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Publications

Journal Article Review Epublish

PubMed: 40805232 DOI: 10.3390/cancers17152537

The Exposome Perspective: Environmental and Infectious Agents as Drivers of Cancer Disparities in Low- and Middle-Income Countries.

Cancers (Basel) 17(15)

Authors: Zodwa Dlamini, Mohammed Alaouna, Tebogo Marutha, Zilungile Mkhize-Kwitshana, Langanani Mbodi, Nkhensani Chauke-Malinga, Thifhelimbil E Luvhengo, Rahaba Marima, Rodney Hull, Amanda Skepu, Monde Ntwasa, Raquel Duarte, Botle Precious Damane, Benny Mosoane, Sikhumbuzo Mbatha, Boitumelo Phakathi, Moshawa Khaba, Ramakwana Christinah Chokwe, Jenny Edge, Zukile Mbita, Richard Khanyile, Thulo Molefi

Affiliations

  • SAMRC Precision Oncology Research Unit (PORU), DSI/NRF SARChI Chair in Precision Oncology and Cancer Prevention (POCP), Pan African Cancer Research Institute (PACRI), University of Pretoria, Hatfield 0002, South Africa.
  • Wolfson Wohl Cancer Research Centre, School of Cancer Sciences, University of Glasgow, Garscube Estate, Switchback Road, Bearsden, Glasgow G61 1QH, UK.
  • Department of Life and Consumer Sciences, College of Agriculture and Science & Environmental Sciences, Science Campus, University of South Africa, Florida 1709, South Africa.
  • Department of Obstetrics and Gynecology, Gynecologic Oncology Unit, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Parktown, Johannesburg 2193, South Africa.
  • Department of Plastic, Reconstructive and Aesthetic Surgery, Steve Biko Academic Hospital University of Pretoria, Hatfield 0028, South Africa.
  • Department of Surgery, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Parktown, Johannesburg 2193, South Africa.
  • Next Generation Health, Division 1, Council for Scientific and Industrial Research, Meiring Naude Road, Brummeria, Pretoria 0001, South Africa.
  • Department of Internal Medicine, Division of Translational Research, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown 2193, South Africa.
  • Department of Surgery, Faculty of Health Sciences, Steve Biko Academic Hospital, University of Pretoria, Hatfield 0028, South Africa.
  • Department of Anatomical Pathology, National Health Laboratory Services, Tshwane Academic Division, University of Pretoria, Pretoria 0002, South Africa.
  • Department of Surgery, Nelson R Mandela School of Medicine, University of Kwa-Zulu Natal, 719 Umbilo Road, Durban 4001, South Africa.
  • Department of Anatomical Pathology, Dr George Mukhari Academic Laboratory, National Health Laboratory Services, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa.
  • Department of Chemistry, College of Science, Engineering, and Technology, University of South Africa, Florida Park, Johannesburg 1709, South Africa.
  • Charlotte Maxeke Hospital, University of Witwatersrand, Johannesburg 2193, South Africa.
  • Department of Biochemistry, Microbiology and Biochemistry, University of Limpopo, Sovenga 0727, South Africa.
  • Department of Medical Oncology, Faculty of Health Sciences, Steve Biko Academic Hospital, University of Pretoria, Hatfield 0028, South Africa.

Abstract

Cancer disparities in low- and middle-income countries (LMICs) arise from multifaceted interactions between environmental exposures, infectious agents, and systemic inequities, such as limited access to care. The exposome, a framework encompassing the totality of non-genetic exposures throughout life, offers a powerful lens for understanding these disparities. In LMICs, populations are disproportionately affected by air and water pollution, occupational hazards, and oncogenic infections, including human papillomavirus (HPV), hepatitis B virus (HBV), Helicobacter pylori (H. pylori), human immunodeficiency virus (HIV), and neglected tropical diseases, such as schistosomiasis. These infectious agents contribute to increased cancer susceptibility and poor outcomes, particularly in immunocompromised individuals. Moreover, climate change, food insecurity, and barriers to healthcare access exacerbate these risks. This review adopts a population-level exposome approach to explore how environmental and infectious exposures intersect with genetic, epigenetic, and immune mechanisms to influence cancer incidence and progression in LMICs. We highlight the critical pathways linking chronic exposure and inflammation to tumor development and evaluate strategies such as HPV and HBV vaccination, antiretroviral therapy, and environmental regulation. Special attention is given to tools such as exposome-wide association studies (ExWASs), which offer promise for exposure surveillance, early detection, and public health policy. By integrating exposomic insights into national health systems, especially in regions such as sub-Saharan Africa (SSA) and South Asia, LMICs can advance equitable cancer prevention and control strategies. A holistic, exposome-informed strategy is essential for reducing global cancer disparities and improving outcomes in vulnerable populations.

MeSH

Environmental Exposure, Neoplasms, Income, Hiv, Viruses, Alphapapillomavirus, Exposome, Human Papillomavirus Viruses