Introduction. Chronic infections and infestations represent one of the leading causes of cancer. Eleven agents have been categorized by the International Agency for Research on Cancer (IARC) in Group 1, 3 in Group 2A and 4 in Group 2B. We previously estimated that the incidence of cancers associated with infectious agents accounted for the 8.5% of new cancer cases diagnosed in Italy in 2014.
Methods. In the present study we evaluated the incidence of cancer in Italy and in the 20 Italian regions in 2018, based on the data of Cancer Registries, and calculated the fraction attributable to infectious agents.
Results. Cancers of infectious origin contributed to the overall burden of cancer in Italy with more than 27,000 yearly cases, the 92% of which was attributable to Helicobacter pylori, human papillomaviruses, and hepatitis B and C viruses. With the exception of papillomavirus-related cancers, the incidence of cancers of infectious origin was higher in males (16,000 cases) than in females (11,000 cases). There were regional and geographical variations of cancers depending on the type of cancer and on the gender. Nevertheless, the overall figures were rather similar, the infection-related cancers accounting for the 7.2, 7.6, and 7.1% of all cancers in Northern, Central, and Southern Italy, respectively.
Conclusions. The estimate of the incidence of cancers attributable to infectious agents in Italy in 2018 (7.3% of all cancer cases) is approximately half of the worldwide burden, which has been estimated by IARC to be the 15.4% of all cancer cases in 2012.
 De Flora S, Crocetti E, Bonanni P, Ferro A, Vitale F. Vaccines and Cancer Prevention/Screening Working Groups of the Italian Society of Hygiene, Preventive Medicine and Public Health (SItI). Incidence of infection-associated cancers in Italy and prevention strategies. Epidemiol Prev. 2015;39(4):14-20.
 De Flora S, La Maestra, S. Epidemiology of cancers of infectious origin and prevention strategies. J Prev Med Hyg. 2015;56(1):E15-20.
 Pisani P, Parkin D., Muñoz N, Ferlay J. Cancer and infection: estimates of the attributable fraction in 1990. Cancer Epidemiol Biomarkers Prev. 1997;6(6):387-400.
 Parkin DM. The global health burden of infection-associated cancers in the year 2002. Int J Cancer. 2006;118(12):3030-44. https://doi.10.1002/ijc.21731.
 de Martel C, Ferlay J, Franceschi S, Vignat J, Bray F, Forman D, Plummer M. Global burden of cancers attributable to infections in 2008: a review and synthetic analysis. Lancet Oncol. 2012;13(6):607-15. https://doi.10.1016/S1470-2045(12)70137-7.
 Plummer M, de Martel C, Vignat J, Ferlay J, Bray F, Franceschi S. Global burden of cancers attributable to infections in 2012: a synthetic analysis. Lancet Glob Healt. 2016;4(9):e609-16. https://doi.10.1016/S2214-109X(16)30143-7.
 Doll R, Peto R. The causes of cancer: quantitative estimates of avoidable risks of cancer in the United States today. J Natl Cancer Inst. 1981; 66(6):1191-308.
 Doll, R. Epidemiological evidence of the effects of behaviour and the environment on the risk of human cancer. Recent Results Cancer Res. 1998;154:3-21.
 Doll R, Pet R. Epidemiology of cancer. In: Warrel DA, Cox TM, Firth J, eds. Oxford Textbook of Medicine. 4th edn. New York, NY: Oxford University Press. 2005;3:193-218.
 Boffetta P, Tubiana M, Hill C, Boniol M, Aurengo A, Masse R, Valleron AJ, Monier R, de Thé G, Boyle P, Autier P. The causes of cancer in France. Ann Oncol. 2009;20(3):550-555. https://doi.10.1093/annonc/mdn597.
 Wang JB, Jiang Y, Liang H, Li P, Xiao HJ, Ji J, Xiang W, Shi JF, Fan YG, Li L, Wang D, Deng SS, Chen WQ, Wei WQ, Qiao YL, Boffetta P. Attributable causes of cancer in China. Ann Oncol. 2012; 23(11):2983-9. https://doi.10.1093/annonc/mds139.
 Shield KD, Marant Micallef C, de Martel C, Heard I, Megraud F, Plummer M, Vignat J, Bray F, Soerjomataram, I. New cancer cases in France in 2015 attributable to infectious agents: a systematic review and meta-analysis. Eur J Epidemiol. 2018;33(3):263-274. https://doi.10.1007/s10654-017-0334-z.
 Xiang W, Shi JF, Li P, Wang JB, Xu LN, Wei WQ, Zhao FH, Qiao YL, Boffetta P. Estimation of cancer cases and deaths attributable to infection in China. Cancer Causes Control. 2011;22(8):1153-61. https://doi.10.1007/s10552-011-9791-y.
 Islami F, Chen W, Yu XQ, Lortet-Tieulent J, Zheng R, Flanders WD, Xia C, Thun MJ, Gapstur SM, Ezzati M, Jemal A. Cancer deaths and cases attributable to lifestyle factors and infections in China, 2013. Ann Oncol. 2017;28(10):2567-74. https://doi.10.1093/annonc/mdx342.
 Shin A, Park S, Shin HR, Park EH, Park SK, Oh JK, Lim M, Choi BY, Boniol M, Boffetta P. Population attributable fraction of infection-related cancers in Korea. Ann Oncol. 2011;22 (6):1435-42. https://doi.10.1093/annonc/mdq592.
 Antonsson A, Wilson LF, Kendall BJ, Bain CJ, Whiteman DC, Neale RE. Cancers in Australia in 2010 attributable to infectious agents. Aust N Z J Public Health. 2015;39(5):446-51. https://doi: 10.1111/1753-6405.12445.
 AIOM (Associazione Italiana di Oncologia Medica) / AIRTUM (Associazione Italiana dei Registri Tumori)/Fondazione Passi. The Numbers of Cancer in Italy 2018 (in Italian). Intermedia Editore, Brescia, Italy, 2018:1-344 pages.
 Kim HJ, Fay MP, Feuer EJ, Midthune DN. Permutation tests for join-point regression with applications to cancer rates. Statistics in Medicine. 2000;19(3):335-51.
 Bucci L, Garuti F, Lenzi B, Pecorelli A, Farinati F, Giannini EG, Granito A, Ciccarese F, Rapaccini GL, Di Marco M, Caturelli E, Zoli M, Borzio F, Sacco R, Cammà C, Virdone R, Marra F, Felder M, Morisco F, Benvegnù L, Gasbarrini A, Svegliati-Baroni G, Foschi FG, Missale G, Masotto A, Nardone G, Colecchia A, Bernardi M, Trevisani F; Italian Liver Cancer (ITA.LI.CA) group. The evolutionary scenario of hepatocellular carcinoma in Italy: an update. Liver Int. 2017;37(2):259-70. https://doi.10.1111/liv.13204.
 de Martel C, Plummer M, Vignat J, Franceschi S. Worldwide burden of cancer attributable to HPV by site, country and HPV type. Int J Cancer. 2017;141(4): 664-70. https://doi.10.1002/ijc.30716.
 De Vuyst, H, Clifford GM, Nascimento MC, Madeleine MM, Franceschi S. Prevalence and type distribution of human papillomavirus in carcinoma and intraepithelial neoplasia of the vulva, vagina and anus: a meta-analysis. Int J Cancer. 2009;124(7):1626-36. https://doi.10.1002/ijc.24116.
 Kreimer AR, Clifford GM, Boyle P, Franceschi S. Human papillomavirus types in head and neck squamous cell carcinomas worldwide: a systematic review. Cancer Epidemiol Biomarkers Prev. 2005;14(2):467-75. https://doi.10.1158/1055-9965.EPI-04-0551.
 Au WW. Life style, environmental and genetic susceptibility to cervical cancer. Toxicology. 2004;198(1-3):117-20. https://doi.org/10.1016/j.tox.2004.01.022.
 Singh S, Jha HC. Status of Epstein-Barr virus coinfection with Helicobacter pylori in gastric Cancer. J Oncol. 2017:3456264. https://doi.10.1155/2017/3456264.
 Stroffolini T, Sagnelli E, Mele A, Almasio P. Trends of aetiological factors of hepatocellular carcinoma in Italy. Dig Liver Dis. 2005;37(12):985-6. https://doi.org/10.1016/j.dld.2005.07.002
 Maucort-Boulch D, de Martel C, Franceschi S, Plummer M. Fraction and incidence of liver cancer attributable to hepatitis B and C viruses worldwide. Int J Cancer. 2018;142(12):2471-77. https://doi: 10.1002/ijc.31280.
 World Health Organization. Combating hepatitis B and C to reach elimination by 2030. Advocacy brief. 2016. Available at https://www.who.int/hepatitis/publications/hep-elimination-by-2030-brief/en/
 Curado MP, Edwards B, Shin HR, Storm H, Ferlay J, Heanue M, Boyle P. Cancer incidence in five continents, Vol. IX. IARC Sci. Publ. 2007 No. 160, Lyon: IARC.
 Fusco M, Girardi E, Piselli P, Palombino R, Polesel J, Maione C, Scognamiglio P, Pisanti FA, Solmone M, Di Cicco P, Ippolito G, Franceschi S, Serraino D, Collaborating Study Group. Epidemiology of viral hepatitis infections in an area of southern Italy with high incidence rates of liver cancer. Eur J Cancer. 2008;44(6):847-53. https://doi.10.1016/j.ejca.2008.01.025.
 Cislaghi C, Decarli A, La Vecchia C, Laverda N, Mezzanotte G, Smans. Dati, indicatori e mappe di mortalità tumorale: Italia, 1975-1977 (in Italian). Pitagora, Bologna, 1986.
 Watson RA. Human papillomavirus: Confronting the epidemic - A urologist's perspective. Rev Urol. 2005;7(3):135-44.
 de Martel C, Maucort-Boulch D, Plummer M, Franceschi S. World-wide relative contribution of hepatitis B and C viruses in hepatocellular carcinoma. Hepatology. 2015;62(4):1190-200. https://doi.10.1002/hep.27969.