Background
Commercial determinants of health, the private-sector activities that affect health policies and practices, are increasingly recognized as major barriers to effective disease prevention and care. Our previous work has showed how lobbying and influence from health-harming (tobacco, processed food, etc) and health-producing industries (pharmaceutical and medical device sector) compromise cancer prevention and care in many countries.
Objectives
The present work aimed to:
1/ map the evidence on commercial determinants (CD) influencing cancer prevention, early detection, treatment and palliative care,
2/ illustrate how CD generate low?value cancer prevention and care and exacerbate inequalities
inequalities, and
3/ propose policy and practice solutions
Methods
We conducted a review of scientific and grey literature, including media reports, to complement findings from our EuroHealth special issue on commercial determinants in cancer control (2022) and our WHO Europe report on commercial determinants of NCDs (2024). We applied the EU Expert Group on Health System Performance Assessment low?value care framework (overuse, misuse, underuse, unwarranted variation) to analyze how commercial influences manifest across the cancer continuum.
Results
While the negative impact of commercial interests on primary cancer prevention is well established, our findings highlight equally profound effects on secondary prevention and care.
Vested interests promote opportunistic and non-evidence-based screening through sophisticated marketing, lobbying, and sponsorship of patient groups. These practices drive overdiagnosis, overtreatment, and growing inequalities both across and within countries.
In treatment, pharmaceutical and medical?device companies influence regulatory pathways, guideline development, and clinical practices, ensuring rapid diffusion of high?priced technologies and therapies—some offering modest or no benefit at all. Marketing expenditures (25–31%) often exceed investments in research and development (5–19%), reinforcing adoption of low?value interventions and diverting substantial resources that could support high?value care.
Pharmaceutical marketing expenditures (25–31%) often exceed R&D (5–19%), reinforcing uptake of low-value treatment, diverting large resources. Commercial determinants compromise equity, sustainability, and quality, resulting in inefficient resource allocation, delayed uptake of effective interventions, and widening disparities in outcomes.
Conclusions
Commercial determinants significantly shape cancer policies and practices, driving high costs, low?value care, and entrenched inequalities. Addressing these forces requires systematic de?implementation of low?value interventions and reinvestment in high?value services across primary and secondary prevention, treatment, and supportive care. Science-policy collaboration is critical to counterbalance corporate influence, safeguard patient interests, and re-align health systems with goals of equity, effectiveness, and sustainability.