MD Anderson links hepatitis C to greater risk of head and neck cancers
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Dr. Harrys Torres, associate professor of Infectious Disease, MD Anderson Cancer Center.
Researchers from MD Anderson have identified for the first time a link between hepatitis C infection and head and neck cancers, according to a study released Wednesday. If confirmed in follow-up studies, the finding could have significant implications for screening and treatment of affected patients.
"The association between hepatitis C and head and neck cancers is something that's not been definitely shown before," said Dr. Andrew Sikora, co-director of the Head and Neck Cancer Program at Baylor College of Medicine. "They have some exciting results that, should they bear out in subsequent studies, could be quite impactful."
In 2009, MD Anderson opened a hepatitis C clinic, the first such clinic within a cancer center. Dr. Harrys Torres, an associate professor of infectious disease and director of the clinic, expected he would see primarily patients with liver cancer and non-Hodgkin's lymphoma, the two most common hepatitis-linked cancers.
"All of a sudden, I started to see all these patients with head and neck cancer coming through the clinic," he said. "We began to wonder if there was an undiscovered connection."
Torres and his colleagues analyzed the records of more than 34,000 patients tested for hepatitis C, then compared the rates among head and neck cancer patients with those of other cancers.
Because smoking is a major risk factor for head and neck cancers, they chose patients with other smoking-related cancers - lung, esophageal and bladder - as their control group.
They found that 14 percent of patients with cancers of the throat, tongue, soft palate or tonsils tested positive for hepatitis C, compared with 6.5 percent of patients in the control group. Among those with cancer of the oral cavity, nasal cavity and larynx, 20 percent tested positive for hepatitis C.
"We are going to recommend that all patients with head and neck cancer should be screened for hepatitis C, which is not done so far," he said.
The findings, published Wednesday in the Journal of the National Cancer Institute, represent the first step in establishing a link, and researchers will have to confirm the link in much broader studies before screening guidelines are likely to be changed.
Hepatitis C is a blood-borne virus, most commonly transmitted by sharing needles or other equipment to inject drugs. Some patients will clear the virus quickly, but for 70 to 85 percent of those infected-representing as many as 3.9 million Americans-it becomes a long-term chronic infection that can damage the liver.
New treatments that have come on the market since 2011 are highly effective at clearing even chronic hepatitis C infections.
Michael Szczepanski, 55, of Port St. Lucie, Fla., had two surgeries and multiple biopsies to address his oral cancer before coming to MD Anderson last year for a second opinion. The night before he was due to start chemotherapy, he learned he had tested positive for hepatitis C.
"It was just a shock," said Szczepanski, who has a fear of needles and never used IV drugs. "It's a big mystery as to how I got it."
That's not uncommon. The U.S. Preventive Services Task Force recommends adults born between 1945 and 1965 be screened at least once, regardless of whether they have any other risk factors for infection, in order to capture more of the estimated 25 percent of people with hepatitis C who are unaware they are infected.
Szczepanski saw Torres at the hepatitis C clinic and was prescribed medications that cleared the virus. He undergoes regular monitoring for some pre-cancerous lesions but does not need additional treatment at this time.
"It's amazing," he said. "I was cured of something that kills people. It just so happened that all the doctors were alert enough to help me."
Torres now plans further research to identify how likely hepatitis C patients are to develop head and neck cancers, and will examine whether eliminating the infection will also affect their cancer.
Previous studies have shown that eliminating the hepatitis C virus in patients with non-Hodgkin's lymphoma has caused the cancer to disappear.
"We also realized that many of our hepatitis patients were excluded from clinical trials," Torres said. "Now that many with hepatitis C can be cured, it is important that we first address and potentially cure the virus, so that they can have access to necessary cancer therapy."
The researchers also found that patients with hepatitis C and head and neck cancers were also more likely to test positive for the human papillomavirus, or HPV. The link will be studied as part of MD Anderson's Moon Shot program looking at ways to combat HPV-caused cancers.
"What we are trying to make all understand is this is an infection that has consequences," Torres said. "And it's an infection we can cure."
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