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Cancers attributable to infectious agents in Italy

Published:January 24, 2023DOI:https://doi.org/10.1016/j.ejca.2023.01.010

      Highlights

      • Infectious agents are responsible for a high proportion of cancer in Italy.
      • Helicobacter pylori is the main cancer-related infectious agent.
      • Most infectious-related cancers are preventable.

      Abstract

      Objectives

      To provide an evidence-based, comprehensive assessment of the current burden of infection-related cancer in Italy.

      Methods

      We calculated the proportion of cancers attributable to infectious agents (Helicobacter pylori [Hp]; hepatitis B and C viruses [HBV and HCV]; human papillomavirus [HPV]; human herpesvirus-8 [HHV8]; Epstein–Barr virus [EBV]; and human immunodeficiency virus [HIV]) to estimate the burden of infection-related cancer incidence (2020) and mortality (2017). Data on the prevalence of infections were derived from cross-sectional surveys of the Italian population, and relative risks from meta-analyses and large-scale studies. Attributable fractions were calculated based on the counterfactual scenario of a lack of infection.

      Results

      We estimated that 7.6% of total cancer deaths in 2017 were attributable to infections, with a higher proportion in men (8.1%) than in women (6.9%). The corresponding figures for incident cases were 6.5%, 6.9%, and 6.1%. Hp was the first cause of infection-related cancer deaths (3.3% of the total), followed by HCV (1.8%), HIV (1.1%), HBV (0.9%), HPV, EBV, and HHV8 (each ≤0.7%). Regarding incidence, 2.4% of the new cancer cases were due to Hp, 1.3% to HCV, 1.2% to HIV, 1.0% to HPV, 0.6% to HBV, and < 0.5% to EBV and HHV8.

      Conclusions

      Our estimate of 7.6% of cancer deaths and 6.9% of incident cases that were attributable to infections in Italy is higher than those estimated in other developed countries. Hp is the major cause of infection-related cancer in Italy. Prevention, screening, and treatment policies are needed to control these cancers, which are largely avoidable.

      Graphical abstract

      Keywords

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