P e r c e n t

5 . 0 % o r l e s s5 . 1 - 1 5 % 1 5 . 1 - 2 5 %2 5 . 1 - 4 0 %4 0 . 1 % o r m o r eN o d a t a

FIGURE 2Proportion of cancers worldwide attributable to infections, by sex

canceratlas.cancer.org

FIGURE 3

0

100

canceratlas.cancer.org

35%

27%

5%

24%

4%5%

Sub-SaharanAfrica

Eastern Asia(incl. China)

Central Asia(incl. India)

PacificIslands

Latin America North Africa &West Asia

Europe NorthAmerica

Australia/New Zealand

WORLD0

5

10

15

20

25

30

35

canceratlas.cancer.org

canceratlas.cancer.org canceratlas.cancer.org

INFECTIONInfections are an important cause of many cancers worldwide, especially in economically transitioning countries

04 RISK FACTORS

Human papillomavirus, Helicobacter pylori,

and Hepatitis B and C viruses account for the majority of infection-related cancers

worldwide.

FEMALEMALE

Human papillomavirus

Helicobacter pylori

Hepatitis B virus

Hepatitis C virus

Other agents

Leading cancer-causing infections worldwide, by sex (%)

FIGURE 4.2

is a necessary cause of cervical cancer, which is the leading cause of cancer death among women in many less-developed regions of the world because of lack of screening. HPV infection is also responsible for a proportion of vulvar (25%), vaginal (78%), anal (88%), penile (50%), oropharyngeal (31% on average, but much higher in North America and Northern Europe), oral cavity (2.2%) and laryngeal cancer (2.4%). FIGURE 4.3

Worldwide, HBV and HCV infections account for 56% and 20% of liver cancer deaths, respectively. However, these proportions substantially vary by region, with HBV the predominant cause of liver cancer in less developed countries (2/3 of cases) and HCV in more developed settings (44%). Other infections that cause cancer include Epstein-Barr virus (120,000 cases, estimated conservatively), Kaposi sarcoma-associated herpesvirus (HHV-8; 40,000 cases, mainly in sub-Saharan Africa), human T-cell lymphotropic virus, liver flukes, and schistosomal infections. Human immunodeficiency virus (HIV) infection also indirectly causes infection-related cancers through immunodepression. In the US, for instance, the proportion of infection-associated cancer in people with HIV (40%) is 10 times larger than in the general US population (4%).

Powerful prevention tools exist for infection-related cancer, including HPV and HBV vaccines, screening for HPV-driven cervical precancer, and drugs to treat HBV, HCV, Helicobacter pylori, and HIV infections.

Infectious agents are responsible for an estimated 15% of all new cancer cases annually worldwide, of which two-thirds occur in less developed countries (where they account for up to one quarter of all cancer). FIGURE 4.1 The four most important cancer-causing infections worldwide are Helicobacter pylori (770,000 cases globally in 2012), human papillomavirus (HPV) (640,000), hepatitis B virus (HBV) (420,000), and hepatitis C virus (HCV) (170,000), which together account for more than 90% of all infection-related cancers. FIGURE 4.2 Helicobacter pylori causes 90% of stomach cancers, half of which occur in China alone. HPV infection

31%Infections account for

a large percentage of cancers in transitioning countries.

1 in 3 cancers in sub-Saharan Africa

are caused by infections.

FIGURE 4.1

Proportion of cancers attributable to infections (%), by agent and region

The main infection-related

cancers are stomach, liver, and cervix.

FIGURE 4.3

Stomach

Liver

Cervix

Head and neck

Other anogenital

Other

Most common infection-attributable cancers worldwide

HPV infection causes virtually all cervical cancers. HPV vaccines

can protect against the types of HPV that cause about

90% of all cervical cancers.

ACCESS CREATES PROGRESS

11

5

6 54

10

1

1 6 46

25

27

One woman dies of cervical cancer every two minutes, making it one of the greatest threats

to women’s health…But it doesn’t have to be this way.

Cervical cancer is one of the most preventable and treatable

forms of cancer.

— Dr Tedros Adhanom Ghebreyesus, WHO Director-General, Call to action

for global elimination of cervical cancer, May 2018.

“

copyright © 2019 the american cancer society, inc.

40.1% or more No data25.1–40%15.1–25%5.0% or less 5.1–15%

MAP 4.1

Proportion of cancers attributable to infections (%), by country

Other agents

Human herpes virus-8

Epstein-Barr virus

Hepatitis C virus

Hepatitis B virus

Helicobacter pylori

Human papillomavirus

JordanMorocco

Mauritania

Western Sahara

MaliNiger

Nigeria

Chad Sudan

South Sudan

Ethiopia

Eritrea

Somalia

Sri Lanka

Senegal

Guinea

Cameroon

Central African Rep.

Ghana

GabonCongo

Rwanda—

AngolaZambia

Malawi

MozambiqueZimbabwe

Botswana

Namibia

S. Africa

UgandaKenya

Tanzania

—Burundi

Burkina Faso

Benin

|Togo

Côte d’Ivoire

Gambia—

Guinea-Bissau

Sierra Leone

Liberia

AlgeriaEgypt

Kazakhstan Mongolia

China

Australia

IndiaSaudi Arabia

Libya

Armenia—

Lebanon—

Maldives—

—IsraelKuwait—

Syria

GeorgiaAzerbaijan

Turkmenistan

Afghanistan

Pakistan

Uzbekistan

Tajikistan

Japan

Philippines

Kyrgyzstan

—Lesotho

—Comoros

— Mauritius

—Djibouti

—QatarBahrain—

UAE

Oman

Nepal

Bangladesh

Bhutan

DPR Korea

Rep. Korea

Myanmar

Thailand

Cambodia

Viet Nam

Lao PDR

Yemen

Iraq

New Zealand

Indonesia

Singapore—Malaysia

—Eswatini

Turkey

Cabo Verde |

Equatorial Guinea—

Madagascar

Brunei Dar.—

—Timor-Leste

Fiji—

French Polynesia—

Samoa—

New Caledonia|

Vanuatu—

—Guam

Solomon Is.|

United Kingdom

Ireland

Iceland

Portugal

Tunisia

Spain

France

Belgium

Netherlands |

Denmark

Norway

Sweden

Finland

Germany

Croatia

Poland

Bulgaria

Romania

Ukraine

Belarus

Lithuania Latvia

Estonia

GreeceItaly

Slovenia—

Slovakia

—Malta

Swit.

Lux.— Czechia

Serbia

MoldovaAustria Hungary

Albania

Montenegro—N. Macedonia

Bos. & Herz.

Russia—

Papua New Guinea

Russia

Palestine—

DR Congo

—

Réunion

IranCyprus—

Canada

Mexico

—Belize

GuatemalaHonduras

| El Salvador Nicaragua

Costa Rica

Panama

Colombia

Ecuador

Peru

Bolivia

Brazil

Paraguay

Uruguay

Argentina

Chile

Venezuela

Haiti

Guyana

Suriname

French Guiana

United States of America

Jamaica—

Puerto Rico |

—Guadeloupe—Martinique

—Barbados—St. Lucia

—Trin. & Tob.

| Dominican

Rep.

Cuba

—Bahamas