Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MS, USA.
Department of Population Health Sciences, Weill Cornell Medicine, New York, USA.
Breast Cancer Res Treat. 2024 Sep;207(2):235-252. doi: 10.1007/s10549-024-07388-6. Epub 2024 Jul 6.
Several viruses have been casually linked to human cancers, including cervical, nasopharyngeal, liver, sarcoma, and Merkel cell carcinomas. However, the etiologic contribution of viral infections to breast cancer, the number one incident cancer among women worldwide, is not well established. Among studies exploring associations of viruses with breast cancer, potential linkages have been identified between breast cancer and five viruses: beta retrovirus, (i.e., mouse mammary tumor virus), human papillomavirus, Epstein Barr virus. bovine leukemia virus, and human cytomegalovirus.
In this review, we provide a comprehensive evaluation of epidemiological ecologic, case-control, case-only, and cohort studies investigating these associations. We discuss results from several existing reviews and meta-analyses, evaluate epidemiological studies published in the past five years, and assess the relationship between these viruses and breast tumor clinicopathological factors.
The strongest epidemiological evidence for a viral role in breast cancer exists for MMTV and HPV, though limitations include lack of prospective studies for MMTV and potential detection bias in HPV studies. Viral detection challenges have limited studies of EBV and HCMV. Fewer studies have evaluated BLV, and though it has been associated with higher risk of breast cancer, sample sizes are quite small. CONCLUSION: While epidemiologic evidence exists for an association between these five viruses and breast cancer, various methodological issues and lack of prospective studies preclude robust conclusions. Future research should prioritize establishing a temporal relationship between infection and disease, minimizing misclassification of detection assays, and further exploring the influence of co-infections.
有几种病毒与人类癌症有偶然关联，包括宫颈癌、鼻咽癌、肝癌、肉瘤和 Merkel 细胞癌。然而，病毒感染对乳腺癌的病因贡献（乳腺癌是全球女性发病率最高的癌症）尚未得到充分证实。在研究病毒与乳腺癌之间关联的研究中，已经确定了乳腺癌与五种病毒之间存在潜在联系：β逆转录病毒（即鼠乳腺肿瘤病毒）、人乳头瘤病毒、Epstein Barr 病毒、牛白血病病毒和人巨细胞病毒。
在这篇综述中，我们全面评估了流行病学、生态、病例对照、仅病例和队列研究这些关联的研究。我们讨论了几个现有综述和荟萃分析的结果，评估了过去五年发表的流行病学研究，并评估了这些病毒与乳腺肿瘤临床病理因素之间的关系。
在乳腺癌中病毒作用的最强流行病学证据存在于 MMTV 和 HPV 中，尽管存在缺乏前瞻性研究的局限性MMTV 和 HPV 研究中潜在的检测偏倚。EBV 和 HCMV 的检测挑战限制了研究。评估 BLV 的研究较少，尽管它与乳腺癌风险增加有关，但样本量相当小。
虽然有流行病学证据表明这五种病毒与乳腺癌之间存在关联，但各种方法学问题和缺乏前瞻性研究限制了得出可靠结论。未来的研究应优先确定感染与疾病之间的时间关系，最大限度地减少检测分析的分类错误，并进一步探索合并感染的影响。
