Research

Aim 1. To investigate environmental and lifestyle causes of cancer

Environmental and lifestyle causes of cancer provide the major avenues for primary prevention. The rationale for continued research in this domain is that, among several cancer types with unknown causes, variations in incidence by geography, generation, or sociodemographic factors point to environmental origins. Furthermore, among known environmental and lifestyle causes of cancer, the exposure–response association is not well known, in particular at low exposure levels.

Projects:

Oesophageal cancer
Oesophageal Squamous Cell Carcinoma African Prevention Research (ESCCAPE): a collaborative research effort to investigate the etiological epidemiology of oesophageal squamous cell carcinoma in the high-incidence belt in East Africa; major case–control studies have been conducted in Eldoret (Kenya), in Moshi, Kilimanjaro (United Republic of Tanzania), and in Blantyre (Malawi), and further pilot work is being conducted in Ethiopia (https://esccape.iarc.who.int/).

Testicular cancer
The TESTIS, SIGEXPO, and SIGEXPOSOME projects: a case–control study of testicular cancer in France (TESTIS), with the development of a contemporary dust measurement-based pesticide exposure metric (SIGEXPO) and an exploration of possible biomarkers of pesticide exposure (SIGEXPOSOME).

Childhood cancer
Collaboration in the Childhood Cancer and Leukemia International Consortium (CLIC): a pooled analysis of case–control studies on childhood leukaemia investigating the role of potential lifestyle and environmental risk factors (https://clic.iarc.who.int/).

The Environment and Child Health International Consortium (ECHIG) has been established to strengthen the collaboration and coordinate the activities of the birth cohorts from China, Denmark, France, Japan, and Norway, among others. The current focus is on maternal exposures to per- and polyfluoroalkyl substances (PFAS) during pregnancy.

The Cancer in Children – Epidemiology, Registration, Omics (CICERO) project aims to study childhood cancer in sub-Saharan Africa, including awareness of childhood leukaemia, short-term survival of childhood leukaemia in Kenya, the United Republic of Tanzania, and Malawi, and a better understanding of the journey to diagnosis of children with leukaemia; this research is emerging from the Global Acute Leukaemia network (GALnet; https://galnet.iarc.who.int).

Environmental and lifestyle factors
Mining and cancer risk: This started with projects in the West Rand region of South Africa, including a study on analysing human exposure to uranium in composite hair samples from communities living near the gold mining activities in the region, and retrospective and prospective case series of patients with haematological malignancies from the Chris Hani Baragwanath Academic Hospital in Soweto. It has expanded to other mining areas in Africa, including a pilot study in Guinea on bauxite mining.

Contamination from the petroleum industry in the Niger Delta: This study, together with the Hydrocarbon Pollution Remediation Project (HYPREP), initiated by the United Nations Environment Programme (UNEP), will be started in 2025.

Tattoos and cancer risk (CRABAT): Despite the high population prevalence of tattoos, knowledge on the health consequences of tattoos is scarce. Research has shown that tattoo pigments contain carcinogenic substances and migrate from the skin into the body. Epidemiological research led by ENV is established within nationwide cohorts in France and Germany.

Climate change: a focus on cancer-vulnerable populations
Within the French Cancer Prevention Network (CANCEPT) and in collaboration with the Cancer Prevention Europe (CPE) network, ENV is conducting an overview and quantification of how climate mitigation measures have beneficial effects for cancer prevention, so as to endorse their implementation.

Skin cancer in persons with albinism: Persons with albinism have excessive skin cancer incidence rates. ENV has started a programme of research including work to provide updated estimates of non-melanoma skin cancer incidence rates and the survival rates in persons with albinism, especially in sub-Saharan Africa.

Aim 2. To study the epidemiology of cancers associated with known and suspected carcinogens in the occupational setting

ENV undertakes investigations of known and suspected carcinogens in the occupational setting, directly informing assessments for worker protection or worker compensation. To date, most evidence on occupational cancer has stemmed from research in high-income countries, where exposures and circumstances differed substantially from those in LMICs in terms of exposure levels, pathways, and co-exposures. ENV’s international network is particularly suited to integrate LMICs into global occupational cancer research and worker protection.

Projects:

Pesticides and other agricultural exposures
AGRICOH: a research consortium of cohort studies of agricultural workers or pesticide applicators and their families, to investigate the risk of cancer and other diseases related to pesticide exposure and other prevalent agricultural exposures (https://agricoh.iarc.who.int/); ongoing work focuses on haematological malignancies, breast cancer in female workers, and prostate cancer.

Asbestos
The Asbest Chrysotile Cohort Study: a cohort study on occupational exposure to chrysotile asbestos in workers in mines and enrichment factories in the town of Asbest, Russian Federation (https://asbest-study.iarc.who.int/); the first follow-up including deaths from 1975–2015, with continuation until 2025, is in preparation.

Various occupational carcinogens
The SYNERGY project: a lung cancer consortium studying lung cancer risk associated with combined occupational exposures and smoking, pooling case–control studies of lung cancer from 13 countries; the project currently focuses on exposure to asbestos, respirable crystalline silica, polycyclic aromatic hydrocarbons (PAHs), chromium, and nickel (https://synergy.iarc.who.int/).

The SMOX project: aims at developing strategies for smoking cessation at workplaces; includes a pilot study analysing the joint effects between smoking and occupational lung carcinogens under different exposure scenarios and two surveys to assess current practices regarding smoking prevention among construction workers in France.

Occupational Cancer in LMICs programme: Occupational cancer epidemiology in Europe, Oceania, and North America has over time contributed to improved legislation, awareness, surveillance, and safety for workers, but awareness of and research on cancer in relation to workplace exposures in other parts of the world is often less developed. Encouraged by national governments, ENV is collaborating with the national occupational health experts, starting a programme on occupational cancer in the Russian Federation and the Islamic Republic of Iran.

Aim 3. To study the epidemiology of cancers associated with exposure to low doses of ionizing radiation and to non-ionizing radiation (electromagnetic fields)

Characterization of cancer risks associated with environmental exposures to ionizing radiation remains controversial, especially cancer risks from low-dose protracted ionizing radiation exposure at different stages of life. Furthermore, there remains an open question about whether exposure to electric, magnetic, or electromagnetic fields is associated with an increased risk of certain cancers.

Projects:

Exposure due to nuclear accidents or nuclear testing
Chernobyl Health Research: long-term research on the health effects of the Chernobyl accident (following the research agenda developed in https://co-cher.iarc.who.int/), including on breast cancer and haematological cancers in the affected populations and thyroid cancer risk in young people exposed to radioactive iodine, including assessment of genetic predisposition.

The SEMI-NUC project: cancer risk in residents of areas near the former Semipalatinsk nuclear test site in Kazakhstan (https://semi-nuc.iarc.who.int/); the project building up a cohort of 30 000 affected residents started in late 2024.

International Expert Group on Long-Term Strategies for Thyroid Health Monitoring after Nuclear Accidents (TM-NUC): to provide scientific information and advice to policy-makers and health professionals, in order to better plan and implement thyroid ultrasound examinations as long-term health monitoring for populations possibly affected by radiation exposure due to nuclear accidents (https://tmnuc.iarc.who.int/).

Occupational and medical exposure
The International Nuclear Workers Study (INWORKS): extended follow-up of cancer and all-cause mortality among cohorts of nuclear industry workers in France, the United Kingdom, and the USA.

Epidemiological Study to Quantify Risks for Paediatric Computed Tomography (CT) and to Optimize Doses (EPI-CT): a multinational consortium of cohort studies of children who have undergone CT examination, followed up for childhood cancer (https://epi-ct.iarc.who.int/).

Electromagnetic fields
The COSMOS study: an international prospective study of mobile phone users, of which ENV is coordinating the French component (https://cosmos.iarc.who.int/).

The INTERPHONE study: a large, multicentre, multinational case–control study of tumours of the brain, acoustic nerve, and parotid gland in relation to radiofrequency fields emitted by mobile phones (https://interphone.iarc.who.int/); the INTER-CAL project, which is based on the INTERPHONE study, is exploring the possible impact of bias and confounding.

The CIRE-RF study: a registry- and geographic information system (GIS)-based case–control study in France exploring the relationship between exposure to radiofrequency electromagnetic fields from radio and television broadcast transmitters and childhood cancer risk.

ENV is participating in the European Union multipartner and interdisciplinary projects SEAWave (https://seawave-project.eu/) and NEXTGem (https://www.nextgem.eu/) for provision of epidemiological expertise, evidence synthesis, and risk assessments.

Aim 4. To research strategies to improve survival and survivorship of common curable cancers

A major focus is on the epidemiology of breast cancer in sub-Saharan Africa, including studies of barriers, within a social and cultural context, to early presentation and diagnosis, treatment, and ultimately survival.

Projects:

The African Breast Cancer – Disparities in Outcomes (ABC-DO) study: a multinational African study of the entire experience of a patient with breast cancer, to identify determinants and pathways contributing to poor survival; patients are recruited at public hospitals in five countries (Namibia, Nigeria, South Africa, Uganda, and Zambia) and actively followed up using mHealth technology (https://abc-do.iarc.who.int/). This study is now being continued through an investigation of whether breast awareness levels can be increased in the next generation of patients with breast cancer through dissemination of information on menstrual hygiene products.

IARC and the WHO Global Breast Cancer Initiative

Global estimates of orphans due to cancer: The intergenerational impact of cancer deaths is rarely given attention; prompted by results in the African Breast Cancer – Disparities in Outcomes (ABC-DO) study, ENV is quantifying the size and impact of this intergenerational effect of cancer deaths globally (https://cancer-orphans.iarc.who.int/).

Virtual RealiTy and mUsic in the Oncology SEtting (VRtuose): At Centre Léon Bérard in Lyon, ENV is conducting a feasibility study of offering a music distraction tool via a virtual reality headset to patients with breast cancer who are undergoing chemotherapy.

Aim 5. To enable cancer prevention and control through translation of research evidence

This objective, which ENV had initially hosted on behalf of the Agency, is now fully integrated into the Branch, and the related activities are led by ENV, with the respective involvement of other IARC Branches. This captures the activities on cancer prevention recommendations, with a current focus on Europe and Latin America. It also ensures that ENV’s scientific knowledge is reaching the relevant health decision-making bodies for appropriate action.

Projects:

World Code Against Cancer Framework: an initiative to develop and disseminate Regional Codes Against Cancer to promote cancer prevention globally. The framework provides an umbrella strategy, based on a common and rigorous methodology, to maintain the coherence of the different Regional Codes. Each Regional Code offers an exceptional public health tool that provides evidence-based recommendations (https://cancer-code-world.iarc.who.int/).

European Code Against Cancer, 4th edition: an initiative resulting in the development of 12 recommendations to inform the general population about how they can reduce their risk of cancer (https://cancer-code-europe.iarc.fr/); this is currently being updated to the 5th edition, to be launched in 2025.

Latin America and the Caribbean Code Against Cancer, 1st edition: this Code, developed as part of the World Code Against Cancer Framework, was launched in 2023 (https://cancer-code-lac.iarc.who.int/en/).

Cancer Prevention Europe: ENV provides the scientific secretariat for this consortium (https://cancerpreventioneurope.iarc.fr/).