• Strengthening cancer screening data collection to update the European Cancer Information System and improve the quality and coverage of cancer screening programmes in Europe
  The CanScreen-ECIS project aimed to develop and pilot a new cancer screening data management system to be integrated into the European Cancer Information System (ECIS; https://ecis.jrc.ec.europa.eu/). The project revised and updated cancer screening performance indicators, data collection tools (qualitative and quantitative), the data collection platform, the data analytics tool, and a web application for visualization of the results. This project has led to an IARC initiative to prepare the third report on the status of implementation of EU Council recommendations on cancer screening in the EU and EEA Member States (the third European Cancer Screening Report). Both projects have been supported by the European Commission.
  Website: https://canscreen-ecis.iarc.who.int/
  
  
• Risk-Based Screening for Cervical Cancer for Europe (RISCC)
  RISCC is an EU-funded consortium aiming to identify optimal risk-based cervical cancer screening protocols. The RISCC consortium is based on data from four large European population-based randomized controlled trials of HPV screening and from the Finnish phase IV cluster-randomized vaccination trial of vaccinating only girls versus both girls and boys. EPR contributes to RISCC through its open-source model for disease progression by assessing health gains and screening-related harms associated with different risk-based programmes. The project is funded by the EU Horizon 2020 Research and Innovation Programme.
  Website: https://www.riscc-h2020.eu/
  
  
• Identifying context-appropriate solutions to improve cervical cancer screening in vulnerable women in Europe (CBIG-SCREEN)
  EPR is supporting the implementation of this multicentre research study, which aims to tackle inequality in the cervical cancer screening continuum in Estonia, Portugal, and Romania. These focus countries have been identified to represent different health-care settings within Europe. The interventions aim to increase screening participation among vulnerable women from the current 26% to 45%, and intend to offer support to policy-makers and national programmes to help Europe reach the WHO 2030 target of screening at least 70% of women for cervical cancer. EPR developed a protocol (CervScreen-SARA) to assess health system capacity before the introduction of HPV-based cervical screening. The project is supported by the EU Horizon 2020 Research and Innovation Programme.
  Website: https://cbig-screen.eu

• AI image recognition in cervical screening in LMICs (SAVE-CERVIX and EASTER)
  EPR is supporting the development and evaluation of a promising AI-driven technology to recognize cervical precancers and cancers. The technology includes a high-acuity image capturing device (n-GYN) and a meditab to visualize and evaluate cervical images using a built-in AI algorithm. Training of the algorithm using images captured from HPV-positive women is under way in several countries (India, Thailand, Antigua and Barbuda, Zimbabwe, and the USA) to improve its accuracy and generalizability. EPR is also developing a Cervical Cancer Image Bank comprising thousands of cervical images captured from HPV-positive women to support development of AI tools globally. The study has another component: developing AI algorithms to interpret infrared spectroscopic signals from urine samples for the detection of HPV and cervical neoplasia. The study is supported by a grant from the United States National Cancer Institute/National Institutes of Health.
  Websites:
  Visit webpage
  https://www.isrctn.com/ISRCTN18333554
  https://clinicaltrials.gov/study/NCT06042543
  https://screening.iarc.fr/cervicalimagebank.php

• Cervical cancer Screening and TRiage in women LivING with HIV in Cameroon: a cross-sectional study nested in the OptiTri cohort study (STRING)
  The STRING project is a cross-sectional study nested within the OptiTri cohort, evaluating the clinical utility of urine samples for HPV detection and cervical lesion screening among women living with HIV in Cameroon. The study will compare HPV detection in urine samples versus self-collected vaginal samples and provider-collected cervical samples among 2228 women. It also aims to assess DNA methylation as a triage method for HPV-positive cases. The study is ongoing as part of the larger OptiTri implementation research project. The project is funded by ANRS.

• Interventions to improve participation in cervical cancer screening in France (AppDateYou)

  The AppDateYou study aims to develop and assess the impact of women’s informed decision-making through conversational AI (a chatbot) to increase adherence to cervical cancer screening among non-respondent women.

  The MIRABELLE project is a randomized controlled trial to be implemented in two regions in France, evaluating HPV self-sampling strategies in the general population among 4500 women. The study will compare standard care against direct home delivery with navigation support and an informed-choice approach. The project includes cost–effectiveness analysis and qualitative assessment, and it aims to provide evidence-based recommendations for national cervical cancer screening policy by July 2027.

  The projects are supported by the French Institut national du Cancer (INCa).

• National colorectal cancer screening programme: Experimentation with the direct home delivery of the screening kit without previous order (KITCOLO) and analysis of colorectal cancer screening programmes in Spain
  EPR is leading a randomized controlled trial to evaluate a novel strategy for colorectal cancer screening, specifically testing the direct home delivery of faecal immunochemical test (FIT) kits alongside invitation letters. The KITCOLO project aims to assess whether this new delivery approach can improve the current low participation rate (32%) in France’s national colorectal cancer screening programme and provide evidence to support the French Ministry of Health’s decision-making process.

  In addition, EPR is analysing the organization of the regional colorectal cancer screening programmes in Spain. This project, funded by the Spanish Association Against Cancer (AECC), is collecting mainly qualitative information on dimensions such as policies, financing, organization, awareness, protocol, information system, and quality assurance, and identifying strengths and areas for improvement for each participating region.

• Stratification of clinical, biological, epigenetic, and environmental factors for prostate cancer progression (KP-CARAIBES-BREIZH)
  EPR is launching a study with two main objectives: (1) to identify prognostic determinants, both modifiable and non-modifiable, of prostate cancer progression according to therapeutic choices and studied populations, and (2) to identify and validate DNA methylation signatures and biomarkers enabling better stratification of patients with prostate cancer. This bicentric, prospective, longitudinal etiological cohort study, called KP-CARAIBES-BREIZH, will be conducted in two different regions in France. The project is funded by the French Institut national du Cancer (INCa).

• Multicentre pilot programmes for lung cancer screening
  EPR is supporting this study to evaluate the development and implementation of a pilot programme for low-dose computed tomography (LDCT) lung cancer screening in Belarus (https://www.isrctn.com/ISRCTN16878075) and Uruguay (https://doi.org/10.1186/ISRCTN88299564).
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• Anal cancer natural history and screening (APACHES)
  EPR has a particular interest in the natural history and prevention of anal cancer, a cancer type that is rare in the general population but has an elevated incidence in established high-risk groups. APACHES is an ongoing prospective study of 500 HIV-positive men who have sex with men, in six centres in France. APACHES was designed particularly to answer essential questions about the progression and regression of high-grade anal lesions, and will evaluate the utility of several (bio)markers (including epigenetic) for anal cancer prevention (https://clinicaltrials.gov/ct2/show/NCT02287961).
  
  
• Improving cancer care coordination and screening in Latvia and Slovakia – the ICCCS project
  Latvia and Slovakia are lagging among the EU Member States regarding their performance indicators related to the cancer care continuum and particularly their cancer screening programmes. The ministries of health of both countries requested support to prepare a strategic plan and a roadmap tailored to the needs and expectations of Latvia and Slovakia regarding improving cancer care coordination, cancer screening, and reduction of cancer mortality in both countries by:

• • improving population-based cancer registration (Latvia),
  • aiming for comprehensive cancer care and research infrastructure/network accreditation (Latvia),
  • improving the coverage and quality of breast, cervical, and colorectal cancer screening programmes (Latvia and Slovakia), and
  • improving awareness of stakeholders (Slovakia).

  The project is funded by the European Union through the Technical Support Instrument (TSI).
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• Improving cancer screening in Slovenia – the ICSIS project
  This project aims to enhance Slovenia’s cancer early detection programmes by using a health systems framework that emphasizes key components such as leadership and governance, health workforce, service delivery, and information systems, with a strong focus on quality assurance and communication. The project is particularly focused on:
  1. Planning organized lung cancer screening,
  2. Switching from opportunistic to organized prostate cancer screening, and
  3. Switching from cytology-based to HPV-based cervical cancer screening.
     
  This approach addresses the complexities associated with improving cancer detection programmes within the context of a dynamic health-care system. The initiative supports the Slovenia Ministry of Health’s National Cancer Control Program (NCCP) 2022–2026 and aligns with Europe’s Beating Cancer Plan. The project is funded by the European Union through the Technical Support Instrument (TSI).

• Improving cancer screening and care in Latvia and Luxembourg – the LLUMINAS project
  This initiative aims to strengthen cancer screening and care in Latvia and Luxembourg, aligning both countries with EU Council Recommendations on Cancer Screening to reduce cancer-related morbidity and mortality.

• • Latvia: The project focuses on improving governance of population-based cancer screening programmes and conducting cost–effectiveness and budget impact analyses for screening and treatment options. These measures will inform policy decisions and reinforce cancer screening and care within the health-care system in Latvia.
  • Luxembourg: The project supports the implementation of a new lung cancer screening programme and the assessment of existing screening programmes, with a focus on integration into the health-care system, quality assurance, communication, and economic analysis. These efforts will guide revisions and contribute to the sustainability of effective cancer screening and care within the health-care system in Luxembourg.

The project is funded by the European Union through the Technical Support Instrument (TSI).

• Developing a scalable, woman-centred model for cervical cancer screening in vulnerable women in India (SHE-CAN Study)
  This project is an implementation research study on cervical screening that aims to co-design, implement, and evaluate HPV-based self-sampling in vulnerable populations in the Indian states of Tamil Nadu and Mizoram. After a formative phase and a co-design phase, a cluster-randomized trial will be conducted among about 6000 women from rural, tribal, and urban poor populations over 1 year. The project is funded by the Global Alliance for Chronic Diseases (GACD)/National Health and Medical Research Council (NHMRC).
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• PRostate cancer Awareness and Initiative for Screening Europe (PRAISE-U)
  The PRAISE-U project aims to reduce morbidity and mortality caused by prostate cancer in EU Member States through smart early detection. In partnership with the consortium, PRAISE-U works to encourage early detection and diagnosis of prostate cancer through customized and risk-based screening programmes. The goal is to align protocols and guidelines across Member States and enable the collection and distribution of relevant data to reduce prostate cancer morbidity and mortality rates in Europe. EPR is leading a work package to develop context-appropriate risk-stratified screening protocols for men aged 50–69 years for implementation pilots in five EU regions (Ireland, two sites in Spain, Lithuania, and Poland) through the PRAISE-U project. In addition, EPR led the work to develop key performance indicators to monitor the effectiveness of prostate cancer screening.
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• ProScreen Slovenia
  EPR researchers are extending the learnings of the PRAISE-U project to an additional site in Slovenia through the ProScreen project, where EPR will develop a context-appropriate prostate cancer screening programme based on stakeholder engagement and local capacity and assess the potential for nationwide scalability. The project is funded by the Union for International Cancer Control (UICC).

• Offering combined HPV vaccination and HPV-based cervical screening to vulnerable populations (HPV-FASTER-Implement)
  This hybrid efficacy and implementation study will evaluate offering combined HPV vaccination and HPV-based cervical cancer screening to unvaccinated and underscreened vulnerable populations in Europe. The specific strategies will be tailored to the local contexts of the intervention countries (Denmark, France, Romania, Spain, and Sweden). EPR will be involved in assessing the capacity of services to provide cervical cancer screening and HPV vaccination, creating an operational plan for each country, and conducting evaluation using the RE-AIM implementation research framework. EPR will also contribute with a dynamic microsimulation model based on HPV transmission and cervical cancer natural history and costing data collection from the pilots to assess the economic resources required and the benefit–harm ratio of scaling up the pilots. The project is funded by the European Commission.
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• European Commission Initiative on Cervical Cancer (EC-CvC)
  Led by IARC in collaboration with the European Commission’s Joint Research Centre (JRC), the initiative aims to develop European cervical cancer prevention guidelines (covering primary and secondary prevention), along with an integrated quality assurance (QA) scheme that also includes tertiary prevention of cervical cancer. This is a novel, quality-driven framework to harmonize cervical cancer prevention across Europe, addressing inequities and implementation challenges. All project outputs are delivered through an interactive web-based platform, ensuring broad accessibility and facilitating timely updates. The project is funded by the EU4Health programme.
  Websites:
  https://cancer-screening-and-care.jrc.ec.europa.eu/en/ec-cvc
  https://health.ec.europa.eu/non-communicable-diseases/cancer/europes-beating-cancer-plan-eu4health-financed-projects/projects/eucervscreen-qa_en

• Improving screening among women living with HIV
  EPR is collaborating with the University of Bern (Switzerland) on a screening cohort study in Lusaka, Zambia. Initially designed as a screening test accuracy (DTA) study, it compared visual inspection with acetic acid (VIA), HPV testing, and assessment with the portable colposcopy device, using histopathology as the reference standard. The study has since expanded to include follow-up at 36 months and 48 months, enabling assessment of longer-term outcomes and cervical precancer dynamics. The study has also supported capacity-building through training local doctors and nurses in colposcopy, biopsy, and treatment of precancerous lesions. Study outputs, including publications and policy-relevant findings, are being produced and disseminated through the collaborative efforts of the research teams.
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• Zimbabwe cervical precancer treatment failure study (Zceptre)
  EPR collaborates with the Zceptre study, which is a prospective cohort of 250 women living with HIV aged 18–65 years treated for cervical precancer at the Newlands Clinic in Harare, Zimbabwe. The study aims to assess the risk of disease recurrence and the predictive value of post-treatment tests, ultimately improving monitoring guidelines and outcomes for women living with HIV in low-resource settings. The participants undergo cervical biopsies for histology, HPV genotyping, and DNA methylation testing, with follow-up every 6 months for 24 months. Re-treatment is offered for cervical intraepithelial neoplasia grade 2 or higher (CIN2+) per local guidelines. IARC will analyse cervicovaginal samples for the microbiome to identify a possible association between vaginal bacterial flora and treatment failure.
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• RESET Gulf
  EPR and CSU in collaboration with the Gulf Center for Disease Prevention and Control (Gulf CDC) are implementing the RESET Gulf project in the six Gulf Cooperation Council countries with the aim of improving cancer screening and cancer surveillance in the region. For cancer screening, the project is being implemented in two phases. The first phase will focus on capacity-building on implementation, monitoring, evaluation, and quality assurance of cancer screening programmes, by focusing on data management and continuous quality improvement of cancer screening activities. To achieve this, the project will train, set up, and facilitate a network of master trainers in the region using the CanScreen5 learning resources. The second phase will focus on the evaluation of the cancer screening programmes in a selected country, assessing the cancer screening process health systems capacity and readiness, monitoring and evaluation framework, quality assurance framework, and communication strategies, and the CanScreen5 data collection tools will be used. On the basis of the findings, IARC will co-design a strategic plan to support the country in designing and implementing policies based on evidence-based interventions and best practices on cancer control aligned with international standards, to improve the cancer screening programme.

• Towards Gastric Cancer Screening Implementation in the European Union (TOGAS)
  EPR is an Associate Partner of the TOGAS project, which aims to provide the missing evidence-based knowledge to be further transferred to design, plan, and implement appropriate gastric cancer prevention across the EU. TOGAS has three specific objectives: (i) assessing the state of play as well as the needs of EU Member States and target populations in gastric cancer prevention, including information on opportunistic screening initiatives organized in public and private settings; (ii) assessing the appropriateness of various gastric cancer screening modalities for use in the EU; and (iii) assuring the sustainability of the results by an effective dissemination strategy and coordination of the methodology with the approaches used within the EU, including with the European guidelines and quality assurance schemes, which EPR has been tasked to lead. The project is funded by the EU4Health Programme.
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• European Commission Initiative on Gastric Cancer (EC-GaC)
  EPR is leading the European Commission Initiative on Gastric Cancer (EC-GaC) in collaboration with the Joint Research Centre and will develop the first set of evidence-based European guidelines and quality assurance schemes focusing on primary prevention of gastric cancer, especially population-based H. pylori screen-and-treat programmes, for particular consideration by those EU Member States with the highest gastric cancer incidence and mortality rates, allowing for a stepwise and gradual roll-out. These efforts are expected to continue, to expand the aim to cover secondary prevention of gastric cancer, diagnosis, and treatment, addressing the entire care pathway as in other established guidelines in the next work programmes. This initiative recommended by the EU Council is the first of its kind in the EU context and may be applicable in other regions of the world with a high burden of gastric cancer. The project is funded by the EU4Health programme.
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• Mapping cancer inequalities by migration background in Europe (Cancer RADAR)
  Cancer RADAR addresses the urgent need to quantify and reduce disparities in cancer among individuals with a migration background in Europe. In recent years, there have been increases in migration to and within Europe, resulting in more-diverse populations whose health needs may differ from those of the general (host) population. In addition, migrants can face significant barriers to accessing appropriate health care. Currently, a unified way of measuring cancer disparities by migration background does not exist, limiting the ability of policy-makers to respond effectively. To close this gap, Cancer RADAR is establishing an infrastructure that combines systematic data collection with advanced analytical methods, offering a harmonized, Europe-wide perspective on the current and future cancer burden and mortality among people with a migration background. As a first step, Cancer RADAR will focus on infection-related cancers (specifically, liver cancer, gastric cancer, and cervical cancer) and screening-preventable cancers, including breast cancer, cervical cancer, colorectal cancer, and lung cancer.

• EUCanScreen (European Joint Action on Implementation of Cancer Screening Programmes)
  EUCanScreen aims to ensure sustainable implementation of high-quality screening for breast, cervical, and colorectal cancers, as well as prepare for the implementation of screening programmes for lung, prostate, and gastric cancers as per recommendation by the European Commission. The project brings together 29 countries, including 25 EU Member States, Ukraine, the Republic of Moldova, Norway, and Iceland, to achieve the overarching goal of reducing the cancer burden while achieving equity in cancer across Europe. EPR is leading several initiatives aimed at ensuring the sustainability of cancer screening programmes while also supporting tasks focusing on interval cancers and leadership, among others. The project is funded by the EU4Health programme.
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• Biomarker-based early detection of HPV-driven cancers (HPVC3/SCREEN-HPV)
  The HPVC3/SCREEN-HPV project aims to develop and validate blood-based biomarkers for the early detection of HPV-driven cancers, including cervical, anal, and oropharyngeal cancers. Using large international prospective cohorts, the project evaluates circulating HPV DNA and HPV-related antibody markers to identify individuals at elevated risk before clinical diagnosis. The project also assesses how these biomarkers can be integrated into risk-stratified screening strategies and triage pathways to improve early detection while minimizing unnecessary diagnostic procedures. This work supports the development of scalable, minimally invasive screening tools with potential applicability across diverse health-care settings.

• Lung Cancer Cohort Consortium (LC3)

  The LC3 is a global consortium involving 26 population cohorts and more than 3 million longitudinally followed up research participants (with the database hosted at IARC), and it is a long-term initiative that provides the pre-eminent, world-leading resource to study lung cancer risk. A long-standing and successful component of the LC3 is a large-scale initiative to develop and validate protein-based biomarkers to optimize risk-based eligibility and nodule management in lung cancer screening. By leveraging study resources amassed within the LC3 over the past 7 years, this work has resulted in a novel and clinically valid biomarker tool superior to existing risk assessment tools in diverse populations that is affordable for wider implementation. Future work will involve implementation and acceptability studies, evaluation of the added value of serial measurements over time, assessing utility for follow-up of screen-detected lung nodules, and extension of the panel to include biomarkers specific to lung cancer among people who never smoked, to guide lung cancer screening. This work is funded by the United States National Cancer Institute (NCI) and the French Institut national du Cancer (INCa).

  Also, using the LC3, EPR conducts research to study early-onset lung cancer and also to facilitate risk assessment and identification of individuals (including people who never smoked) who are at high risk and may benefit from screening. A complementary area of work will focus on incorporating occupational exposures and geospatial data into lung cancer risk assessment for people with and without tobacco exposure. This work incorporates complementary consortia and data sources, such as the Synergy project (ENV) and geospatial information on air pollution and radon. This work is funded by the French Institut national du Cancer (INCa).
  Website: https://lc3.iarc.who.int/
  

• Overdiagnosis and End-points in Cancer Screening Trials (OVERCAST)
  The OVERCAST project will provide definitive evidence on whether alternative standards of evidence can be applied for multi-cancer early detection tests (MCEDs) without compromising the principle of requiring that cancer screening reduce cancer-specific mortality. This will involve developing standards of evidence, where the project will evaluate proposed alternative trial end-points (e.g. reductions in late-stage cancer incidence) as potential surrogates for mortality using data from 15 randomized cancer screening trials. In parallel, the project will develop strategies for efficient implementation of MCEDs by targeting individuals who are most likely to benefit using risk-based strategies based on multi-cancer risk models. This work is funded by the French Institut national du Cancer (INCa).
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Research projects related to early diagnosis and timely care of common adult cancers and childhood cancers

• Access Cancer Care India (ACCI)
  This project aims to assess barriers to access to early detection and treatment services for oral, breast, and cervical cancers among rural populations, review the capacity of the current health services for early detection of oral, breast, and cervical cancers, and co-develop an intervention strategy to improve participation in early detection programmes for oral, breast, and cervical cancers among rural populations in three states in India. Finally, this project will evaluate the intervention strategy to improve access to early diagnosis and screening of oral, breast, and cervical cancers in these three states. The project is a collaboration between King’s College London, RTI International, and IARC. It will be implemented in western and southern India by the American International Institute of Medical Sciences in Udaipur (Rajasthan) and Adyar Cancer Institute and Karkinos Healthcare in Chennai (Tamil Nadu) and Kochi (Kerala), respectively. The project is funded by the United Kingdom Medical Research Council (MRC).
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• Patterns of care of childhood cancers and common adult cancers in LMICs (DECAN)
  The DECAN project aims to quantify the delays occurring at different phases of the cancer diagnosis and care pathway, document the barriers to access diagnostic, treatment, and follow-up care, and assess the survival of patients diagnosed with the most common cancers (breast, lung, cervical, stomach, colorectal, and oral cancer) and childhood cancers at the B. P. Koirala Memorial Cancer Hospital (BPKMCH), Nepal. The prospective hospital-based study (cohort of 1350 patients with cancer) will also assess the quality and timeliness of cancer care and their impact on treatment response and survival. The evidence from this study will generate robust evidence that will be crucial to inform policy-makers for developing cancer prevention and control strategies, which will help to improve the delays currently existing at the patient level, provider level, and health system level. Similar studies have been initiated in India, Egypt, and Iraq. The DECAN-CHILD project aims to assess the quality of care, financial protection, and health system capacity for equitable childhood cancer outcomes in Nepal. The project is a collaboration between the University of Toronto, the University of Sydney, and IARC/WHO (as coordinator). The project is funded by the Canadian Institutes of Health Research (CIHR).

• Evaluation of new technologies for breast cancer early diagnosis
  EPR is supporting the implementation of a multi-level, multi-component intervention strategy, including telepathology, a low-cost portable breast ultrasound device, and novel strategies such as molecular and histopathological diagnosis from cell blocks, to reduce delays in access and diagnosis and improve the quality of diagnostic services for patients with breast cancer in India and Uganda. The project evaluated detection of molecular markers (ER/PR/HER2/Ki67) of breast cancer from tissue and cell block samples and also fine-needle aspirate specimens using a novel mRNA detection test (STRAT4).

• Portable ultrasound device to triage clinical breast examination-positive women
  The aim of this study is to estimate the diagnostic accuracy of a low-cost, battery-powered portable ultrasound device (PUD) to triage which lumps need further evaluation from those that are clearly benign, and compare it with that of standards of care among clinical breast examination (CBE) screen-positive women. The use of the PUD can save CBE-positive women from unnecessary radiation, can lower costs, and can reduce the workload of radiologists. Non-radiologist clinicians can be trained to use the PUD to evaluate CBE-positive women. Evaluation of ultrasound triage of CBE-positive women is ongoing in Indonesia, nested in the national breast cancer screening programme, and in two centres in India.
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• Development of oncology services – Uzbekistan
  EPR is supporting the Ministry of Health of Uzbekistan to strengthen the monitoring and evaluation of breast cancer early detection by providing training to epidemiologists and statisticians on data reporting and quality control. EPR will also provide technical support in piloting colorectal cancer screening in Uzbekistan and will co-design a plan for strengthening/implementing interventions for prevention and early diagnosis of gastric cancer and liver cancer in coordination with WHO and the Ministry of Health of Uzbekistan. The project is funded by IDB.