Abstract
BackgroundSome infectious agents have been shown to be human carcinogens. The current study focused on estimation of cancer burden attributable to infection in different regions of Asia.MethodsBy systematically reviewing previous studies of the infection prevalence data of 13 countries in Asia and relative risks of specific cancers, we calculated the population attributable fraction of carcinogenic infections. Using data from GLOBOCAN 2012, the overall country-specific and gender-specific number of new cancer cases and deaths resulting from infection were estimated.ResultsAcross 13 principal Asian countries, the average prevalence and range was 6.6% (0.5% in Japanese women to 15.0% in Vietnamese men) for hepatitis B virus (HBV), 2.6% (0.3% in Iran to 5.1% in Saudi Arabia) for hepatitis C virus (HCV), 7.9% (2.8% in Pakistan to 17.7% in China) for human papillomavirus (HPV), and 61.8% (12.8% in Indonesia to 91.7% in Bangladesh) for Helicobacter pylori (HP). The estimated total number of cancer cases and deaths caused by infection in these 13 countries were 1 212 026 (19.6% of all new cancer cases) and 908 549 (22.0% of all deaths from cancer). The fractions of cancer incidence attributable to infection were 19.7% and 19.5% in men and women, respectively. The percentages of cancer deaths attributable to infection were 21.9% and 22.1% in men and women, respectively. Among the main infectious agents, HP was responsible for 31.5% of infection-related cancer cases and 32.8% of infection-related cancer deaths, followed by HBV (28.6% of new cases and 23.8% of deaths), HPV (22.0% of new cases and 27.3% of deaths), and HCV (12.2% of new cases and 10.6% of deaths).ConclusionsApproximately one quarter of all cancer cases and deaths were infection-associated in Asia, which could be effectively prevented if appropriate long-term controls of infectious agents were applied.
Highlights
Chronic infection with potentially carcinogenic agents is recognized as a major risk factor of human cancer[1,2] and was estimated to be responsible for around 2 million new cancer cases worldwide in 2008
Oncogenic human papillomavirus (HPV) is the etiological agent of cervical cancer, while Epstein-Barr virus (EBV) and Kaposi’s sarcomaassociated herpes virus/human immunodeficiency virus (KSHV/human immunodeficiency virus type 1 (HIV-1)) play vital roles in nasopharynx cancer (100.0% of nasopharynx cancers were assumed to be EBV-related in medium- and high-risk areas, and 90.0% elsewhere4) and Kaposi’s sarcoma.[15]
The present study is the first to assess the burden of potentially oncogenic infections and their related cancers in Asia
Summary
Chronic infection with potentially carcinogenic agents is recognized as a major risk factor of human cancer[1,2] and was estimated to be responsible for around 2 million new cancer cases worldwide in 2008. The overall population attributable fraction (PAF) for infectious agents was 16.1% worldwide,[3] indicating that 16.1% of new cancer cases could be prevented by elimination of such infectious agents. As a part of global analysis, the burden of infection-associated cancer in Asia has been estimated.[3,4] While the diversity of environment, culture, and economics in different countries contributes to the variety of infectious agents and their prevalence in the general population, the effects of those factors have not been revealed in previous studies. Methods: By systematically reviewing previous studies of the infection prevalence data of 13 countries in Asia and relative risks of specific cancers, we calculated the population attributable fraction of carcinogenic infections. Conclusions: Approximately one quarter of all cancer cases and deaths were infection-associated in Asia, which could be effectively prevented if appropriate long-term controls of infectious agents were applied
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