Transforming evidence into action: The case of viral-related cancers

Zisis Kozlakidis and Sofia Dafnomili from the World Health Organization’s International Agency for Research on Cancer discuss the importance of transforming evidence into action for cancer prevention, specifically focusing on viral-related cancers

Modern examples of cancers caused by viral infections clearly show how modern cancer control can move upstream, away from late-stage treatment and towards prevention, early detection, and public health planning. Among these cancers, those linked to human papillomavirus (HPV) and Epstein-Barr virus (EBV) deserve special policy attention as they account for a significant and uneven global burden, and they expose how strongly cancer outcomes still depend on geography, income, sex, and access to health systems. Clinical, laboratory-based, and epidemiological studies, complemented by biomarker research and implementation-focused work over the years, have strengthened the evidence base that policymakers need. For HPV, that evidence is already informing vaccine delivery, screening strategies, and elimination planning. For EBV, for which no licensed vaccine yet exists, the knowledge gained is intended to inform future vaccines, risk-stratified screening, and earlier intervention. Here, we summarise how the evidence has been used to transform modern clinical practice and cancer prevention.

The HPV exemplar for vaccine research and impact

HPV remains the most immediate example of vaccine-linked cancer prevention in practice. Persistent infection with oncogenic HPV types is the necessary cause of almost all cervical cancers and contributes to a wider group of cancers. The latest global estimates continue to show the scale of the burden. In 2022, cervical cancer caused about 662,000 new cases and about 349,000 deaths worldwide. (1) In the same year, the World Health Organization (WHO) updated its recommendation to permit a single-dose vaccine schedule for girls and boys (down from two doses), as simplifying to one dose can dramatically expand coverage by reducing costs and logistical barriers. Yet these totals conceal profound inequalities.

For HPV, the central question is no longer whether prevention works, but whether countries can implement it equitably and at scale.

In countries with sustained HPV immunization and screening, cervical incidence is declining. However, global coverage remains far below targets. In 2021, only around 15% of eligible girls worldwide had completed the two-dose HPV series. The difference is stark: about 70% of upper-middle-income countries have the HPV vaccine in their national immunization schedules, whereas only 31% of non-Gavi lower-middle-income countries (LMICs) had introduced it by 2022. (2) According to WHO, 94% of cervical cancer deaths now occur in LMICs, reflecting inequitable access to vaccines and screening, with sub-Saharan Africa, Central America, and South-East Asia suffering the highest cervical cancer rates worldwide. (1) This emphasizes that without much stronger, equitable vaccine uptake, elimination of cervical cancer will be out of reach for the poorest populations.

EBV: building the evidence for the next prevention frontier

EBV-related cancers present a different policy challenge. Unlike HPV, EBV is not yet the target of a licensed cancer-preventing vaccine, though several are in preparation and/or early phase clinical trials. That means the current task is not a scale-up of an existing immunization programme, but the development of the evidence that will make future prevention well-targeted and thus, possible. EBV is associated with several malignancies, including nasopharyngeal carcinoma, Hodgkin lymphoma, Burkitt lymphoma, and a subset of gastric cancers, but their distribution is highly uneven. Nasopharyngeal carcinoma, for example, remains strongly concentrated in East and Southeast Asia. At the same time, some EBV-linked lymphomas are more common in parts of sub-Saharan Africa, where co-infections and immunosuppression can intensify the risk. In 2022, nasopharyngeal cancer accounted for more than 120,000 new cases and more than 73,000 deaths globally, with the large majority occurring in Asia.

Recent studies are moving the field beyond broad association and towards actionable prediction. Work in prospective cohorts in southern China has shown that positivity for EBV viral capsid antigen immunoglobulin A is associated with increased risk of multiple cancers, including nasopharyngeal carcinoma, with the strongest relationship observed for that disease. (3) Other research indicates that combining EBV serology with polygenic risk scores may improve risk stratification for nasopharyngeal carcinoma. (4) This matters for public policy because it suggests a route towards targeted screening strategies in high-risk populations, instead of relying only on late diagnosis after symptoms appear. Thus, the groundwork has been laid for targeted interventions once vaccines or therapies become available.

From evidence to policy

The policy relevance of all this work is clear. For HPV, the central question is no longer whether prevention works, but whether countries can implement it equitably and at scale. WHO’s cervical cancer elimination strategy already provides a clear and ambitious framework to be achieved by 2030: 90% vaccination coverage by age 15, 70% screening coverage, and 90% access to treatment for women with detected cervical pre-cancer and diagnosed invasive cervical cancer. (5) In Europe, in March 2026, scientists presented updated European recommendations on cervical screening through the European Commission Initiative on Cervical Cancer. (6) Crucially, these recommendations introduce tailored screening strategies for populations vaccinated against HPV, signaling a more risk-based approach to screening in the post-vaccination era. For EBV, the pathway is less mature but no less important. Policymakers already have access to longitudinal cohort data and region-specific risk profiles, as this data is already shaping discussions for near-future vaccination efforts and the next generation of prevention tools.

Integrating multi-disciplinary approaches for effective cancer prevention

The lesson across both viruses is that cancer prevention is no longer only about demonstrating causation but identifying who bears the burden, which interventions are ready now, and where evidence must still be built so that future tools can be deployed efficiently and fairly. Implementing a multi-disciplinary approach, for example, by connecting surveillance, epidemiology, laboratory tests, diagnostics, and implementation science, helps turn complex evidence into decisions that ministries, health systems, and international partners can act on. The latest data not only show where HPV- and EBV-related cancers occur but also where prevention is succeeding, where it is failing, and where greater political and financial commitment is urgently needed.

Disclaimer:

Where authors are identified as personnel of the International Agency for Research on Cancer/WHO, the authors alone are responsible for the views expressed in this article, and they do not necessarily represent the decisions, policy, or views of the International Agency for Research on Cancer/WHO.

References

1. World Health Organization. (2025). Cervical cancer. https://www.who.int/news-room/fact-sheets/detail/cervical-cancer
2. World Health Organization. (2024). New report highlights critical gaps in immunization coverage in middle-income countries. https://www.who.int/news/item/30-05-2024-new-report-highlights-critical-gaps-in-immunization-coverage-in-middle-income-countries
3. Ji, M.-F., He, Y.-Q., Tang, M.-Z., Xue, W.-Q., Yu, X., Diao, H., Yang, D.-W., Mai, Z.-M., Cheong, I. H., Zhao, Z.-Y., Wu, B.-H., Li, F.-G., Zhan, J.-Y., Huang, C.-L., Ma, H.-L., Li, J., Li, Y.-C., Wang, T.-M., Liao, Y., & Chen, X.-Y. (2025). Epstein Barr virus antibody and cancer risk in two prospective cohorts in Southern China. Nature Communications, 16(1). https://doi.org/10.1038/s41467-025-60999-5
4. He, Y.-Q., Wang, T.-M., Ji, M., Mai, Z.-M., Tang, M., Wang, R., Zhou, Y., Zheng, Y., Xiao, R., Yang, D., Wu, Z., Deng, C., Zhang, J., Xue, W., Dong, S., Zhan, J., Cai, Y., Li, F., Wu, B., & Liao, Y. (2022). A polygenic risk score for nasopharyngeal carcinoma shows potential for risk stratification and personalized screening. Nature Communications, 13(1). https://doi.org/10.1038/s41467-022-29570-4
5. World Health Organization. (2020). Global strategy to accelerate the elimination of cervical cancer as a public health problem. https://www.who.int/publications/i/item/9789240014107
6. International Agency for Research on Cancer. IARC presents updated European recommendations on cervical screening at EUROGIN 2026. (2026). https://www.iarc.who.int/news-events/iarc-presents-updated-european-recommendations-on-cervical-screening-at-eurogin-2026/