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CANCER RATES IN PATIENTS WITH CHRONIC HEPATITIS C IN A LARGE U.S. HEALTH MAINTENANCE ORGANIZATION (Kaiser)....HCV Linked to Increased Cancer Risks/Not just liver cancer
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Reported by Jules Levin
EASL 2015 April 22-26 Vienna Austria
Anders H. Nyberg1, Ekaterina Sadikova2, T. Craig Cheetham2 Jiaxiao M. Shi2 ,Kevin M. Chiang3, Joanie WL. Chung2, Reina Haque2, Zobair M. Younossi4, Lisa M. Nyberg1
1. Hepatology Research, Kaiser Permanente, San Diego, CA, USA
2. Kaiser Permanente, Department of Research and Evaluation, Pasadena, CA, USA
3. Pharmacy Analytical Services, Kaiser Permanente, Downey, CA, USA
4. Center for Liver Diseases, Dept. of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA
Conclusions: In our cohort of Hepatitis C infected patients, cancer rates were significantly increased compared to the non-HCV cohort. This suggests that another extrahepatic manifestation of HCV may be an increased risk of cancer.
As expected, analysis found that the rate of liver cancer was dramatically higher among those with HCV -- more than 68 times as high, Nyberg told reporters. The rate ratio was lower for most other cancers studied but still ranged between 1.83 and 3.59 times as high for people with HCV (see Forest Plot below). Lumping all cancers together, the rate ratio comparing people with and without HCV was 2.33 while if liver cancers were excluded, the rate ratio was 1.84, Nyberg said.
The researchers stratified HCV participants by tobacco use, alcohol abuse, diabetes, and body mass index above or below 30. Lumping all sites together, Nyberg said, they found that smoking, diabetes, and body mass index significantly affected the risk of cancer, but alcohol abuse did not. On the other hand, when the analysis considered liver cancer alone the pattern was slightly different -- tobacco, alcohol abuse and diabetes were significant predictors of risk, but body mass index was not, he said. Interestingly, Nyberg said, in the absence of alcohol abuse, tobacco use and diabetes, there was an increase in the rate of many cancer types among those with HCV. But when those factors were present, he said, HCV had a more moderate effect on the cancer rates. That was largely because such things as smoking have very powerful effects that swamp the effect of HCV (these comments are from the program abstract & from Medpagetoday report on the study)
People with hepatitis C (HCV) appear to be more prone to cancer -- not just liver tumors -- than those without the infection, a researcher said here. To investigate the issue, he and colleagues analyzed medical records of members of the Kaiser Permanente health maintenance organization. In a retrospective analysis of medical records, those with HCV were more than twice as likely to have any of a range of common cancers, according to Anders Nyberg, MD. Even when liver cancer was excluded from the analysis, people with HCV had more than an 80% increase in the risk of cancer, Nyberg told reporters. But Nyberg cautioned that the nature of the study means it is difficult to make any conclusions about cause and effect and that not all factors at play are known to be accurately recorded. In particular, tobacco and alcohol use might have been under-reported, he noted. Nyberg said that a relationship between HCV and non-Hodgkin's lymphoma has been suggested and other recent analyses have reported links with other forms of cancer. This is a retrospective study at Kaiser Permanente Southern California (KPSC), a large health maintenance organization with 3.5-4 million members. The KPSC cancer registry is an accredited program maintaining a complete profile of all cancer diagnoses for all KP members. In this study, we recorded all cancer diagnoses in patients ≥18 years of age with or without HCV during 2008-2012. From 2008 to 2012, 145,210 patient years were included in the HCV cohort, and 13,948,826 patient years were included in the non HCV cohort. Mean age at cancer diagnosis in the HCV cohort was 61.8 years, in the non-HCV cohort, 63.5 years. In the HCV cohort there were 2,213 cancer diagnoses (1524/100000) during the 5 year period and 1,654 cancer diagnoses when liver cancer was excluded (1139/100000). In the non HCV cohort there were 84,419 cancer diagnoses (605/100000) during the same 5 year period and 83,795 (601/100000) when liver cancer was excluded. The rate ratios between the HCV and non HCV cohorts for the total number of cancer cases including and excluding liver cancer are shown in Table 1.
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