Preventing cancers by treating or preventing infections
September 25, 2024
The New York Times reported this weekend that 13% of cancers are caused by infections. This is the ultimate convergence of communicable disease (infections) and noncommunicable disease. It also points to some good ways we can prevent cancer.
Here is a post I publisted last fall on this topic. (I’ll be back on Friday with original posts)
We’ve made huge progress in oncology in recent years. We can detect lung cancer earlier, often when it is curable. Eighty five percent of those with childhood cancer survive over five years, and overall cancer mortality among children is down 50% compared to 1975. Immune therapy can turn what was once a life expectancy of mere months into years of good quality life. But cancer is still a dreaded killer. Many employers have looked at new technology like full-body scanning or multi-cancer early detection tests to lower risk of cancer death, although these are expensive and, so far, have not been shown to lower the risk of death over the entire population.
But there are evidence-based approaches that can reduce the toll of cancer. Screening is one way to protect us from bad cancer outcomes. We encourage mammography and screening for colon and cervical cancer, because this cancer screening has been shown to lower death rate in large populations.
Here’s another way to decrease cancer mortality. Many cancers are initially caused by a viral or bacterial infection, so immunization or drug treatment can dramatically reduce the risk of cancer. The human papillomavirus (HPV) vaccine could make cervical cancer a rare disease, and vaccines against hepatitis B and effective curative drug treatment for hepatitis C dramatically reduce the risk of primary liver cancer.
Researchers in JAMA Oncology performed a meta-analysis of studies about 31 cancers that are associated with various infections, and found that 4.3% of adult cancers are attributable to eight infectious diseases. These are HPV (human papilloma virus) HCV (hepatitis C virus) HBV (hepatitis B virus), H pylori (a frequent cause of heartburn and ulcers), EBV (Epstein Barr Virus), KSHV (Kaposi’s Sarcoma-associated herpes virus), HTLV-1 (related to Human Immunodeficiency Virus, HIV), and MCPyV (Merkel Cell Polyomavirus).
Number of estimated cancer cases (2017) with infectious causes
Source: Volesky-Avellaneda, JAMA Oncology, October 13, 2023 LINK
DLBCL is diffuse large B-cell lymphoma.
Implications for employers:
- Childhood vaccinations, including vaccinations against hepatitis B and HPV, can not only prevent infections - they can prevent cancers. HPV vaccine prevents cervical cancer in young women as well as head and neck cancers in middle age.
- Proper treatment of H. pylori can prevent many cases of stomach (gastric) cancer, which is difficult to treat and has a high mortality rate.
- Drugs can now reliably cure hepatitis C, and those who have been treated are much less likely to get hepatocellular (liver) cancer. Most adults 18 years of age and older should be screened for Hep C infection.
- Employers can continue to encourage their members to take advantage of childhood vaccination without cost sharing and can provide ready access to drug treatment to cure hepatitis C and H. pylori infections.
Thanks for reading. You can find previous posts in the Employer Coverage archive
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Friday: Claim denials and social determinants of health