Cancer (medicine)

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Pathogens

Some carcinogens are living organisms. Certain viruses, bacteria, and parasites account for about 15 percent of all cancer deaths in the United States. Cancer-causing viruses include the human papillomavirus (HPV), a sexually transmitted virus responsible for 70 to 80 percent of all cases of cancer of the cervix. Hepatitis B and C viruses cause almost 80 percent of all liver cancer in the world. Epstein-Barr virus can also be carcinogenic, causing cancer of the lymphatic system. Human immunodeficiency virus (HIV) or a type of herpesvirus can lead to rare cancers of the lymphatic and circulatory systems. Helicobacter pylori, a bacterium associated with stomach ulcers, likely causes cancer of the stomach. Researchers have linked a polyomavirus to a rare, aggressive form of skin cancer called Merkel cell carcinoma.

In developing countries, parasitic organisms are major carcinogens. In parts of Africa, China, and southern Asia, infestation with the liver fluke Clonorchis sinensis causes a form of liver cancer. In North Africa, infection with the parasite Schistosoma haematobium causes cancer of the bladder.

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Radiation

Exposure to electromagnetic radiation, invisible, high-energy light waves such as sunlight and X rays, accounts for a small percentage of cancer deaths (see Radiation Effects, Biological). Most cancer deaths from radiation are from skin cancer, which is triggered by too much sun exposure. Sunlight that reaches the Earth’s surface contains two kinds of ultraviolet (UV) radiation. UV-A and UV-B both contribute to sunburn and skin cancer as well as to conditions such as premature wrinkling of the skin. Depletion of the ozone layer, which absorbs ultraviolet radiation in the upper atmosphere, will continue to increase skin damage and skin cancer rates in the future.

Radon, a colorless, odorless, radioactive gas, seeps from the Earth in some regions of the United States. Breathing the gas over a long period has been linked to a small number of lung cancer cases. Providing adequate air circulation in a building reduces exposure to radon. Infrequently, radiation exposure associated with medical treatments, such as therapeutic radiology, leads to cancer.

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Environmental and Occupational Chemicals

Air pollution, water pollution, and pollutants in the soil contribute particularly to lung and bladder cancer. Lung cancer rates are generally higher in cities, where increased industry and automobile traffic produce air pollution. Some people encounter carcinogenic chemicals in their working environment. Occupational carcinogens include such industrial chemicals as benzene, asbestos, vinyl chloride, aniline dyes, arsenic, and certain petroleum products (see Occupational and Environmental Disease).

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Hereditary Factors

Evidence suggests that heredity plays a role in developing cancer. Some gene mutations associated with cancer are inherited. For example, inheriting mutated tumor suppressor genes BRCA1 or BRCA2 greatly increases a woman’s chances of developing breast cancer. About 50 to 60 percent of women with inherited BRCA1 or BRCA2 mutations will develop breast cancer by the age of 70. Inherited mutations in the genes MSH2, MLH1, PMS1, and PMS2, all of which repair DNA, are especially prevalent in a rare form of hereditary colon cancer.

Scientists suspect that many other hereditary factors contribute to cancer. In addition to inherited mutations, other genetic variations, particularly those influencing how the body responds to carcinogens, may create a greater susceptibility to cancer. The identities of the majority of these genetic variations are not yet known.

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Steroid Hormones

Medical research suggests that cancers of the reproductive organs may be affected by naturally occurring steroid hormones produced by the endocrine system. These hormones stimulate reproductive organ cells to divide and grow. In women, relatively high or long exposure to the female sex hormone estrogen seems to increase the risk of breast and uterine cancers. Thus, early age at first menstruation, late age at menopause, having a first child after age 30, and never having children, all of which affect the duration of estrogen exposure in the body, increase the risk for these cancers. Studies also indicate that hormone replacement therapy (HRT), in which women take estrogen to offset the unpleasant effects of menopause, increases the risk of breast cancer. Male sex hormones, particularly testosterone, appear to play a role in cancers of the male reproductive organs, but this role is not yet well understood.