title: The cancer burden attributable to biologic agents.
abstract: OBJECTIVE
  A review of cohort and case-control studies that attempt to quantify the proportion of cancer cases diagnosed in the United States and throughout the world that may be attributed to biologic or infectious agents.
  
  
  METHODS
  Epidemiologic studies published primarily since the year 2000 are summarized that estimate population attributable fractions based on consensus estimates of relative risk and of the exposure prevalence to putative oncogenic infectious agents in representative populations.
  
  
  RESULTS
  The proportion of incident cancers attributable to infectious agents diagnosed in low- and middle-income countries, comprising more than 80% of the world's population, has been estimated to vary from 20% to 30%, in contrast to a range of 5% or less to 10% in the United States and other highly industrialized populations. More than 90% of the global cancer cases attributed to infectious agents have been caused by hepatitis B virus, hepatitis C virus, human papillomaviruses, and the gram-negative bacterium, Helicobacter pylori.
  
  
  CONCLUSIONS
  Epidemiologic and pathologic studies that use molecular diagnostic probes and immunologic and biochemical assays have described the substantial impact of infectious agents on global cancer incidence. These compelling observations have stimulated the development of effective hepatitis B virus and human papillomavirus vaccines and the rationale for eradication of Helicobacter pylori.
authors.affiliation: Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor. Electronic address: daschott@umich.edu.
authors.forename: David
authors.initials: D
authors.lastname: Schottenfeld
authors.affiliation: Department of Oncology, Wayne State University School of Medicine, Detroit, MI; Karmanos Cancer Institute, Detroit, MI.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Beebe-Dimmer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001685:Biological Factors; D017281:Cost of Illness; D019049:Developed Countries; D003906:Developing Countries; D005260:Female; D014943:Global Health; D016480:Helicobacter pylori; D016174:Hepacivirus; D006509:Hepatitis B / Q000150:complications / Q000453:epidemiology; D006515:Hepatitis B virus; D006526:Hepatitis C / Q000150:complications / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007239:Infections / Q000150:complications* / Q000453:epidemiology / Q000382:microbiology / Q000469:parasitology / Q000821:virology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology / Q000382:microbiology*; D030361:Papillomavirus Infections / Q000150:complications / Q000453:epidemiology; D011159:Population Surveillance; D015995:Prevalence; D012306:Risk
chemical_list: D001685:Biological Factors
keywords: Attributable risk; Helicobacter Pylori; Hepatitis B; Hepatitis C; Human papillomavirus; Population attributable fraction