Exploratory Analysis Links H. pylori to 22% of Global Colorectal Cancers

Researchers combined systematic reviews and GLOBOCAN 2022 incidence figures stratified by region, diagnostic assay, sex, and screening availability. Pooled data from 48.7 million individuals yielded the 22% population attributable fraction, though restriction to 14 population-based cohorts lowered the estimate to 12%. Regional variation was marked, with Mongolia at 36% and the Western Pacific at 25%, while absolute burden peaked in China at 139,619 attributable cases. The analysis also noted higher fractions among cohorts born after 1962.

The 1.6-fold risk increase showed no significant modification by age, sex, or national screening programs. Four studies reporting eradication outcomes suggested risk reduction only after a decade, consistent with slow colorectal carcinogenesis timelines. These patterns align with prior gastric cancer data but diverge from lower attributable fractions reported in African and Southeast Asian registries despite comparable infection prevalence.

Causality remains unproven because all inputs were observational; residual confounding by diet, inflammation, or socioeconomic factors cannot be excluded. Next-step research requires large-scale randomized eradication trials with colorectal cancer incidence as a primary endpoint and 15-year follow-up to test whether antibiotic treatment produces measurable incidence drops above 10% in high-prevalence settings.