Infection causes around 15 per cent of cancer worldwide and is potentially preventable . This proportion is greater in the developing world, where an estimated 22 per cent of cancer has an infectious cause.
Hepatitis B immunization in children has significantly reduced the incidence of infection in China, Korea and West Africa. Shortly we will see if it has reduced the incidence of hepatoma, which begins in endemic regions by the third decade of life. The unconfirmed trends are already encouraging.
12 Cancer of the cervix, the commonest women’s cancer in parts of India and South America, is clearly associated with certain subtypes of human papilloma virus. Vaccines are now becoming available and entering trial.
Helicobacter pylori is associated with stomach cancer. Here, without any intervention, there has been a remarkable downward trend in incidence worldwide. Dissecting out the complex factors involved, including food storage, contamination, preparation and content, is a considerable challenge.
Other cancer-causing infections are schistosomiasis, the liver fluke, the human T-cell leukaemia virus and the ubiquitous hepatitis B virus.
Although geographically localized, their prevention by lifestyle changes and vaccination programmes is a realistic short-term goal. Clearly, the effectiveness of any infection control or immunization programme at reducing the cancer burden will depend on many factors and require careful research and field evaluation.
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