Table 2:

Prevention and early detection of high burden cancers in MICs: examples of feasible, cost-effective, interventions, target population, health system delivery level and country case examples.

	Target population	Delivery level	Country Examples
Improved cancer surveillance in MICs
Population based cancer registries	All cancer cases in a defined population catchment area	National and subnational level, with central coordination	Zimbabwe National Cancer Registry, Kampala Cancer Registry (subnational)34
Participation in epidemiological & clinical studies of cancer risk factors	General population in LMICs	Community based research	H3 Africa consortium on molecular epidemiology and risk factors for NCDs108
Prevention of modifiable risk factors
Tobacco taxation	General population, current and potential future tobacco users	National, through legislation increasing excise taxes on tobacco	Philippines – introduction of high excise tobacco taxes in 2012 led to an estimated 3 million fewer smokers within 3 years31
HPV vaccination	Girls aged 9-12 years	Primary care/community based School based for those enrolled	A number of MICs including Zambia & Ethiopia have introduced community and school-based HPV vaccination program over the past 10 years, achieving >90% coverage 109
Targeted & opportunistic cancer screening
Point of care diagnostics: HPV testing	Sexually-active women, with focus on high risk subpopulations: HIV(+), sex-workers, tobacco users	Primary care or community based	Argentina – used an existing network of trained CHWs to implement self-collection HPV tests among high-risk groups to increase coverage 4 fold110
Screen & treat: VIA + HPV testing	As above	Primary care or community based	Zambia: since 2006 Zambia has used its HIV program infrastructure to introduce the Cervical Cancer Prevention Program, a nurse driven screen and treat program which initially focused on women with HIV and later expanded coverage to oter women, reaching 58,000 women within it’s first 5 years60
Clinical breast examination (conditional recommendation)	Women aged 30 years+	Primary care or community based	Malawi – delivery of CBE through trained lay women, implemented in primary care health clinics among women presenting for reasons other than a breast concern70
Familial/hereditary risk stratification	First-degree relatives of patients with breast, colorectal cancers	Primary care (family history screening tools), secondary/tertiary care (familial cancer registries, kindred studies)	Nigeria – first-degree relative (FDR) registry maintained within African Research Group for Oncology’s multi-site hospital-based colorectal cancer registry. FDRs in registry invited to participate in high risk screening studies111
Earlier detection of symptomatic cancers
Risk stratification tools	Symptomatic patients on first contact with health provider	Primary care	Nigeria – development of a cardinal symptoms tool for colorectal cancer, to prompt referral for further investigation of symptoms92
Public awareness campaigns	General population	Community based	Rwanda (a LIC) introduced a public awareness campaign for women’s cancers in 2020 as part of it’s National Cancer Control Plan112
Provider education	Community health workers, primary care	Community health and primary care facilities	Peru: Community-based Program for Breast Health, a collaboration between PATH, the Peruvian Ministry of Health, the National Cancer Institute (Lima), and the Regional Cancer Institute (Trujillo). Phased implementation of public and primary care provider education on breast cancer diagnosis improved capacity for early diagnosis among first-level health workers113
Point of care diagnostics	Symptomatic patients presenting to primary care or a first level hospital	All levels of the health system but targeted at primary care, first level hospitals without advanced imaging and pathology capacity	Nigeria – prospective evaluation of urine-based POC testing for colorectal cancer using metabolomics114