Universal hepatitis screening may be warranted to identify patients with cancer who have undiagnosed viral infections.
Many newly-diagnosed patients with cancer are unaware that they have hepatitis B virus (HBV) or hepatitis C virus (HCV) infection, according to a new study published in JAMA Oncology. The findings indicate a need for universal screening practices in this patient population.
The study, led by investigators from SWOG Cancer Research Network, is the largest analysis of HBV, HCV, and HIV infection prevalence in patients with cancer.
For the study, the researchers examined data from 3051 patients who were enrolled between 2013 and 2017. The study’s participants received a simple blood test to check for HIV status, as well as for the presence of HBV and HCV.
According to their findings, 6.5% of patients had HBV, 0.6% had chronic HBV, 2.4% had HCV, and 1.1% had HIV infection. Additionally, 87.3% of patients with past HBV infections and 42.1% of patients with chronic HBV were undiagnosed prior to the study screening, as well as 31% of patients with HCV infections. The researchers noted that the overall prevalence of hepatitis infection in these patients is similar to the general US population.
Cancers that had the highest prevalence of infection included liver, cancers of the gastrointestinal tract other than liver or colorectal, as well as head and neck, lung, and prostate, according to the study.
Many of the patients in the study had no risk factors for infection. The researchers indicated that screening patients with newly diagnosed cancer for hepatitis infections may be warranted to prevent potential complications related to some cancer therapies. Universal screening for HBV or HCV in community cancer clinics may be beneficial, the researchers noted.
Currently, practice guidelines vary when it comes to viral screening for patients with cancer. The American Society of Clinical Oncology and National Comprehensive Cancer Network (NCCN) guidelines recommend screening for HBV infection before initiating anti-CD20 therapy or hematopoietic cell transplantation. The NCCN also recommends that patients with risk factors for HBV infection should also be screened.
“While our results don’t suggest that universal HIV screening is necessary for cancer patients, they do provide new evidence to inform a discussion in the oncology community about whether we should require hepatitis screenings,” study investigator Scott Ramsey, MD, PhD, director of the Hutchinson Institute for Cancer Outcomes Research at Fred Hutchinson Cancer Research Cancer, said in a press release. “The presence of a potentially life-threatening infection could guide care in very important ways. In medicine, more knowledge is always better.”
A separate analysis led by these study authors is investigating whether universal hepatitis and HIV screenings for patients with cancer would be cost effective, with the results expected to be released later this year.
Ramsey SD, Unger JM, Baker LH, et al. Prevalence of hepatitis B virus, hepatitis C virus, and HIV infection among patients with newly diagnosed cancer from academic and community oncology practices. JAMA Oncology. 2019. doi:10.1001/jamaoncol.2018.6437.
Hepatitis Goes Undiagnosed in Cancer Patients [news release]. SWOG’s website. https://www.swog.org/news-events/news/2019/01/17/hepatitis-goes-undiagnosed-cancer-patients. Accessed January 17, 2019.