Hepatitis C Associated with Increased Risk of Head and Neck Cancers

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Infection with hepatitis C virus (HCV) is associated with an increased risk of head and neck cancers, U.S. investigators reported recently in the Journal of the National Cancer Institute. The risk of certain cancers was especially high for patients who were also infected with human papillomavirus (HPV). Overall, hepatitis C was associated with an almost 3-fold increase in the risk of head and neck cancers.

[Produced in collaboration with infohep.org]

"Our results add to the growing body of epidemiological evidence that HCV infection has extrahepatic manifestations and may well be associated with non-liver related cancers," commented Parag Mahale from the University of Texas MD Anderson Cancer and colleagues. "Clinicians should be aware that non-liver cancers…can develop in patients chronically infected with HCV."

Approximately 2.7 to 3.9 million individuals in the U.S. are chronically infected with HCV. It is well known that HCV infection increases the risk of liver cancer, and it has also been associated with an increased risk of non-Hodgkin lymphoma.

In 2009, clinicians from the National Cancer Institute established a center specializing in the treatment of cancers in patients with hepatitis C. An unexpectedly large number of cases of head and neck cancers were observed.

Investigators therefore designed a case-control study to determine if HCV infection increased the risk of these cancers. They analyzed records of patients who received care at their clinic and who were tested for HCV between 2004 and 2014.

Cases were patients with head and neck cancers, including oropharyngeal and non-oropharyngeal (oral cavity, nasopharynx, hyopharynx, and larynx) cancers. Controls were patients with smoking-related cancers (lung, esophagus, and urinary bladder). Biopsy reports were obtained to see if cancers were positive for HPV. Patients with lymphoma were excluded.

The study population comprised 1103 patients: 409 cases and 694 controls. Most patients were male, white, and were born during 1945-1965. Approximately half were current smokers and 52% reported alcohol consumption at the time of cancer diagnosis.

Overall, 11% of patients had antibodies against HCV. Hepatitis C prevalence was higher among patients with oropharyngeal cancers (14%), particularly HPV-related oropharyngeal cancers (17%) compared to controls (6.5%).

After adjustment for age, sex, age, smoking, and alcohol consumption, HCV infection was associated with a more than 2-fold increase in the risk of oropharyngeal cancers (OR 2.04).

Separate analyses were then performed for HPV-related and non-HPV-related oropharyngeal cancers. HCV infection was associated with an increased risk of HPV-related cancers (OR 2.97), but not non-HPV-related tumors (OR 1.44).

HCV prevalence was also higher among patients with non-oropharyngeal cancers (20%) than among controls (6.5%). After adjustment for confounding factors, the investigators found that HCV increased the risk of non-oropharyngeal cancers almost 3-fold (OR 2.85).

Final analysis showed that HCV infection was associated with a significant increase in the risk of non-oropharyngeal cancers (OR 3.17), but not nasopharyngeal cancers (OR 1.3).

"HCV is statistically significantly associated with not only non-oropharyngeal cancer (except nasopharyngeal) [head and neck cancers] but also with HPV-related oropharyngeal cancers," commented the investigators. "Oncologists treating patients with [head and neck cancers] should consider testing patients for HCV to enable early identification and linkage to care for this disease to prevent progression of underlying liver disease."

The authors concluded that HCV infection appears to increase the risk of head and neck cancers. They call for further research to validate their findings.

6/3/16

Reference

P Mahale, EM Sturgis, DJ Tweardy, et al. Association Between Hepatitis C Virus and Head and Neck Cancers. Journal of the National Cancer Institute 108(8):djw035. April 13, 2016 (online ahead of print).

Other Source

University of Texas MD Anderson Cancer Center. People with hepatitis C are two to five times more likely to develop certain head and neck cancers. Press release. April 13, 2016.