 Exposure
to Hepatitis B Virus May Increase the Risk of Pancreas Cancer
It
is well known that chronic infection with hepatitis
B virus (HBV) or hepatitis C virus (HCV)
can eventually lead to liver
cancer, or hepatocellular
carcinoma. This is not surprising, since these viruses replicate in the liver,
where they damage cells and trigger fibrosis (build-up of scar tissue). But
hepatitis B may cause cancer of the pancreas as well, according to a study published
in the October 1, 2008 Journal of Clinical Oncology. 
Manal
Hassan, James Abbruzzese, and colleagues recruited 476 patients at the University
of Texas M.D. Anderson Cancer Center in Houston who had confirmed adenocarcinoma
of the pancreas, as well as 879 healthy control subjects matched for age, sex,
and race.
Blood samples were tested for the presence of HCV antibodies,
HBV surface antigen (HBsAg), antibodies against HBV core antigen (anti-HBc), and
antibodies against HBsAg (anti-HBs); positive samples confirmed with additional
tests. The presence of anti-HBc antibodies indicates that a person has been exposed
to HBV. Presence of both anti-HBc and anti-HBs indicates that a person has cleared
the virus, while anti-HBc without anti-HBs indicates acute or chronic active infection. 
Results
•
7 patients with pancreas cancer (1.5%) and 9 control subjects (1.0%) had detectable
anti-HCV antibodies, which was not a significant difference.
•
However, pancreas cancer patients were significant more likely to have detectable
anti-HBc antibodies (36 patients, or 7.6%) compared with control subjects (28
patients, or 3.2%).
The estimated adjusted odds ratios were as follows:
•
Positive for anti-HCV antibodies: AOR 0.9;
•
Positive for anti-HBc antibodies: AOR 2.5;
•
Positive for both anti-HBc and anti-HBs antibodies: AOR 2.3;
•
Positive for anti-HBc but negative for anti-HBs: AOR 4.
•
Smoking, diabetes, and family history were also significant predictors of pancreas
cancer.
•
Risk modification according to past exposure to HBV was observed among diabetics
(AOR 7.1).
Based
on these findings, the investigators concluded, "Past exposure to HBV may
be associated with pancreatic cancer development."
"Should such
findings be confirmed by other studies," they continued, "it may offer
important insights into the etiology of pancreatic cancer and may suggest the
need to consider prevention of HBV reactivation among patients with HBV-related
pancreatic cancer during chemotherapy."
While the rate of pancreas
cancer was greatest among people with chronic active infection, the risk was still
significantly elevated in people who had spontaneously cleared HBV. These findings
are important because such individuals may experience recurrence if their immune
function is suppressed, for example during chemotherapy. Thus, if HBV plays a
role in promoting pancreas cancer, immunosuppressive treatment could potentially
do more harm than good. Departments
of Gastrointestinal Medical Oncology, Epidemiology, and Gastroenterology, Hepatology,
and Nutrition, University of Texas M.D. Anderson Cancer Center, Houston, TX. 10/07/08
Reference
MM
Hassan, D Li, AS El-Deeb, and others. Association between hepatitis B virus and
pancreatic cancer. Journal of Clinical Oncology 26 (8): 4557-4562. October 1,
2008. (Abstract).
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