Medical Bulletin 01/October/2025

The analysis found that in 2023, an estimated 42% (4.3 million) of the 10.4 million cancer deaths were attributable to 44 potentially modifiable risk factors, presenting significant opportunities for prevention. Tobacco use alone accounted for 21% of cancer deaths, remaining the leading risk factor globally, except in low-income countries, where unsafe sex was the top contributor, linked to 12.5% of cancer deaths.

Lead author Dr Lisa Force, from IHME, University of Washington, emphasized the urgency of global action: “Cancer remains an important contributor to disease burden globally, and our study highlights how it is anticipated to grow substantially over the coming decades, with disproportionate growth in countries with limited resources.” She added, “Despite the clear need for action, cancer control policies and implementation remain underprioritised in global health, and there is insufficient funding to address this challenge in many settings.”

The study also called for improved cancer surveillance, especially in low and middle income countries, to ensure data-informed policymaking.

With cancer cases continuing to rise, researchers are urging governments and international health bodies to prioritize cancer prevention, equitable care, and robust health systems to mitigate the future impact.

Reference: The global, regional, and national burden of cancer, 1990–2023, with forecasts to 2050: a systematic analysis for the Global Burden of Disease Study 2023, Force, Lisa M et al. The Lancet, Volume 0, Issue 0

HPV Vaccine Offers Strong Protection-Even for the Unvaccinated: JAMA Pediatrics Study

A large, long-term study led by a researcher at the Albert Einstein College of Medicine and published in JAMA Pediatrics has found that the human papillomavirus (HPV) vaccine is highly effective at preventing HPV infections in real-world settings. The study also revealed significant herd immunity effects, offering protection even to young women who were not vaccinated.

HPV is the most common sexually transmitted infection globally and is responsible for more than 690,000 new cancer cases annually. It is the primary cause of cervical cancer, along with several other genital and head and neck cancers in both women and men. To assess real-world performance, the researchers conducted six separate studies in Cincinnati between 2006 and 2023, enrolling 2,335 adolescent and young adult women aged 13 to 26. Many participants were considered high-risk for HPV, with 79% reporting two or more male sexual partners and over half having a history of at least one sexually transmitted infection. Participants were categorized as vaccinated if they had received at least one dose of any of the available HPV vaccines: 2-valent, 4-valent, or the newer 9-valent vaccine.

Over 17 years, vaccination rates rose from 0% to 82%, and HPV infection rates dropped substantially. Infections from HPV types targeted by the 2-valent vaccine fell by 98.4%, by 94.2% for the 4-valent, and by 75.7% for the 9-valent. Even among unvaccinated women, infection rates fell significantly, offering strong evidence of herd protection.

“There are two encouraging takeaways from our study,” said lead author Dr. Jessica Kahn. “First, HPV vaccines work remarkably well in a real-world setting, even among women at high risk for HPV and who may not have received all vaccine doses. Second, we saw clear evidence of herd immunity, meaning when enough people are vaccinated, the vaccine indirectly protects unvaccinated people by reducing overall virus transmission.”

Reference: DeSieghardt A, Ding L, Ermel A, et al. Population-Level Effectiveness and Herd Protection 17 Years After HPV Vaccine Introduction. JAMA Pediatr. Published online September 29, 2025. doi:10.1001/jamapediatrics.2025.3568

Do Heart Attacks Really Strike Without Warning or Are We Just Missing Signs?

A large-scale international study published in The Journal of the American College of Cardiology has found that more than 99% of people who experience heart attacks, strokes, or heart failure had at least one cardiovascular risk factor above optimal levels before their event. The study challenges the long-standing belief that heart disease often strikes without warning.

Cardiovascular disease remains the leading cause of death globally, and this new research offers strong evidence that nearly all major cardiac events are preceded by identifiable and modifiable risk factors.

The study examined over a decade of health data from more than 9.3 million adults in South Korea and nearly 7,000 adults in the United States. Researchers focused on four key cardiovascular risk factors: high blood pressure, elevated cholesterol, high blood sugar, and tobacco use, as defined by the American Heart Association’s thresholds for ideal cardiovascular health. Secondary analysis used even stricter clinical definitions.

The findings were consistent across both countries. More than 99% of individuals who later developed coronary heart disease, stroke, or heart failure had at least one nonoptimal risk factor prior to the event. Additionally, over 93% had two or more risk factors, with high blood pressure being the most common. Even in groups traditionally considered lower risk—such as women under 60—the pattern held.

“We think the study shows very convincingly that exposure to one or more nonoptimal risk factors before these cardiovascular outcomes is nearly 100%,” said senior author Dr. Philip Greenland, professor of cardiology at Northwestern University Feinberg School of Medicine. “The goal now is to work harder on finding ways to control these modifiable risk factors rather than to get off track in pursuing other factors that are not easily treatable and not causal.”

The study underscores the urgent need for early detection and proactive management of cardiovascular risk factors. The authors stress that controlling blood pressure, cholesterol, glucose levels, and eliminating tobacco use could drastically reduce the global burden of heart disease.

Reference: Lee, H., et al. (2025) Very High Prevalence of Nonoptimally Controlled Traditional Risk Factors at the Onset of Cardiovascular Disease. Journal of the American College of Cardiology. doi.org/10.1016/j.jacc.2025.07.014