The impact of armed conflict on cancer among civilian populations in low- and middle-income countries: a systematic review

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: 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: 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: 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.