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Abstract Details
Cancer in People with and without Hepatitis C Virus Infection: Comparison of Risk Before and After Introduction of Direct-Acting Antivirals
Cancer Epidemiol Biomarkers Prev. 2021 Sep 28. doi: 10.1158/1055-9965.EPI-21-0742.Online ahead of print.
Jennifer O Lam1, Leo B Hurley2, Jennifer B Lai3, Varun Saxena45, Suk Seo67, Scott Chamberland8, Charles P Quesenberry Jr2, Jamila H Champsi4, Joanna Ready9, Elizabeth Y Chiao101112, Julia L Marcus#13, Michael J Silverberg#2
Author information
1Division of Research, Kaiser Permanente Northern California, Oakland, California.
2Division of Research, Kaiser Permanente Northern California, Oakland, California.
3San Rafael Medical Center, Kaiser Permanente Northern California, San Rafael, California.
4South San Francisco Medical Center, Kaiser Permanente Northern California, South San Francisco, California.
5University of California San Francisco, San Francisco, California.
6Antioch Medical Center, Kaiser Permanente Northern California, Antioch, California.
7Walnut Creek Medical Center, Kaiser Permanente Northern California, Walnut Creek, California.
8Regional Pharmacy, Kaiser Permanente Northern California, Oakland, California.
9Santa Clara Medical Center, Kaiser Permanente Northern California, Santa Clara, California.
10Department of General Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.
11Department of Epidemiology, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, Texas.
12Baylor College of Medicine, Houston, Texas.
13Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
#Contributed equally.
Abstract
Background: Chronic hepatitis C virus (HCV) infection is a leading cause of liver cancer. The association of HCV infection with extrahepatic cancers, and the impact of direct-acting antiviral (DAA) treatment on these cancers, is less well known.
Methods: We conducted a cohort study in a healthcare delivery system. Using electronic health record data from 2007 to 2017, we determined cancer incidence, overall and by type, in people with HCV infection and by DAA treatment status. All analyses included comparisons with a reference population of people without HCV infection. Covariate-adjusted Poisson models were used to estimate incidence rate ratios.
Results: 2,451 people with HCV and 173,548 people without HCV were diagnosed with at least one type of cancer. Compared with people without HCV, those with HCV were at higher risk for liver cancer [adjusted incidence rate ratio (aIRR) = 31.4, 95% confidence interval (CI) = 28.9-34.0], hematologic cancer (aIRR = 1.3, 95% CI = 1.1-1.5), lung cancer (aIRR = 1.3, 95% CI = 1.2-1.5), pancreatic cancer (aIRR = 2.0, 95% CI = 1.6-2.5), oral/oropharynx cancer (aIRR = 1.4, 95% CI = 1.1-1.8), and anal cancer (aIRR = 1.6, 95% CI = 1.1-2.4). Compared with people without HCV, the aIRR for liver cancer was 31.9 (95% CI = 27.9-36.4) among DAA-untreated and 21.2 (95% CI = 16.8-26.6) among DAA-treated, and the aIRR for hematologic cancer was 1.5 (95% CI = 1.1-2.0) among DAA-untreated and 0.6 (95% CI = 0.3-1.2) among DAA-treated.
Conclusions: People with HCV infection were at increased risk of liver cancer, hematologic cancer, and some other extrahepatic cancers. DAA treatment was associated with reduced risk of liver cancers and hematologic cancers.
Impact: DAA treatment is important for reducing cancer incidence among people with HCV infection.