Innovations Teams
Cancer Inequalities Team (CIN)

Starting date: March 2021

Work Programme

The landscape of cancer is largely shaped by social structures and inequalities and by the organization and inefficiencies of health systems. This context reveals a paradox: that too little care co-exists with too much care, even within the same population.

On the one hand, cancer outcomes continue to be characterized by large, though avoidable, social inequalities. Underuse of existing, effective care is strongly linked to inequalities and, although it affects everyone, has a disproportionate impact on the most disadvantaged individuals and populations.

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On the other hand, increasing human and financial resources are increasingly devoted to medical interventions that offer limited benefit or may even cause harm. Overuse of unnecessary and potentially harmful interventions is often driven by system practices and incentives rather than by evidence or patients’ informed choices. In cancer, the growing concern about overuse relates to overdiagnosis and overtreatment.

Inequalities and the underuse and overuse of cancer prevention and care are not independent but stem from shared environmental, social, economic, cultural, and health-system mechanisms, and together constitute interconnected forms of health-care inefficiency, harming millions of individuals.

The aim of the Cancer Inequalities Team (CIN) is to measure, understand, and reduce low-value care in cancer, i.e. underuse, overuse, and cancer inequalities.

Details of the programme are available at https://cancer-inequalities.iarc.who.int/.

Websites:
Cancer Inequalities
Cancer Surveillance Branch – Research

Team Composition

Team Leader: Dr Salvatore Vaccarella, Cancer Surveillance Branch (CSU), IARC
Email: VaccarellaS@iarc.who.int

Team members:
Dr Serra Kerman (Postdoctoral Scientist, CSU)
Dr Margherita Pizzato (Visiting Scientist, CSU)
Dr Valentina Lorenzoni (Visiting Scientist, CSU; Sant’Anna University, Pisa)
Dr Mohamed El Amine Youcef Ali (Postdoctoral Scientist, CSU)
Dr Sébastien Lamy (Visiting Scientist, CSU; INSERM, Toulouse, France)
Dr Komodo Matta (Postdoctoral Scientist, NME)
Dr Heinz Freisling (Scientist, NME)
Dr Freddie Bray (Branch Head, CSU)

Landmark publication

Vaccarella S, Lortet-Tieulent J, Saracci R, Conway DI, Straif K, Wild CP, editors (2019). Reducing social inequalities in cancer: evidence and priorities for research (IARC Scientific Publication No. 168). Lyon, France: International Agency for Research on Cancer. Available from: https://publications.iarc.who.int/580.

Key publications

1. Vaccarella S, Vineis P (2025). Cancer care underuse, overuse, and inequalities. J Natl Cancer Inst. https://doi.org/10.1093/jnci/djaf290 PMID:41059997
2. Vaccarella S, Li M, Bray F, Kvale R, Serraino D, Lorenzoni V, et al. (2024). Prostate cancer incidence and mortality in Europe and implications for screening activities: population based study. BMJ. 386:e077738. https://doi.org/10.1136/bmj-2023-077738 PMID:39231588
3. Malagón T, Franco EL, Tejada R, Vaccarella S (2024). Epidemiology of HPV-associated cancers past, present and future: towards prevention and elimination. Nat Rev Clin Oncol. 21(7):522–38. https://doi.org/10.1038/s41571-024-00904-z PMID:38760499
4. Singh D, Vignat J, Lorenzoni V, Eslahi M, Ginsburg O, Lauby-Secretan B, et al. (2023). Global estimates of incidence and mortality of cervical cancer in 2020: a baseline analysis of the WHO Global Cervical Cancer Elimination Initiative. Lancet Glob Health. 11(2):e197–206. https://doi.org/10.1016/S2214-109X(22)00501-0 PMID:36528031
5. Vaccarella S, Georges D, Bray F, Ginsburg O, Charvat H, Martikainen P, et al. (2022). Socioeconomic inequalities in cancer mortality between and within countries in Europe: a population-based study. Lancet Reg Health Eur. 25:100551. https://doi.org/10.1016/j.lanepe.2022.100551 PMID:36818237
6. Vaccarella S, Ginsburg O, Bray F (2021). Gender inequalities in cancer among young adults. Lancet Oncol. 22(2):166–7. https://doi.org/10.1016/S1470-2045(21)00001-2 PMID:33539738
7. Li M, Zheng R, Dal Maso L, Zhang S, Wei W, Vaccarella S (2021). Mapping overdiagnosis of thyroid cancer in China. Lancet Diabetes Endocrinol. 9(6):330–2. https://doi.org/10.1016/S2213-8587(21)00083-8 PMID:33891886
8. Vaccarella S, Lortet-Tieulent J, Saracci R, Fidler MM, Conway DI, Vilahur N, et al. (2018). Reducing social inequalities in cancer: setting priorities for research. CA Cancer J Clin. 68(5):324–6. https://doi.org/10.3322/caac.21463 PMID:30152865
9. Vaccarella S, Franceschi S, Zaridze D, Poljak M, Veerus P, Plummer M, Bray F (2016). Preventable fractions of cervical cancer via effective screening in six Baltic, central, and eastern European countries 2017–40: a population-based study. Lancet Oncol. 17(10):1445–52. https://doi.org/10.1016/S1470-2045(16)30275-3 PMID:27567054
10. Vaccarella S, Franceschi S, Bray F, Wild CP, Plummer M, Dal Maso L (2016). Worldwide thyroid-cancer epidemic? The increasing impact of overdiagnosis. N Engl J Med. 375(7):614–7. https://doi.org/10.1056/NEJMp1604412 PMID:27532827

Events and media highlights

• Presentation to the Italian Senate: Members of CIN presented a new report on thyroid cancer care in Italy, highlighting inequalities in access to quality care. Read more
• Coverage by Euronews: On the occasion of World Cancer Day 2023, Euronews Italia featured an interview with members of CIN, emphasizing the need for more equitable cancer prevention efforts. Read article
• Coverage by The Guardian: The Guardian highlighted CIN research findings showing that women in more deprived areas of the United Kingdom have some of the highest cancer death rates in Europe, drawing attention to stark socioeconomic disparities. Read article
• Feature in Le Monde: The French newspaper Le Monde reported on CIN research linking educational inequalities to disparities in cancer mortality across Europe. Read article