The WHO Classification of Tumours (WCT) serves as a global standard for cancer diagnosis, providing a consistent framework by integrating clinical, histopathological, and molecular tumor characteristics, ensuring unified...The WHO Classification of Tumours (WCT) serves as a global standard for cancer diagnosis, providing a consistent framework by integrating clinical, histopathological, and molecular tumor characteristics, ensuring unified interpretation of diagnostic findings. Uniform terminology and standardized diagnostic criteria applied by WCT facilitates effective interdisciplinary communication, reduces variability in cancer diagnosis and reporting, enhances collection and comparability of cancer surveillance data, and supports clinical and epidemiological cancer research. The WCT informs the development of cancer screening programs and bolsters early detection strategies through the identification and classification of precursor lesions, playing a pivotal role across the cancer care continuum. Moving towards the sixth edition, the WCT adopts an increasingly multidimensional, interdisciplinary, and global approach. The program will actively contribute to the strategic planning and implementation of cancer prevention and early detection initiatives.
The increased understanding of epigenetics has significantly advanced our understanding of cancer development, especially regarding environmental, occupational, and lifestyle exposures. Unlike genetic mutations, epigenet...The increased understanding of epigenetics has significantly advanced our understanding of cancer development, especially regarding environmental, occupational, and lifestyle exposures. Unlike genetic mutations, epigenetic changes may be reversible, making them critical mediators and promising targets for cancer prevention and control. This review synthesizes two decades of transformative research by the International Agency for Research on Cancer (IARC), which positioned the epigenome as a central focus in cancer epidemiology and mechanistic research among the 10 Key Characteristics (KCs) of carcinogens by the IARC Monographs program. From foundational in vitro and animal studies to large-scale population-based research, IARC researchers contributed to unraveling epigenetic mechanisms of carcinogenesis and identifying epigenetic biomarkers of exposures and cancer risk. We highlight progress in epigenetic biomarker development, mechanistic epigenomics, toxico-epigenomics, and the interplay between diet, microbiome, and epigenome. As IARC marks its 60th anniversary, this review underscores the growing role of epigenetics in guiding global cancer prevention efforts and public health strategies.
In the 60 years since Epstein-Barr virus (EBV) was identified as the first human oncogenic virus, the International Agency for Research on Cancer (IARC) has classified 13 infectious agents as carcinogenic. Globally, appr...In the 60 years since Epstein-Barr virus (EBV) was identified as the first human oncogenic virus, the International Agency for Research on Cancer (IARC) has classified 13 infectious agents as carcinogenic. Globally, approximately 2.3 million cancer cases (12% of all cancers) are attributable to infection each year. Main causes are Helicobacter pylori (850 000), human papillomavirus (HPV; 730 000), hepatitis B virus (HBV; 380 000), EBV (240 000), and hepatitis C virus (160 000). Infection-attributable cancer burden varies greatly, exceeding 25% of all cancers in parts of Asia and in sub-Saharan Africa where HIV also causes an important cancer burden. Substantial progress in effective interventions has been made, often informed by IARC-led research. IARC Codes Against Cancer provide recommendations for reducing infection-attributable cancer risk including by prophylactic vaccines (HPV and HBV), diagnosis and treatment of infections (hepatitis C virus, HBV, HIV, and H. pylori), and screening to detect and treat precancerous lesions (HPV). Improving efficiency and implementation of existing interventions and developing novel tools (eg, EBV and H. pylori vaccines) are crucial.
McCormack V, Simba H, Abnet CC
… +12 more, Buckle G, Middleton DRS, Menya D, Muchengeti M, Kantelhardt EJ, Addissie A, Mmbaga BT, Lemmens V, Sheils O, Boucheron P, Kim J, Schüz J
J Natl Cancer Inst Monogr
· 2026 Apr · PMID 42008730
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On the International Agency for Research on Cancer's 60th birthday, we reflect on the continuing importance of the agency's international remit in cancer research, driven by its founding principle that the discovery of c...On the International Agency for Research on Cancer's 60th birthday, we reflect on the continuing importance of the agency's international remit in cancer research, driven by its founding principle that the discovery of carcinogenic agents is relevant to all humans globally. The present narrative elaborates on this continued stimulus through the discussion of three themes: (1) trust and independence, especially amid vested interests and misinformation; (2) equity and efficiency as essential elements of progress in cancer research, achieved by prioritizing research in underserved and understudied areas and locations where exposure doses or contrasts are high; and (3) a commitment to context-relevant research through strong local collaborations and capacity building. We demonstrate that the international research conducted at the International Agency for Research on Cancer is a core means to advance carcinogenic discovery, building reciprocal partnerships where all countries benefit when discoveries are shared across borders. If we do not attempt to understand cancer everywhere, we will never fully understand it anywhere.
Kim J, Beane Freeman LE, Deltour I
… +11 more, Foerster M, Kovalevskiy EV, Kromhout H, McCormack V, Olsson AC, Ostroumova E, Parent MÉ, Spycher BD, Turner MC, Zupunski L, Schüz J
J Natl Cancer Inst Monogr
· 2026 Apr · PMID 42008729
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Approximately half of cancers are attributed to modifiable risk factors or inherited genetic mutations, thus there remains the potential for as-yet unidentified environmental risk factors to explain substantially more of...Approximately half of cancers are attributed to modifiable risk factors or inherited genetic mutations, thus there remains the potential for as-yet unidentified environmental risk factors to explain substantially more of the global cancer burden. Current estimates of the environmental and occupational cancer burden account for a relatively small number of exposures, because of challenges in characterizing exposure patterns and human cancer risks. Hence, the environmental cancer burden may be underestimated because of combinations of not having identified all carcinogenic agents, lack of understanding of cancer risks at very low exposure levels of even known carcinogens, and lack of understanding of joint effects. The International Agency for Research on Cancer has a long history of addressing these challenges, and of advancing our understanding of occupational and environmental causes of cancer, with primary research predominantly conducted by the Environment and Lifestyle Epidemiology Branch. The International Agency for Research on Cancer's position within the World Health Organization has facilitated the conduct of cross-border collaborations on important and sensitive topics, ranging from asbestos, ionizing radiation, and pesticides to its current work on artisanal petroleum refining. Here, we highlight some important Environment and Lifestyle Epidemiology contributions to several areas of occupational and environmental cancer, describe recent progress in other important and emerging exposures, and finally, provide suggestions for future research. In our constantly changing world, with new products, technologies, and demands transforming our environment and workplaces, there is a continued need for high-quality human cancer investigations of potential occupational and environmental carcinogens, especially those characterizing environmental levels of exposure encountered by the general population in their daily life and in underresearched regions of the world.
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
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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
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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.
Galvão DA, Courneya KS, Lucia A
… +7 more, May AM, Mustian K, Warner AB, Joachim W, Wonders K, Schmitz KH, Newton RU
J Natl Cancer Inst Monogr
· 2025 Sep · PMID 40828163
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Exercise is increasingly recognized by patients, clinicians, and allied health professionals globally as an important component of cancer care. In this paper, we provide a viewpoint on developments in exercise oncology o...Exercise is increasingly recognized by patients, clinicians, and allied health professionals globally as an important component of cancer care. In this paper, we provide a viewpoint on developments in exercise oncology over the past 4 decades leading up to the creation of the International Society of Exercise Oncology (ISEO). We briefly review research in adult and pediatric cancers from early foundation studies to larger randomized controlled trials published in mainstream oncology journals alongside critical work undertaken in exercise and cancer biological mechanisms. We also discuss potential strengths, weaknesses, opportunities, and threats facing ISEO in becoming a global forum for exercise oncology. Building on the foundational work undertaken over the past 4 decades by researchers, clinicians, and practitioners, ISEO provides an opportunity to support research, leverage collaborations and partnerships, facilitate education and training, increase awareness of exercise oncology, and support translation of research to clinical practice, ultimately improving the quality and quantity of life for people with cancer.
Zopf EM, Müller J, Trevaskis M
… +20 more, Kias A, Hiensch AE, Bland KA, Lorenz MC, Monninkhof EM, Schmidt ME, Binyam D, Clauss D, Gunasekara N, Crisafio M, De Jongh E, Olivier F, Wengström Y, Steindorf K, Alves AJC, Campbell A, Campbell KL, Stuiver MM, May AM, Winters-Stone K
J Natl Cancer Inst Monogr
· 2025 Sep · PMID 40828162
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Exercise is safe and beneficial for people diagnosed with cancer. The use of live-remote exercise approaches, where exercise trainers deliver exercise programs via a videoconferencing platform, has increased rapidly, gre...Exercise is safe and beneficial for people diagnosed with cancer. The use of live-remote exercise approaches, where exercise trainers deliver exercise programs via a videoconferencing platform, has increased rapidly, greatly expanding the reach of exercise programs. This method retains key elements of supervised exercise, which provide greater benefits than unsupervised programs. However, challenges in adapting in-person supervised exercise programs to remote delivery exist. This article discusses the key considerations for the effective and safe delivery of live-remote exercise, such as technological requirements, exercise professional skills, safety aspects, exercise programming features, social interactions, costs, and legal and ethical considerations. Considerations relevant for the design and execution of exercise oncology clinical trials and for community practice are described. Remaining knowledge gaps are outlined and point to opportunities to further inform evidence-based practice and practice-based evidence.
Exercise is recommended as a part of standard cancer care, based upon its favorable impact on treatment-related side effects and its association with better cancer outcomes. Fully incorporating exercise into oncology pra...Exercise is recommended as a part of standard cancer care, based upon its favorable impact on treatment-related side effects and its association with better cancer outcomes. Fully incorporating exercise into oncology practice will require multidisciplinary efforts across oncology and exercise professionals. This article examines current patterns of exercise advice and prescription in oncology settings and highlights the roles of oncology clinicians, physiatrists, physical and occupational therapists, exercise physiologists and fitness trainers, and patient advocates in expanding exercise oncology across the cancer continuum. Future efforts to enhance provider education, expand community-based programs, establish referral pathways, and address policy challenges related to reimbursement will be needed to establish exercise as a universally accessible and effective component of oncology care.
The complex requirements of people with cancer can impact the provision of safe, effective, evidence-based exercise prescription. Consequently, a range of essential competencies are required from the exercise oncology wo...The complex requirements of people with cancer can impact the provision of safe, effective, evidence-based exercise prescription. Consequently, a range of essential competencies are required from the exercise oncology workforce. There is a global need for a standardized approach to the development of this workforce. By defining, standardizing, and training the workforce in essential competencies, this will enable various professionals to safely and effectively screen, access, design, and deliver appropriate exercise programs. Therefore, this is also a call for a global collaboration on the development of the exercise oncology workforce with special attention to assisting low- or middle-income countries with their increasing cancer burden and unique challenges, which may require unique context-specific strategies. The building of an appropriate internationally standardized workforce is essential in the provision of physical activity and exercise options as part of standard cancer care.
Exercise oncology has emerged as a distinctive area of research and clinical practice. To obtain a global overview of this field, we summarize viewpoints from experts across 6 continents on (1) the scope of exercise onco...Exercise oncology has emerged as a distinctive area of research and clinical practice. To obtain a global overview of this field, we summarize viewpoints from experts across 6 continents on (1) the scope of exercise oncology research and programs, (2) the availability of reimbursement for cancer exercise services, and (3) pathways and initiatives for developing the exercise oncology workforce. From an international perspective, the field of exercise oncology has progressed substantially; however, gains made to date are uneven, with general underdevelopment in Africa, Asia, and South and Central America. In addition, the availability of cancer exercise services continues to fall short of the increasing demand worldwide. With the upcoming formation of the International Society of Exercise Oncology, we suggest leveraging coordinated efforts from the global exercise oncology community to optimize research capacity, enhance workforce development, and expand the delivery of exercise services to advance the field across the world.
Courneya KS, Lucia A, May AM
… +2 more, Rundqvist H, Rogers LQ
J Natl Cancer Inst Monogr
· 2025 Sep · PMID 40828158
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Exercise oncology is a multidisciplinary field that encompasses research across the translational continuum. Some of the major disciplines contributing to the field include biology, immunology, physiology, psychology, be...Exercise oncology is a multidisciplinary field that encompasses research across the translational continuum. Some of the major disciplines contributing to the field include biology, immunology, physiology, psychology, behavioral science, epidemiology, and clinical oncology. Here, we provide a brief overview of the field under the headings of preclinical studies, observational studies, interventional outcome studies, interventional behavioral studies, dissemination and implementation studies, and childhood cancer studies. Preclinical studies have generally demonstrated that exercise can reduce tumor growth, primarily by modulating the tumor microenvironment. Observational studies have generally demonstrated that higher postdiagnosis exercise is associated with lower rates of mortality, however, most studies have not considered the combination and sequencing of exercise with other cancer treatments. Interventional outcome studies have consistently demonstrated strong evidence that aerobic and/or resistance exercise have beneficial effects on fatigue, anxiety, depression, physical functioning, and quality of life in adult patients treated with curative intent. Childhood cancer studies have demonstrated beneficial effects on cardiorespiratory fitness and muscular strength; however, the quality of evidence is often low. Interventional behavioral studies have identified multiple effective exercise behavior change strategies, yet the evidence is limited by a lack of diversity, minimal attention to social determinants, and insufficient knowledge to tailor interventions. Dissemination and implementation studies are occurring globally, yet an evidence base identifying the most cost-effective, equitable, and sustainable strategies is limited. Notwithstanding substantial limitations and remaining research gaps, multidisciplinary exercise oncology research across the translational continuum has provided cancer patients with evidence-based recommendations for improving quality of life and possibly survival.
J Natl Cancer Inst Monogr
· 2025 Sep · PMID 40828157
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Exercise oncology is coming of age, with more than 30 000 peer-reviewed citations in the scientific literature and multiple guidelines published by major medical institutions based on strong evidence from randomized cont...Exercise oncology is coming of age, with more than 30 000 peer-reviewed citations in the scientific literature and multiple guidelines published by major medical institutions based on strong evidence from randomized controlled trials. There is enthusiasm around the formation of a new international organization that will form a nexus for exercise oncology researchers, clinicians, and practitioners. The contents of this monograph document the progression of exercise oncology research and practice, laying the groundwork for the formation of the International Society of Exercise Oncology. The society will aim to be an organizing body to shepherd the field toward the goal of using exercise as standard of care in the setting of oncology in collaboration with existing medical organizations so that every patient can benefit.