We highlight the ability of the tuberculosis (TB) causing bacterial pathogen, Mycobacterium tuberculosis (Mtb), to induce key characteristics that are associated with established IARC classified Group 1 and Group 2A carcinogenic agents. There is sufficient evidence from epidemiological case-control, cohort and meta-analysis studies of increased lung cancer (LC) risk in pre-existing/active/old TB cases. Similar to carcinogens and other pathogenic infectious agents, exposure to aerosol-containing Mtb sprays in mice produce malignant transformation of cells that result in squamous cell carcinoma. Convincing, mechanistic data show several characteristics shared between TB and LC which include chronic inflammation, genomic instability and replicative immortality, just to name a few cancer hallmarks. These hallmarks of cancer may serve as precursors to malignant transformation. Together, these findings form the basis of our postulate that Mtb is a complete human pulmonary carcinogen. We also discuss how Mtb may act as both an initiating agent and promoter of tumor growth. Forthcoming experimental studies will not only serve as proof-of-concept but will also pivot our understanding of how to manage/treat TB cases as well as offer solutions to clinical conundrums of TB lesions masquerading as tumors. Clinical validation of our concept may also help pave the way for next generation personalized medicine for the management of pulmonary TB/cancer particularly for cases that are not responding well to conventional chemotherapy or TB drugs.

中文翻译：

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结核分枝杆菌对人类致癌吗？

我们强调了导致结核病 (TB) 的细菌病原体结核分枝杆菌( Mtb ) 诱导与已确定的 IARC 分类的第 1 组和第 2A 组致癌剂相关的关键特征的能力。已有足够证据来自流行病学病例对照、队列和荟萃分析研究，表明既往/活动性/老年结核病例中肺癌 (LC) 风险增加。与致癌物和其他病原体感染因子相似，接触含有气溶胶的Mtb小鼠喷雾会导致细胞恶性转化，导致鳞状细胞癌。令人信服的机械数据显示了 TB 和 LC 之间共有的几个特征，包括慢性炎症、基因组不稳定性和复制永生性，仅举几个癌症标志。癌症的这些标志可能是恶性转化的前兆。总之，这些发现构成了我们假设Mtb是一种完全人类肺部致癌物的基础。我们还讨论了Mtb可作为肿瘤生长的启动剂和促进剂。即将进行的实验研究不仅可以作为概念验证，而且还将改变我们对如何管理/治疗结核病病例的理解，并为伪装成肿瘤的结核病病变的临床难题提供解决方案。我们概念的临床验证也可能有助于为下一代个性化医疗铺平道路，以管理肺结核/癌症，特别是对于对常规化疗或结核病药物反应不佳的病例。