Infectious Agents and Cancer
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Cancer Epidemiology Matters Blog
World Cancer Incidence Attributed to Infections in 2008
Click to enlarge.
The World Health Organization estimates about 2 million cancer cases per year (18% of the global cancer burden) are attributable to chronic infections cancer, making them the second most preventable cause of cancer. This prevalence is significantly larger in low- and -middle income countries (26%) than in high-income countries (8%). Thus prevention or eradication of these infections is pivotal to overcome inequalities in cancer incidence and reduce the global burden of infection-related cancers.
Interestingly, although many of these infections are highly prevalent in the world, most infected individuals do not develop cancer but remain lifelong carriers. Malignancies associated with infectious agents often occur after prolonged latency or chronic infections in the host.
The International Agency for Research on Cancer (IARC) has identified seven major infectious agents as carcinogenic to humans:
- Hepatitis B virus (HBV),
- Hepatitis C virus (HCV),
- Certain strains of the human papilloma virus (HPV),
- Epstein-Barr virus (EBV),
- Human immunodeficiency virus type 1 (HIV-1),
- Human T-cell lymphotropic virus type-1 (HTLV-1), and
- Gram-negative bacterium Helicobacter pylori (H. pylori).
Despite several advances highlighting the role of infectious agents in cancer, the global burden of infection-related cancer is still high and in need of additional cancer surveillance, prevention, and treatment research. The presence of an infection is not sufficient to cause cancer and requires other cofactors in the host - such as genetic susceptibility, age, the robustness of the immune system, dietary habits, co-infections, and environmental factors. Co-infections, including HIV infection, alter the immune system, can increase host susceptibility to cancer, and are a leading cause of morbidity and mortality in some populations.
NCI's Epidemiology and Genomics Research Program (EGRP) supports various projects to develop resources and technologies for identifying key determinants of cancer risks and improving outcomes to reduce the cancer burden by:
- Fostering domestic and international collaborative research through epidemiological studies to identify risk factors and biomarkers in high-risk populations who have infection-related cancers;
- Understanding the natural history of infectious agents in causing cancer in diverse populations, investigating determinants of cancer incidence patterns, and identifying the pathogenic, host, or other factors that predispose some infected individuals to develop cancer;
- Developing and improving epigenetics tools that can be used to identify sites of integration and targeted therapies for cancer prevention since many malignant viral infections are associated with integration of viral oncogenes into host DNA; and
- Increase the understanding of the human microbiome to improve prevention and treatment of the coevolved infection.
NCI-sponsored Funding Opportunity Announcements (FOAs) related to infectious diseases and risk of cancer include:
- Multidisciplinary Studies of HIV and Viral Hepatitis Co-Infection – expires May 8, 2017 unless reissued
- Research on Malignancies in the Context of HIV/AIDS - expires September 8, 2016 unless reissued
- View the full list of EGRP FOAs
- AIDS and Cancer Specimen Resource
A collection of tissues and biological fluids with associated clinical and follow-up data from patients with HIV-related malignancies. Specimens and clinical data are available for research studies, particularly those that translate basic research findings to clinical application.
- Center for AIDS Research (CFAR) Network of Integrated Clinical Systems
Provides integrated clinical data from the large and diverse population of HIV-infected people in the modern HIV/AIDS Alliance for Region Two (HAART) era who are receiving care at one of the many U.S. federally funded CFAR sites and data to address the challenging and rapidly evolving issues in HIV care and research.
- National Institute of Allergy and Infectious Diseases (NIAID) Research Resources
A compilation of scientific literature, laboratory and clinical research support and tools, and training opportunities.
- NIH Common Fund Human Microbiome Project
Provides links to funding opportunities and research resources enabling comprehensive characterization of the human microbiota and analysis of their role in human health and disease.
- NCI Cancer Bulletin - Charting the Path from Infection to Cancer
- NCI Fact Sheets
- Key NCI information on disease incidence and mortality, funding, research activities, and recent scientific advances can be found at NCI's Snapshots website:
- CDC Preventing Infections in Cancer Patients
- World Health Organization - Global Health Observatory
Links to reports containing statistics for key health indicators on an annual basis
- de Martel C, Ferlay J, Franceschi S, Vignat J, Bray F, Forman D, Plummer M. Global burden of cancers attributable to infections in 2008: a review and synthetic analysis. Lancet Oncol. 2012 Jun;13(6):607-15.
- De Flora S, Bonanni P. The prevention of infection-associated cancers. Carcinogenesis. 2011 Jun;32(6):787-95.
- de Martel C, Franceschi S. Infections and cancer: established associations and new hypotheses. Crit Rev Oncol Hematol. 2009 Jun;70(3):183-94.
- IARC. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, Biological agents. Volume 100B. Lyon (France): IARC; 2007.
- IARC. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, Volume 90. Human Papillomaviruses. Lyon (France): IARC; 2007.
- Pagano JS, Blaser M, Buendia MA, Damania B, Khalili K, Raab-Traub N, Roizman B. Infectious agents and cancer: criteria for a causal relation. Semin Cancer Biol. 2004 Dec;14(6):453-71.
- Kinlen L. Infections and immune factors in cancer: the role of epidemiology. Oncogene. 2004 Aug 23;23(38):6341-8.
- IARC. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, Volume 70. Epstein-Barr Virus and Kaposi's Sarcoma Herpesvirus/Human Herpesvirus 8. Lyon (France): IARC; 1997.
- IARC. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, Volume 67. Human Immunodeficiency Viruses and Human T-Cell Lymphotropic Viruses. Lyon (France): IARC; 1996.
- IARC. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, Volume 59. Hepatitis Viruses. Lyon (France): IARC; 1994.
- International Agency for Research on Cancer (IARC). IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, Volume 61. Schistosomes, Liver Flukes, and Helicobacter pylori. Lyon (France): IARC; 1994.
- Parkin DM. The global health burden of infection-associated cancers in the year 2002. Int J Cancer. 2006 Jun 15; 118 (12):3030-44.
- Vedham V, Divi RL, Starks VL, Verma M. Multiple Infections and Cancer: Implications in Epidemiology. Technol Cancer Res Treat. 2013 Aug 2. [Epub ahead of print]
- Biomarkers, epigenetics, and risk assessment: Mukesh Verma, Ph.D.
- HIV-related malignancies studies: Vaurice L. Starks, B.S.