Cancer-Associated Parasitic Neglected Tropical Diseases: Precision Diagnostics, Risk Stratification, and Implementation Priorities

Parasitic neglected tropical diseases (PNTDs) are primarily infections of poverty, impaired sanitation, and environmental exposure, but only a limited subset has recognized links to malignancy. The rationale for this Perspective is that these cancer-associated infections sit at the interface of communicable disease control, chronic inflammation, delayed organ damage, and non-communicable cancer prevention. At least 253.7 million people required preventive treatment for schistosomiasis in 2024, while infection-attributable cancer estimates suggest that liver flukes accounted for approximately 1300 to nearly 7000 new cholangiocarcinoma cases annually depending on modelling assumptions. The strongest recognized cancer associations involve Schistosoma haematobium with urinary bladder cancer and the food-borne liver flukes Opisthorchis viverrini and Clonorchis sinensis with cholangiocarcinoma. Importantly, infection with these parasites does not inevitably lead to cancer; malignant transformation is an uncommon, long-latency outcome shaped by parasite burden, reinfection, chronic inflammation, host susceptibility, co-infections, environmental exposures, nutrition, and access to care. This Perspective proposes a focused, risk-stratified framework that links parasite control, precision diagnostics, digital surveillance, targeted longitudinal follow-up, and implementation priorities for selected high-risk infections and settings. Rather than advocating broad cancer surveillance for all PNTDs, the article argues for staged, locally feasible approaches that strengthen existing control platforms while using advanced tools selectively for research, referral pathways, and populations at elevated risk.