Parag Mahale MBBS, PhD, Harrys A. Torres MD, Jennifer R. Kramer PhD, Lu-Yu Hwang MD, Ruosha Li PhD, Eric L. Brown PhD, Eric A. Engels MD, MPH
First published: 24 January 2017
DOI: 10.1002/cncr.30559
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Abstract
BACKGROUND
Hepatitis C virus (HCV) infection causes hepatocellular carcinoma (HCC) and subtypes of non-Hodgkin lymphoma (NHL). Associations with other cancers are not established. The authors systematically assessed associations between HCV infection and cancers in the US elderly population.
METHODS
This was a registry-based case-control study using Surveillance, Epidemiology, and End Results (SEER)-Medicare data in US adults aged ≥66 years. Cases (n = 1,623,538) were patients who had first cancers identified in SEER registries (1993-2011). Controls (n = 200,000) were randomly selected, cancer-free individuals who were frequency-matched to cases on age, sex, race, and calendar year. Associations with HCV (documented by Medicare claims) were determined using logistic regression.
RESULTS
HCV prevalence was higher in cases than in controls (0.7% vs 0.5%). HCV was positively associated with cancers of the liver (adjusted odds ratio [aOR] = 31.5; 95% confidence interval [CI], 29.0-34.3), intrahepatic bile duct (aOR, 3.40; 95% CI, 2.52-4.58), extrahepatic bile duct (aOR, 1.90; 95% CI, 1.41-2.57), pancreas (aOR, 1.23; 95% CI, 1.09-1.40), and anus (aOR, 1.97; 95% CI, 1.42-2.73); nonmelanoma nonepithelial skin cancer (aOR, 1.53; 95% CI, 1.15-2.04); myelodysplastic syndrome (aOR, 1.56; 95% CI, 1.33-1.83); and diffuse large B-cell lymphoma (aOR, 1.57; 95% CI, 1.34-1.84). Specific skin cancers associated with HCV were Merkel cell carcinoma (aOR, 1.92; 95% CI, 1.30-2.85) and appendageal skin cancers (aOR, 2.02; 95% CI, 1.29-3.16). Inverse associations were observed with uterine cancer (aOR, 0.64; 95% CI, 0.51-0.80) and prostate cancer (aOR, 0.73; 95% CI, 0.66-0.82). Associations were maintained in sensitivity analyses conducted among individuals without documented alcohol abuse, cirrhosis, or hepatitis B or human immunodeficiency virus infections and after adjustment for socioeconomic status. Associations of HCV with other cancers were not observed.
CONCLUSIONS
HCV is associated with increased risk of cancers other than HCC in the US elderly population, notably bile duct cancers and diffuse large B-cell lymphoma. These results support a possible etiologic role for HCV in an expanded group of cancers. Cancer 2017. © 2017 American Cancer Society.
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Related
Study shows link between Hepatitis C virus, multiple cancers
The connection between Hepatitis C virus (HCV) and certain cancers has been studied previously, with findings showing that HCV infection causes hepatocellular carcinoma, a type of liver cancer, and subtypes of non-Hodgkin lymphoma. In a paper published in Cancer, Dr. Jennifer Kramer and colleagues examine the link between HCV and other cancers within the U.S. elderly population.
“We found that HCV was more prevalent in the cases than in the controls, and that it was positively associated with multiple cancer types,” Kramer said. “This shows us that HCV is associated with an increased risk of cancers outside of hepatocellular carcinoma and supports a potential causative role of HCV in an expanded group of cancers.”
The cancers associated with HCV other than liver included cancers of the bile ducts, pancreas, anus, non-melanoma non-epithelial skin cancers, diffuse large B-cell lymphoma, and myelodysplastic syndrome.
The study was designed and funded by the National Cancer Institute and led by Dr. Parag Mahale, who conducted the research as part of his doctoral dissertation at the University of Texas Health Science Center in Houston.
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