International Agency for Research on Cancer, 69372 Lyon Cedex 08, France.
International Agency for Research on Cancer, 69372 Lyon Cedex 08, France.
Lancet Glob Health. 2016 Sep;4(9):e609-16. doi: 10.1016/S2214-109X(16)30143-7. Epub 2016 Jul 25.
Infections with certain viruses, bacteria, and parasites are strong risk factors for specific cancers. As new cancer statistics and epidemiological findings have accumulated in the past 5 years, we aimed to assess the causal involvement of the main carcinogenic agents in different cancer types for the year 2012.
We considered ten infectious agents classified as carcinogenic to human beings by the International Agency for Research on Cancer. We calculated the number of new cancer cases in 2012 attributable to infections by country, by combining cancer incidence estimates (from GLOBOCAN 2012) with estimates of attributable fraction (AF) for the infectious agents. AF estimates were calculated from the prevalence of infection in cancer cases and the relative risk for the infection (for some sites). Estimates of infection prevalence, relative risk, and corresponding 95% CIs for AF were obtained from systematic reviews and pooled analyses.
Of 14 million new cancer cases in 2012, 2·2 million (15·4%) were attributable to carcinogenic infections. The most important infectious agents worldwide were Helicobacter pylori (770 000 cases), human papillomavirus (640 000), hepatitis B virus (420 000), hepatitis C virus (170 000), and Epstein-Barr virus (120 000). Kaposi's sarcoma was the second largest contributor to the cancer burden in sub-Saharan Africa. The AFs for infection varied by country and development status-from less than 5% in the USA, Canada, Australia, New Zealand, and some countries in western and northern Europe to more than 50% in some countries in sub-Saharan Africa.
A large potential exists for reducing the burden of cancer caused by infections. Socioeconomic development is associated with a decrease in infection-associated cancers; however, to reduce the incidence of these cancers without delay, population-based vaccination and screen-and-treat programmes should be made accessible and available.
Fondation de France.
某些病毒、细菌和寄生虫的感染是某些癌症的强烈危险因素。随着过去 5 年来新的癌症统计数据和流行病学发现的积累，我们旨在评估主要致癌因子在不同癌症类型中的因果关系。
我们考虑了国际癌症研究机构分类为人类致癌的十种感染因子。我们结合癌症发病率估计（来自 GLOBOCAN 2012）和感染归因分数（AF）的估计值，按国家计算了 2012 年归因于感染的新癌症病例数。AF 估计值是从癌症病例中感染的流行率和感染的相对风险（对于某些部位）计算得出的。感染流行率、相对风险以及 AF 的相应 95%置信区间的估计值是从系统评价和汇总分析中获得的。
在 2012 年的 1400 万例新癌症病例中，有 220 万（15.4%）归因于致癌性感染。全世界最重要的感染因子是幽门螺杆菌（770 万例）、人乳头瘤病毒（640 万例）、乙型肝炎病毒（420 万例）、丙型肝炎病毒（170 万例）和 Epstein-Barr 病毒（120 万例）。卡波西肉瘤是撒哈拉以南非洲地区癌症负担的第二大贡献者。感染的 AF 因国家和发展状况而异——从美国、加拿大、澳大利亚、新西兰和西欧和北欧的一些国家的不到 5%到撒哈拉以南非洲的一些国家的超过 50%。
减少感染引起的癌症负担的潜力很大。社会经济发展与感染相关癌症的减少有关；然而，为了毫不拖延地降低这些癌症的发病率，应使基于人群的疫苗接种和筛查及治疗方案能够获得并可利用。
法国基金会。
