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.
中低收入国家（LMICs）的癌症差异源于环境暴露、感染性病原体与系统性不平等（如医疗资源获取受限）之间的多层面相互作用。暴露组作为一个涵盖个体一生中所有非遗传性暴露的整体性框架，为理解这些差异提供了有力视角。在中低收入国家，人群尤其受到空气和水污染、职业危害以及致癌性感染的严重影响，这些感染包括人乳头瘤病毒（HPV）、乙型肝炎病毒（HBV）、幽门螺杆菌（H. pylori）、人类免疫缺陷病毒（HIV）以及血吸虫病等被忽视的热带疾病。这些感染性病原体增加了癌症易感性并导致不良预后，尤其在免疫功能低下人群中更为突出。此外，气候变化、粮食不安全以及医疗可及性障碍进一步加剧了这些风险。本综述采用人群层面的暴露组学方法，探讨环境与感染性暴露如何与遗传、表观遗传及免疫机制相互作用，从而影响中低收入国家的癌症发病与进展。我们重点分析了慢性暴露与炎症关联肿瘤发生的关键通路，并评估了HPV和HBV疫苗接种、抗逆转录病毒治疗及环境监管等干预策略。特别关注暴露组范围关联研究（ExWASs）等工具，这些工具有望推动暴露监测、早期检测和公共卫生政策制定。通过将暴露组学洞见整合到国家卫生系统（尤其是在撒哈拉以南非洲和南亚等地区），中低收入国家能够推进公平的癌症预防与控制策略。采用基于暴露组学的整体性策略，对于减少全球癌症差异、改善脆弱人群的健康结局至关重要。
肿瘤(癌症)患者之家