The impact of armed conflict on cancer among civilian populations in low- and middle-income countries: a systematic review.
cancer
conflict
low-income countries
middle-income countries
systematic review
war
Journal
Ecancermedicalscience
ISSN: 1754-6605
Titre abrégé: Ecancermedicalscience
Pays: England
ID NLM: 101392236
Informations de publication
Date de publication:
2020
2020
Historique:
received:
09
01
2020
entrez:
23
6
2020
pubmed:
23
6
2020
medline:
23
6
2020
Statut:
epublish
Résumé
Armed conflicts are increasingly impacting countries with a high burden of cancer. The aim of this study is to systematically review the literature on the impact of armed conflict on cancer in low- and middle-income countries (LMICs). In November 2019, we searched five medical databases (Embase, Medline, Global Health, PsychINFO and the Web of Science) without date, language or study design restrictions. We included studies assessing the association between armed conflict and any cancer among civilian populations in LMICs. We systematically re-analysed the data from original studies and assessed quality using the Newcastle-Ottawa Scale. Data were analysed descriptively by cancer site. Of 1,543 citations screened, we included 20 studies assessing 8 armed conflicts and 13 site-specific cancers (total study population: 70,172). Two-thirds of the studies were of low methodological quality (score <5) and their findings were often conflicting. However, among outcomes assessed by three or more studies, we found some evidence that armed conflict was associated with increases in the incidence and mortality of non-specific cancers, breast cancer and cervical cancer. Single studies reported a positive association between armed conflict and the incidence of stomach and testicular cancers, some as early as 3 years after the onset of conflict. Some studies reported a post-conflict impact on time to diagnosis. Our findings support the need for more rigorous longitudinal and cohort studies of populations in and immediately post-conflict to inform the development of basic packages of cancer services, and post-conflict cancer control planning and development.
Sections du résumé
BACKGROUND
BACKGROUND
Armed conflicts are increasingly impacting countries with a high burden of cancer. The aim of this study is to systematically review the literature on the impact of armed conflict on cancer in low- and middle-income countries (LMICs).
METHODS
METHODS
In November 2019, we searched five medical databases (Embase, Medline, Global Health, PsychINFO and the Web of Science) without date, language or study design restrictions. We included studies assessing the association between armed conflict and any cancer among civilian populations in LMICs. We systematically re-analysed the data from original studies and assessed quality using the Newcastle-Ottawa Scale. Data were analysed descriptively by cancer site.
RESULTS
RESULTS
Of 1,543 citations screened, we included 20 studies assessing 8 armed conflicts and 13 site-specific cancers (total study population: 70,172). Two-thirds of the studies were of low methodological quality (score <5) and their findings were often conflicting. However, among outcomes assessed by three or more studies, we found some evidence that armed conflict was associated with increases in the incidence and mortality of non-specific cancers, breast cancer and cervical cancer. Single studies reported a positive association between armed conflict and the incidence of stomach and testicular cancers, some as early as 3 years after the onset of conflict. Some studies reported a post-conflict impact on time to diagnosis.
CONCLUSION
CONCLUSIONS
Our findings support the need for more rigorous longitudinal and cohort studies of populations in and immediately post-conflict to inform the development of basic packages of cancer services, and post-conflict cancer control planning and development.
Identifiants
pubmed: 32565892
doi: 10.3332/ecancer.2020.1039
pii: can-14-1039
pmc: PMC7289611
doi:
Types de publication
Journal Article
Review
Langues
eng
Pagination
1039Informations de copyright
© the authors; licensee ecancermedicalscience.
Déclaration de conflit d'intérêts
The authors have declared no conflicts of interest.
Références
Ann Epidemiol. 1998 Jan;8(1):46-51
pubmed: 9465993
PLoS Med. 2013 Oct;10(10):e1001533
pubmed: 24143140
Lancet Oncol. 2006 Sep;7(9):709
pubmed: 16977728
J Natl Cancer Inst. 1959 Jan;22(1):1-18
pubmed: 13621196
BMJ. 2014 Aug 05;349:g4643
pubmed: 25097193
BMC Med Res Methodol. 2008 Feb 25;8:8
pubmed: 18298827
Lijec Vjesn. 2002 Nov-Dec;124(11-12):347-53
pubmed: 12679975
PLoS One. 2015 Sep 25;10(9):e0138303
pubmed: 26406317
Soc Sci Med. 2009 Jul;69(2):172-7
pubmed: 19501443
Environ Health Perspect. 1998 Apr;106 Suppl 2:671-8
pubmed: 9599715
Coll Antropol. 2006 Mar;30(1):149-55
pubmed: 16617590
J Res Med Sci. 2013 Dec;18(12):1026-39
pubmed: 24523792
Coll Antropol. 2002 Jun;26(1):99-106
pubmed: 12137329
Eur J Public Health. 2019 Jun 1;29(3):468-474
pubmed: 30561573
Clin Exp Obstet Gynecol. 2005;32(1):58-60
pubmed: 15864941
Int J Cancer. 2009 Mar 15;124(6):1416-21
pubmed: 19048620
Subst Use Misuse. 2017 Sep 19;52(11):1494-1510
pubmed: 28471305
Coll Antropol. 2005 Dec;29(2):573-8
pubmed: 16417163
PLoS Med. 2009 Jul 21;6(7):e1000097
pubmed: 19621072
Med Arh. 2002;56(1):15-9
pubmed: 11917683
Int J Cancer. 2013 Mar 1;132(5):1222-6
pubmed: 22847218
BMJ. 1997 Nov 22;315(7119):1342-8
pubmed: 9402775
Oral Dis. 2011 Oct;17(7):636-41
pubmed: 21762396
Lancet. 2014 Feb 8;383(9916):549-57
pubmed: 24351322
PLoS One. 2015 Sep 03;10(9):e0136065
pubmed: 26336076
Tob Control. 2016 Mar;25(2):129-40
pubmed: 25770116
Occup Environ Med. 2020 Mar;77(3):151-159
pubmed: 32054819
CMAJ. 2010 Oct 19;182(15):1609-16
pubmed: 20837683
Western Pac Surveill Response J. 2015 Nov 06;6 Suppl 1:18-20
pubmed: 26767129
Int J Cancer. 2004 Jul 10;110(5):775-7
pubmed: 15146569
Adv Med Sci. 2009;54(2):283-8
pubmed: 20022862
Psychiatr Danub. 2015 Dec;27 Suppl 2:571-7
pubmed: 26657984
Lancet Oncol. 2004 Oct;5(10):617-25
pubmed: 15465465
Lancet Oncol. 2018 Mar;19(3):291-292
pubmed: 29508747
Heart. 2019 Sep;105(18):1388-1394
pubmed: 31138670
J BUON. 2003 Apr-Jun;8(2):147-50
pubmed: 17472242
Srp Arh Celok Lek. 2000 Sep-Oct;128(9-10):309-15
pubmed: 11255684
Lancet. 2016 Oct 8;388(10053):1459-1544
pubmed: 27733281
Eur J Epidemiol. 2004;19(1):55-60
pubmed: 15012023
Lancet. 2017 Dec 2;390(10111):2516-2526
pubmed: 28314568
Med Arh. 2005;59(3):183-7
pubmed: 15997680