BURDEN OF CANCER-ATTRIBUTABLE INFECTIONS IN THE US: ANALYSIS FROM NATIONAL POPULATION-BASED SURVEYS (1999-2012)

Purpose: Infections may raise a person’s risk of cancer by causing long-term inflammation, suppressing the immune system or even directly affecting DNA. A growing body of research has identified certain infectious agents as a major cause of cancer. National population-based surveys of such infections provide estimates of population-specific prevalence, trend, and determinants to identify cancer attributable to infections; this can help to eliminate the cancer burden by strengthening public health policy. 

Method: American Cancer Association identified 13 infectious agents (Epstein-Barr virus, Hepatitis A, Hepatitis B, Hepatitis C, Hepatitis D, HSV-1, HPV, Chlamydia, H. pylori, Simian Virus 40, HTLV-1, MCV and HIV) that are likely to be linked to various cancers. National Health and Nutrition Examination Survey (NHANES) provides a representative sample of the US non-institutionalized civilian population and contains information on all infectious agents except SV-40, H. pylori, Hepatitis A, and MCV. Prevalence of cancer-attributable infections is obtained from NHANES 1999-2012 and analyzed using SAS v9.3 (SAS Institute Inc., Cary, NC, USA) by taking into account the complex sampling design.

Result: Epstein-Barr virus, which is linked to Hodgkin’s lymphoma, was the most commonly seen infection with a prevalence of 66.3%. The least commonly seen infection was Hepatitis D (linked to liver cancer) with a prevalence of 0.02%. Other infectious agents linked to cancer with prevalence included Hepatitis C (64.0%), HSV-1 (55.9%), HPV (42.9%), Hepatitis B (27.8%), Chlamydia (1.9%), and HIV (0.4%). These infectious agents are associated respectively with liver (Hepatitis C/B), blood (HSV-1), and cervical (HPV, chlamydia) cancers with numerous cancers linked to HIV infection.  

Conclusion: Our results show that cancer-linked infectious agents are highly prevalent in the US population. Understanding how to decrease the burden of these infections may provide a base for future cancer prevention programs via screening, vaccination, health promotion, and literacy.