The earlier age of onset of malignancy in developing world is related to overall infection burden and could be due to the effect on telomere length.

It is a common observation that many common cancers occur at a younger age in developing countries, like India. The cancer registry data provide incidence rate of different cancers, which suggest the same. Telomere shortening is involved in ageing of cells. Inflammation and infection result in telomere shortening in immune cells. The higher infection burden in developing countries might mean an earlier ageing of immune cells, resulting in decreased efficiency of immune surveillance and thus predisposing to cancer at an earlier age than seen in developed countries with lesser infection burden. Copyright 2003 Elsevier Science Ltd.