Introduction
Cancer represents a growing public health concern in Albania, with a steadily increasing incidence linked to demographic aging, lifestyle changes following the post-communist transition, and improved diagnostic capacity. Cancer is now the second leading cause of death after cardiovascular diseases, with particularly high burdens of lung and breast cancer. Despite ongoing international efforts to strengthen cancer control, Albania continues to face substantial challenges related to organized screening, access to modern treatment, and comprehensive cancer data collection. An estimated 6,000–7,000 new cancer cases occur annually; in 2024, the National Cancer Registry at the Institute of Public Health reported 7,076 new cases.

Infection-related cancers remain an important component of the cancer burden. Hepatitis B virus (HBV) infection is considered endemic in Albania, with an estimated 7–9% hepatitis B surface antigen (HBsAg) positivity in the general population, indicating a high prevalence of chronic infection compared with most European countries. Hepatitis C virus (HCV) prevalence is lower, averaging around 1%, although substantially higher rates are observed in high-risk groups, such as people who inject drugs. Results from national cervical cancer screening programs show human papillomavirus (HPV) positivity rates of approximately 6% among tens of thousands of screened women, reflecting sustained HPV circulation in the adult female population. In contrast, smaller clinical or high-risk cohorts, particularly women with abnormal cytology, report HPV prevalence exceeding 70%, highlighting variation by age, risk profile, and diagnostic method.

Objectives
To provide an evidence-based and comprehensive assessment of the burden of infection-related cancers in Albania.

Methods
We estimated the proportion of cancers attributable to Helicobacter pylori, human papillomaviruses, and hepatitis B and C viruses to quantify the burden of infection-related cancer incidence and mortality in Albania in 2024. Infection prevalence data were obtained from population-based cross-sectional surveys conducted in Albania, while relative risks were derived from meta-analyses and large-scale epidemiological studies. Population attributable fractions were calculated under a counterfactual scenario assuming the absence of infection.

Results
We estimated that 22.5% of cancer deaths in 2024 were attributable to infections, with a higher contribution among men (13%) than women (9%). For cancer incidence, 17.5% of new cases were attributable to infections overall, with corresponding proportions of 9.9% in men and 7.6% in women. Helicobacter pylori was the leading cause of infection-related cancer mortality, accounting for 8.9% of total cancer deaths, followed by HBV (5.1%) and HPV (1.6%). In terms of incidence, 4.5% of new cancer cases were attributable to H. pylori, 1.8% to HPV, 1.3% to HBV and HCV combined, and 0.4% to Epstein–Barr virus.

Conclusions
Our findings indicate that infection-attributable cancers account for a substantial proportion of both cancer mortality (22.5%) and incidence (17.5%) in Albania, exceeding estimates reported in many other developing countries. These results underscore the urgent need to strengthen infection prevention, vaccination, screening, and treatment strategies as integral components of national cancer control efforts.