Cancer is often described as a genetic roll of the dice. A matter of bad luck. But new global estimates from the World Health Organization suggest something different: four in 10 cancer cases could be prevented worldwide.
That statistic raises an obvious question: If so many cancers are preventable, what exactly does prevention look like?
At Duke, researchers across medicine, engineering and public health are working to answer that question with the support of federally funded research grants. They are starting with something fundamental: understanding how cancer begins.
In a recent study, Trudy G. Oliver, professor of pharmacology and cancer biology and a member of the Duke Cancer Institute, helped identify basal stem cells as the likely cells of origin for small cell lung cancer in laboratory models. The finding addresses a central challenge in prevention: It's hard to stop a disease before it starts if you don't know how it begins.
"We now have the tools to explore how the immune system interacts with these basal cells before they transform into aggressive cancer," Oliver said. "That opens the door to therapies that could stop the disease before it even starts."
How Can the Body Stop Cancer Before It Starts?
While researchers are working on solving one piece of the prevention puzzle, it is equally important to learn how to strengthen the body's natural defenses so abnormal cells are eliminated before they develop into tumors.
At the Duke University School of Medicine , assistant professor of surgery Erika J. Crosby is studying how excess weight can weaken the immune system's ability to fight cancer and whether GLP-1 medications might help restore that defense.
Crosby's team found that tumors grew more slowly in obese mice treated with GLP-1 drugs compared to untreated obese mice. The findings suggest that obesity, which is linked to at least 13 types of cancer, may accelerate tumor growth in part because it disrupts normal immune function.
"It was a significant loss of efficacy," said Crosby. "The immune system just didn't seem to recognize the threat in the same way."
By improving metabolic health, GLP-1 therapies may also help restore immune responses, offering a potential way to reduce cancer risk before tumors take hold. Crosby's team is now collaborating with Duke radiologists to study how weight loss affects breast tissue density, a known risk factor for breast cancer, to better understand the connection between metabolism and cancer development.
Strengthening immune function through metabolic health is one approach. Another is teaching the immune system exactly what to recognize and attack.
In a recent "Conversations in Cancer" discussion , Duke medical oncologist Diane Reidy-Lagunes and Duke Cancer Institute researcher Zachary Hartman explained how cancer vaccines work by helping the body recognize cancer cells as a threat. Just like a flu shot trains the immune system to fight a virus, cancer vaccines train immune cells to detect specific signals found on cancer cells and destroy them.
They explained how some vaccines prevent cancer before it starts. The human papillomavirus (HPV) vaccine and the hepatitis B vaccine protect against viruses that can lead to cervical and liver cancer. By stopping the infection, they reduce the risk of developing cancer later.
Duke researchers have also found that prevention is not always about reengineering the immune system. In some cases, it is as simple as identifying and treating a hidden infection before it causes harm.
Meira Epplein , an epidemiologist at the School of Medicine and the Duke Cancer Institute, has found that a common stomach bacterium called H. pylori increases the risk of stomach cancer , particularly in Black, Hispanic and Asian American communities.
The good news is that testing is simple. A quick breath test can detect the infection, and antibiotics can eliminate it, reducing cancer risk before it develops.
"There are so many cancers we don't know how to prevent," Epplein has said. "Stomach cancer is one of the few we do."
Prevention can also begin with understanding inherited risk. A Duke Health study found that about one in 12 patients diagnosed with multiple cancers carry an inherited mutation in a known cancer risk gene. Identifying these mutations could lead to earlier screenings for additional cancers and give family members the chance to assess their own risk.
How are Duke Researchers Increasing Accessibility to Cancer Prevention?
Prevention also depends on access, and at the Duke Global Health Institute , professor of obstetrics and gynecology Megan Huchko has helped develop a mobile health app that allows women in Kenya to test themselves at home for HPV, the virus that causes most cervical cancers. Since the launch of the app, around 25,000 women have been screened for HPV, which if untreated can cause cervical cancer.
"[Community health volunteers] ensure women get into clinics for treatment if they test positive for HPV," Huchko says. "This eliminates the burden for women to come into clinic for screening. Self-testing is increasingly being promoted as a primary [tool] for HPV screening around the world."
Researchers at the Pratt School of Engineering are also working to expand access to early detection. Biomedical engineer Nimmi Ramanujam has developed screening technologies designed to improve cervical cancer detection in low resource settings. She invented the Pocket Colposcope: a small handheld imaging device that takes high quality images of the cervix. This device has reached more than 8,000 women across 11 countries so far, making it possible to treat abnormalities before they develop into cervical cancer globally.
Why Is an Interdisciplinary Approach Necessary for Cancer Prevention Research?
What emerges from this work is not a single solution, but a coordinated effort across fields. This approach reflects the reality of the disease. Cancer does not develop for one reason alone. It is influenced by biology, behavior, environment and genetics. Preventing it requires attention to each of these factors.
By bringing together scientists, clinicians, engineers and public health experts, Duke researchers are building a broader strategy for prevention with the support of federal funding. Together, their work reflects a shared goal: reducing risk of cancer developing in the first place.
