Hepatitis C virus infection and the risk of cancer among elderly US adults: A registry‐based case‐control study

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. We systematically assessed associations between HCV infection and cancers in the US elderly population. Methods: We conducted a registry-based case-control study using the SEER-Medicare data in US adults aged ≥66 years. Cases (n=1,623,538) were people with first cancers identified in SEER registries (1993–2011). Controls (n=200,000) were randomly selected cancer-free individuals frequency-matched to cases on age, sex, race, and calendar year. We determined associations with HCV using logistic regression. Results: HCV prevalence was higher in cases than controls (0.7% vs. 0.5%). HCV was positively associated with cancers of the liver (adjusted odds ratio [aOR]=31.5; 95%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), anus (aOR=1.97; 95%CI=1.42–2.73), and non-melanoma non-epithelial 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 (DLBCL) (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 people 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. Conclusion(s): HCV is associated with increased risk of cancers other than HCC in the US elderly population, notably bile duct cancers and DLBCL. These results support a possible etiologic role for HCV in an expanded group of cancers.

Hepatitis B virus infection and the risk of cancer in the elderly US population

“…The inverse associations between HBV infection and cancers of the breast and prostate were similar to those observed for HCV infection . One possible explanation for this association was that HBV‐infected individuals may be less likely to get screened for cancer than HBV‐uninfected individuals.…”

“…MDS is a heterogeneous group of malignancies characterized by ineffective ‐myeloid blood cell production with an increased risk of acute myeloid leukemia . HCV infection has been previously found to be associated with both DLBCL and MDS . Though we were likely to miss claims for HCV infection, confounding due to HCV infection is improbable because it is rare in the general population, and its associations with DLBCL and MDS were modest.…”

“…The Surveillance, Epidemiology, and End Results (SEER)‐linked Medicare dataset provides a unique opportunity to explore these associations in a large number of elderly adults with comprehensive cancer ascertainment. We previously systematically assessed the associations between different cancer types and chronic hepatitis C virus (HCV) infection using this database . Now, we use the same methodology to thoroughly assess the associations between HBV infection and cancer among a nationally representative cohort of elderly US adults.…”

Hepatitis C Virus Infection in the Older Patient

“…A recent registry-based case-control study 22 using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database in U.S. adults aged ≥65 years from 1993 to 2011 found that as expected, HCV infection was strongly associated with cancers of the liver compared to those without HCV infection. Interestingly, however, HCV infection was also associated with higher odds of intrahepatic (adjusted odds ratio (aOR): 3.40) and extrahepatic (aOR: 1.90) bile duct cancer; pancreatic cancer (aOR: 1.23); anal cancer (aOR: 1.97); nonmelanoma nonepithelial skin cancer (aOR: 1.53); myelodysplastic syndrome (aOR: 1.56), and diffuse large B-cell lymphoma (aOR: 1.57).…”

Epidemiology and viral risk factors for hepatocellular carcinoma in the Eastern Mediterranean countries

“…In patients with HCV-related cirrhosis, annual rate of HCC is 1%-4%, therefore patients with advanced fibrosis and cirrhosis should undergo HCC surveillance. The risk factors for HCC are older age, black race, HCV genotype 1b, co-infection with HBV or HIV, diabetes, obesity, steatosis, heavy alcohol consumption and low platelet levels in patients with cirrhosis [49][50][51][52] .…”