, the number of known human carcinogens has increased by >20%, reflecting the continued advancement of evidence and implying the existence of as yet unrecognized, preventable causes of cancer.
Ezzemni S, Lam F, Al Korhani L
… +19 more, Battaglia I, Downham L, Dossus L, Espina C, Foll M, Langselius O, Meunier D, McCormack V, Mery L, Montigny S, Ribeiro Pinto LF, Specker M, Zhang Y, Kozlakidis Z, Carvalho AL, Soerjomataram I, Basu P, Rol M, Berger A
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-bui...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.
Chandran A, Togawa K, Mosquera I
… +13 more, Selmouni F, Dimitrova N, Lucas E, Muwonge R, Robbins HA, Johansson M, Park JY, Man I, Baussano I, Espina C, Clifford GM, Carvalho AL, Basu P
Prevention and early detection are central to reducing the global cancer burden, yet implementation remains uneven, particularly in low- and middle-income countries. This narrative review synthesizes the contributions of...Prevention and early detection are central to reducing the global cancer burden, yet implementation remains uneven, particularly in low- and middle-income countries. This narrative review synthesizes the contributions of the International Agency for Research on Cancer (IARC) to translating evidence into policy and practice worldwide across vaccination, screening, and early diagnosis. Key advances include generating evidence that enabled the World Health Organization (WHO) recommendation of single-dose human papillomavirus vaccination; contributions to WHO Elimination of Cervical Cancer Initiative and Global Initiative on Breast Cancer; development of guidance for Helicobacter pylori screen-and-treat strategies; building decision platforms to optimize cost-effective strategies; and establishing CanScreen5 to benchmark cancer screening program performance globally. IARC led European Union screening status reports, codeveloped quality-assurance schemes, and standardized performance indicators. Through implementation research, capacity-building, and codesigned solutions, IARC supports prostate, gastric, and lung cancer screening pilots and equity-oriented approaches that strengthen health-care systems. By embedding evidence, modeling, and governance, IARC helps countries transition from pilots to population-level impact, accelerating progress toward WHO targets and equitable outcomes in cancer control.
BACKGROUND: The global rise in cancer incidence and survivorship is contributing to escalating health-care expenditure. Yet comprehensive and internationally comparable data on direct cancer costs worldwide remain scarce...BACKGROUND: The global rise in cancer incidence and survivorship is contributing to escalating health-care expenditure. Yet comprehensive and internationally comparable data on direct cancer costs worldwide remain scarce, limiting insights into cross-country spending patterns, their relationship to cancer outcomes, and future cost trajectories. METHODS: We assembled data on direct cancer costs up to the year 2022 from academic journals, government statistical reports, and the grey literature. Drawing from 19 sources in 39 countries, we estimated total, per-patient, and per-capita cancer expenditure in US dollars (US$) by cancer type, assessing associations between spending and cancer outcomes, alongside recent trends. RESULTS: Annual cancer costs varied substantially and reflected differences in national income, ranging from US$1989 per diagnosis (Ethiopia) to US$129 494 per diagnosis (United States). Annual costs per capita ranged from US$1.43 (Ethiopia) to US$713 (United States). Annual expenditure was positively correlated with survival for most cancers but showed diminishing returns in high-income countries. Moreover, expenditure had no apparent relation with overall cancer mortality. Where data were available, spending patterns by cancer type reflected country-specific incidence profiles. Across all countries, the 4 costliest cancers accounted for one-third to almost one-half (37%-48%) of direct cancer costs. In countries with reliable time series, costs rose steadily over time, with growth rates ranging from 1.4% (Japan, 2009-2022) to 9.3% (Republic of Korea, 2004-2022). These increases consistently outpaced gross domestic product growth by 1.0%-7.7% over the respective observation periods. CONCLUSION: Greater reforms to cancer control, and health-care more broadly, are required to ensure long-term fiscal sustainability while maximizing population health outcomes.
Ferrari P, Loftfield E, Papier K
… +2 more, Huybrechts I, Freisling H
J Natl Cancer Inst Monogr
· 2026 Apr · PMID 42008722
·
Full text
The relationship between diet and cancer is complex and has been the subject of scientific controversy. Recent estimates of the fraction of cancer incidence attributable to (poor) diet ranged from 5% to 13% across differ...The relationship between diet and cancer is complex and has been the subject of scientific controversy. Recent estimates of the fraction of cancer incidence attributable to (poor) diet ranged from 5% to 13% across different study populations. Despite growing evidence linking dietary exposures to cancer risk, nutritional epidemiology faces major challenges, including exposure misclassification, confounding, and difficulties in assessing long-term and changing dietary habits. Advances such as use of biomarker and other -omics measurements, complex statistical framework, and longitudinal web-based exposure assessments have created novel opportunities for examining the diet and cancer relationship with improved accuracy. Increasing attention is also given to composite dietary indices, including ultraprocessed food, and comprehensive lifestyle scores, which better capture the complex nature of nutrition and the multifactorial nature of cancer. Methods like Mendelian randomization and molecular profiling support causal inference and elucidate biological mechanisms. Triangulation, integrating observational, biomarker, experimental, and genetic data, strengthens the evidence for dietary risk factors. Furthermore, the role of obesity and metabolic health in cancer etiology underscores the need for integrative approaches. This manuscript reviews the current state of evidence of research on diet and cancer, current methodological challenges, and promising avenues for advancing prevention strategies and scientific understanding.
Mutational epidemiology integrates genomic techniques with large-scale population studies to uncover new causes of cancer. This approach goes beyond traditional epidemiology by analyzing the patterns of somatic mutations...Mutational epidemiology integrates genomic techniques with large-scale population studies to uncover new causes of cancer. This approach goes beyond traditional epidemiology by analyzing the patterns of somatic mutations in cancer cells to identify specific mutational signatures that serve as a historical record of an individual's past mutagenic exposures. The field is also expanding to study mutational landscapes in normal tissues and precancerous lesions to understand the earliest stages of carcinogenesis. Initial studies are exploring how factors like certain mutagenic bacteria and air pollution can act as mutagens or promoters, influencing the selection and expansion of preexisting mutated clones. Ultimately, the goal is to use this evidence to uncover new and potentially preventive causes of cancer, understand differences and over time changes in incidence of certain cancers and develop tailored prevention strategies and public health policies.
Spoor J, Mureau MAM, de Jong D
… +16 more, Tissier RLM, Vis M, Rakhorst H, Hommes J, de Boer M, Oldenburg HSA, Heuts EM, Vissers YLJ, Dassen AE, Evers DJ, Koppert LB, Zaal LH, van der Hulst RRWJ, Vrancken Peeters MTFD, Bleiker EMA, van Leeuwen FE
BACKGROUND: Over the past decade, various large observational studies have suggested an association between silicone breast implants (SBIs) and autoimmune and rheumatic diseases (ARDs), rekindling long-standing breast im...BACKGROUND: Over the past decade, various large observational studies have suggested an association between silicone breast implants (SBIs) and autoimmune and rheumatic diseases (ARDs), rekindling long-standing breast implant-safety concerns among breast cancer survivors with breast reconstructions and newly diagnosed breast cancer patients. METHODS: We investigated the association between SBIs and ARDs in a large multicenter cohort of women treated for breast cancer, part of whom received SBIs for reconstructive purposes. Clinical data and events of interest were identified through linkages with prospectively maintained nationwide- and institutional registries. Hazard Ratios (HRs) for ARDs were calculated using Cox proportional hazards regression models adjusted for potential confounders. RESULTS: Of 12,262 women in the cohort, 3,082 (25%) had received SBI-based breast reconstructions. Median follow-up time was 12.0 (IQR, 7.0) years. The event rate of ARD-diagnoses was 62.5 per 10,000 person-years. Compared with women without SBI-exposure, women with an implant-based breast reconstruction did not have an increased risk of ARDs (multivariably adjusted HR, 1.06, 95% CI [0.89 to 1.27]). In addition, no statistically significant association was found between SBI-exposure and inflammatory arthritis, systematic rheumatic disease, inflammatory dermatosis, inflammatory bowel disease or any specific condition. Sensitivity analyses in which SBI-exposure was analyzed as a time-dependent variable confirmed the results of the main analysis. CONCLUSION: The findings of this study indicate that SBI-exposure is not associated with an increased risk of ARDs in women with breast cancer and challenge the results of earlier studies in women with cosmetic implants. REGISTRATION: This study is registered at ClinicalTrials.gov on June 2nd 2022 (NCT05400954).
BACKGROUND: While genome-wide association studies (GWAS) have identified hundreds of cancer-associated genetic variants, the specific biological contexts where these variants exert their effects remain largely unknown. W...BACKGROUND: While genome-wide association studies (GWAS) have identified hundreds of cancer-associated genetic variants, the specific biological contexts where these variants exert their effects remain largely unknown. We aimed to prioritize context-specific genetic risk mechanisms for 11 solid cancers at both genome-wide and single-variant resolutions. METHODS: We integrated cancer GWAS summary statistics from European ancestry samples (avg. n cases = 47,856) with 1,473 context-specific annotations representing candidate cis-regulatory elements. For genome-wide analysis, we applied CT-FM, a method that jointly models heritability enrichments across annotations to select likely disease-relevant biological contexts. Following functionally informed fine-mapping to identify high-confidence (PIP ≥ 0.5) causal SNPs, we used CT-FM-SNP to identify relevant contexts for individual variants. A combined SNP-to-gene framework was applied to construct putative {regulatory SNP-context-gene-cancer} quadruplets. RESULTS: Stratified LD score regression analysis identified 141 annotations showing significant heritability enrichment (FDR q ≤ 0.05). CT-FM prioritized four high-confidence (PIP ≥ 0.5) biological contexts mammary luminal epithelial cells for overall and estrogen receptor (ER)-positive breast cancer, a prostate cancer epithelial cell line (VCaP) for prostate cancer, and bulk tumor tissue contexts for colorectal and renal cancers. Variant-level analysis of hundreds of putatively causal SNPs aligned with these findings and identified additional high-confidence contexts for ER-negative breast, endometrial, lung, and bladder cancers. A total of 489 putative regulatory quadruplets were constructed, proposing specific molecular hypotheses underlying the observed GWAS signals. CONCLUSION: These findings advance our understanding of genetic susceptibility to different cancers. Future work in larger, more diverse GWAS, coupled with more comprehensive annotation atlases, is essential to expand upon and validate our results.
The 2022 U.S. Supreme Court decision Dobbs v. Jackson Women's Health Organization raised concerns about access to fertility care for patients with cancer, yet there is limited evidence of its real-world impact. We conduc...The 2022 U.S. Supreme Court decision Dobbs v. Jackson Women's Health Organization raised concerns about access to fertility care for patients with cancer, yet there is limited evidence of its real-world impact. We conducted a national survey of National Comprehensive Cancer Network (NCCN) Member Institutions to evaluate changes in fertility preservation access and utilization in the 24 months following Dobbs. Of 33 institutions surveyed, 24 (72.7%) responded. Most institutions (83.3%) reported that reproductive care remained a clinical priority, and 62.5% reported increased fertility preservation utilization. Nearly all respondents reported stable or expanded institutional resources and staffing to support oncofertility services. Institutions in less restrictive states appeared to absorb increased demand, however notable non-response from institutions in restrictive policy environments limited our findings. This study suggests relative resilience among academic cancer centers, but highlights the need for further study to ensure equitable access to fertility preservation in the post-Dobbs era.
Adults with cancer are at risk for complications from vaccine-preventable diseases, yet vaccine adherence in this population remains poorly characterized. This cross-sectional study used the National Health Interview Sur...Adults with cancer are at risk for complications from vaccine-preventable diseases, yet vaccine adherence in this population remains poorly characterized. This cross-sectional study used the National Health Interview Survey 2019 to 2023 to examine trends in influenza, pneumococcal, and shingles vaccines among adults aged ≥50 years with cancer. Of the 6,533 respondents included, only 30.6% (95% confidence interval [CI; 29.3%, 31.9%]) reported receiving all three recommended vaccines. Factors associated with lower vaccination adherence included younger age (odds ratio [OR] comparing ages ≥75 to 50 to 64 years 5.39; 95% CI [4.70, 6.18]), male sex (OR 0.81; 95% CI [0.73, 0.90]), Black (OR 0.59; 95% CI [0.47, 0.73]) or Hispanic race/ethnicity (OR 0.69; 95% CI [0.52, 0.92]), Medicaid insurance (OR 0.79; 95% CI [0.65, 0.96]), and lower educational attainment (OR 0.65; 95% CI [0.58, 0.73]). Preventable disease vaccination remains subpar in the adult cancer population, and further efforts including targeted interventions are necessary to improve preventative health efforts in these patients.
Lammers EM, Zijlstra JM, Schaapveld M
… +17 more, Haagsma JA, Janus CP, Aarsman KM, Te Boome LC, Schippers MM, Boersma RS, Rademakers SE, Plattel WJ, Böhmer LH, Van Den Berg M, Kroeze AC, Strobbe LS, Deenik W, De Lil HS, Aleman BM, Van Leeuwen FE, Nijdam A
BACKGROUND: Hodgkin lymphoma (HL) survivors are at increased risk of late adverse events, eg cardiovascular diseases (CVD), breast cancer (bc), hypothyroidism and severe infections. At Dutch BETER clinics, HL survivors a...BACKGROUND: Hodgkin lymphoma (HL) survivors are at increased risk of late adverse events, eg cardiovascular diseases (CVD), breast cancer (bc), hypothyroidism and severe infections. At Dutch BETER clinics, HL survivors are regularly screened for (risk factors for) these adverse events. The impact of survivorship care on burden of disease from adverse outcomes has rarely been evaluated. METHODS: In a nationwide retrospective cohort study, we compared HL survivors invited for BETER care in 2013 to 2016 (intervention group) with matched survivors who were eligible for such care, but were not invited until 2019 to 2024 (comparison group). Incidence and mortality rates for CVD, bc, hypothyroidism and severe infections were collected from general practitioners and nationwide registries. Disability-adjusted life years (DALYs) attributable to late adverse events were compared using multivariable regression models. RESULTS: At study start, survivors in the intervention group (n = 491) and comparison group (n = 373) had a median age of 46 years; median time since HL diagnosis was 15 to 18 years. After 8.5 years (median), there were no significant differences in DALYs attributable to CVD, bc, hypothyroidism and severe infections between the groups. In both groups, approximately one third of survivors acquired DALYs attributable to adverse events. Adherence to recommended screening diagnostics was high, but cardiovascular risk management and vaccination rates were suboptimal. CONCLUSION: After 8.5 years of follow-up, survivorship care for HL survivors was not associated with lower disease burden. Better care coordination, amendment of the cardiovascular risk management guidelines and greater survivor involvement may improve long-term effectiveness of measures to prevent late adverse events.
Qin F, Hua X, Wang X
… +14 more, Zhang H, Choi J, Yang XR, Zhang T, Machiela MJ, Anyaso-Samuel S, Landi MT, Berndt SI, Purdue MP, Albanes D, Zhu B, Brown KM, Shi J, Yu K
J Natl Cancer Inst
· 2026 Apr · PMID 41967136
·
Full text
BACKGROUND: Transcriptome-wide association studies (TWAS) integrate gene expression and genome-wide association studies (GWAS) to identify disease susceptibility genes. Because gene expression varies substantially across...BACKGROUND: Transcriptome-wide association studies (TWAS) integrate gene expression and genome-wide association studies (GWAS) to identify disease susceptibility genes. Because gene expression varies substantially across cell types within tissues, cell type-specific prediction models may enhance the power of TWAS. METHODS: We conducted cell type-specific TWAS leveraging single-cell RNA sequencing data from the OneK1K cohort (14 immune cell types, 1.27 million cells) and GWAS summary statistics for seven cancers (>290,000 cases in total). To improve prediction accuracy, we developed a modeling framework that incorporates shared gene expression effects across cell types. RESULTS: At a false discovery rate of 5% (Bonferroni 5%), we identified 106 (13) previously unreported loci for breast cancer, 51 (4) loci for prostate cancer, 11 (4) loci for lung cancer, 39 (5) loci for melanoma, 9 (1) loci for ovarian cancer, and 2 (1) loci for diffuse large B-cell lymphoma, with most genes exhibiting cell type specificity. Gene set analyses confirmed joint associations of unreported genes with breast and prostate cancer risk in UK Biobank data. Additional lung tissue scRNA-seq data with 113 individuals validated 18 of 32 (56.3%) significant genes for lung cancer. Across cancers, 139 significant genes were shared by at least two cancer types and were primarily enriched in specific immune cell types. CONCLUSION: Cell type-specific TWAS improves the identification of novel cancer susceptibility loci and provides insights into the immune landscape of cancer etiology.
Sim AJ, Hoppe BS, Ballas LK
… +12 more, Milgrom SA, Terezakis SA, Ha CS, Figura NB, Parikh RR, Grecula JC, Plastaras JP, Lo AC, Ryckman J, Flampouri S, Pinnix CC, Kelsey CR
J Natl Cancer Inst
· 2026 Apr · PMID 41965109
·
Full text
Modern radiation therapy (RT) technologies allow for improved sparing of normal tissues, decreasing the risk of both acute and long-term toxicities. Existing RT dose constraints for prospective trials within the National...Modern radiation therapy (RT) technologies allow for improved sparing of normal tissues, decreasing the risk of both acute and long-term toxicities. Existing RT dose constraints for prospective trials within the National Clinical Trials Network (NCTN) were formulated in the context of solid malignancies. As patients with hematologic malignancies are often treated with lower RT doses and are usually younger with more favorable prognoses, customized dose constraints are needed. The NRG Oncology Hematologic Malignancies Working Group (NRG HEME) commissioned a review of existing organ at risk (OAR) constraints from published primary literature, the NRG Center for Innovation in Radiation Oncology (CIRO), and national guidelines. Customized constraints were developed by iterative review by NRG HEME. Final recommendations were approved by radiation oncology representatives from all the lymphoma NCTN groups (NRG Oncology, COG, Alliance, ECOG-ACRIN, SWOG, CCTG). For 49 OARs, a strict recommended constraint was determined, of which 20 were not present in CIRO. Of the remaining 29 constraints, 20 were lower, 2 were the same, and 5 used different metrics; 2 were higher than at least one CIRO trial constraint. Acceptable variations were determined and unacceptable variations were added for select critical OARs for plan scoring. While doses to OARs without explicit unacceptable variations should not exceed acceptable variations, violations should not be considered for plan quality assessment on trials. This consensus list of standard OAR constraints should be incorporated for all future NCTN trials in hematologic malignancies. Strict dose constraints will minimize long-term toxicities in this patient population.
Linehan WM, Jemielita T, Cornell J
… +6 more, Chen K, Ball MW, Srinivasan R, Liu Y, Perini RF, Pinto CA
J Natl Cancer Inst
· 2026 Jun · PMID 41964905
·
Full text
BACKGROUND: Randomized controlled trials are the gold standard for demonstrating treatment efficacy. When infeasible, external control arm (ECA) analysis is an effective way to interpret treatment arm results. We develop...BACKGROUND: Randomized controlled trials are the gold standard for demonstrating treatment efficacy. When infeasible, external control arm (ECA) analysis is an effective way to interpret treatment arm results. We developed an ECA for a single-arm trial (LS-004) for a HIF-2α inhibitor (belzutifan) in 61 patients with VHL renal cell carcinoma (RCC) to help interpret results. With a median follow-up of 37.8 months in LS-004, the ORR was 64% (95% CI = 50.6 to 75.8); median time to surgery was not reached. METHODS: The ECA was developed using natural history study data for VHL RCC patients undergoing active surveillance with ≤5 years of follow-up. Key LS-004 eligibility criteria were applied. Propensity score (PS) weighting was used to balance prognostic factors, with balance evaluated using standardized mean difference (SMD). PS adjusted point estimates and 95% CI for ORR and time to surgery (TTS) are presented. For the ECA, ORR was evaluated among patients with ≥3 scans to allow opportunity for a confirmed response. RESULTS: The ECA included 244 patients (167 for ORR analysis). Prognostic factors were balanced with SMD < 0.1 for all covariates. PS adjusted ORR for LS-004 and ECA was 63.9% (95% CI = 51.9 to 76.0) and 1.5% (95% CI = 0.0 to 3.3), respectively. Median TTS was 51.3 (95% CI = 43.8 to not yet reached) months in ECA; not yet reached in LS-004. CONCLUSIONS: The belzutifan treatment effect is large compared with the ECA, supporting belzutifan efficacy in VHL RCC. Although residual confounding is possible, the large effect is unlikely due to chance.
BACKGROUND: Socio-environmental deprivation and discrimination are associated with poorer cancer outcomes, yet their combined impact remains understudied. This study examines the independent and combined impact of these...BACKGROUND: Socio-environmental deprivation and discrimination are associated with poorer cancer outcomes, yet their combined impact remains understudied. This study examines the independent and combined impact of these factors on cancer-related outcomes. METHODS: Survey data (2018 to 2020) from 7,977 participants across six NCI-designated cancer centers assessed perceived discrimination (PD), area-level deprivation, lifestyle factors (smoking and obesity), and self-reported breast and colorectal cancer screening behaviors. Multivariate and multilevel logistic regression models estimated associations and the interclass correlation (ICC) quantified variation attributable to area-level factors. RESULTS: High PD was associated with 2.28 times higher odds of current smoking (95% CI: 1.71-3.05) and 1.33 times higher odds of obesity (95% CI: 1.03-1.72), compared to those with low PD. Living in socially deprived areas increased the odds of smoking by 1.51 (95% CI: 1.20-1.89), relative to socially privileged areas. ICC estimates that 4% of the variation in the association between high PD on smoking, and 2% of the variation between medium PD and obesity, were attributable to area-level factors. Neither PD nor neighborhood disadvantage were significantly associated with being up-to-date on cancer screenings. CONCLUSIONS: PD and neighborhood deprivation independently increase risk of smoking and obesity, both cancer risk factors, but were not significantly associated with screening behaviors. Area-level factors explain modest variation in these associations. IMPACT: Findings highlight the importance of integrating both social experience (PD) and structural conditions (neighborhood deprivation) in cancer prevention research. For practice and policy, results underscore the need for multilevel strategies and targeted prevention efforts to reduce behavioral cancer risk.