Reuters Health Information
By Bridgett Novak
February 26, 2014
NEW YORK (Reuters Health) - In addition to their increased risk of death from hepatocellular carcinoma, chronic hepatitis C virus (HCV)-infected patients also have a higher mortality rate from non-Hodgkin lymphoma and pancreatic, rectal, and oral and pharyngeal cancers, according to a new study.
The findings were presented February 20 at the annual meeting of the American College of Preventive Medicine in New Orleans, Louisiana.
Cancer-related mortality was analyzed for 12,126 chronic HCV-infected patients in the Centers for Disease Control and Prevention's (CDC) Chronic Hepatitis Cohort Study and compared to Multiple Cause-of-Death mortality data for 2006 to 2010 from the National Center for Health Statistics after age adjustment.
Twelve percent (1496) of the HCV patients died during the five-year period, 25% (372) of them from cancer. Compared to the general population, the HCV group was more likely to die from non-Hodgkin lymphoma (RR, 2.27) and rectal (RR, 2.60), pancreatic (RR, 1.63), and oral cavity or pharyngeal cancers (RR, 5.22).
As expected, the risk of dying from liver cancer was elevated among HCV-infected patients - nearly 30 times higher than among non-infected individuals.
Study author Dr. Robert D. Allison from Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, said it is important to point out that "chronic hepatitis C infection is a known risk factor for developing non-Hodgkin lymphoma (NHL). But to our knowledge, this is the first U.S. study to investigate and show that persons with chronic hepatitis C have a higher risk of death from NHL."
He said there are multiple possible explanations for the other cancers. "The HCV group had a higher rate of smoking and alcohol use than the general population. So, it's hard to say for sure if the increased risk of death from the three smoking-related cancers (oral, pancreatic, and rectal) was related to HCV infection. However, NHL is not associated with either smoking or alcohol use."
Dr. Allison told Reuters in an email, "We also analyzed the average age of death. We found that persons with chronic hepatitis C died an average of 12 years earlier than the general population from 12 different cancers - i.e., bladder, breast, colon, esophagus, leukemia, liver, lung, non-Hodgkin lymphoma, oral, pancreatic, prostate, and rectal cancers. This was an unexpected and concerning finding that may have HCV treatment and cancer screening implications."
Dr. T. Jake Liang, chief of liver diseases and deputy director for translational research at the National Institute of Diabetes and Digestive and Kidney Diseases in Bethesda, Maryland, was not involved in the new research. He told Reuters Health, "These findings are significant in the sense that chronic HCV infection may predispose an infected person to cancer of organ systems other than the liver, where the virus infects."
Dr. Allison added, "Baby boomers make up 70% of the hepatitis C infected population in the U.S. (77% in our study). The CDC and the U.S. Preventive Services Task Force recommend that all these individuals - i.e., persons born between 1945 and 1965 - get tested."