In a prospective cohort study reported in JAMA Oncology, Ramsey et al identified the prevalence of hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) infection in patients with newly diagnosed cancer and found that a substantial proportion were unaware of infection at the time of cancer diagnosis. As noted by the investigators, universal screening of patients with newly diagnosed cancer for HBV, HCV, and HIV is not routine in oncology practice, with experts disagreeing as to whether universal screening should be performed.
The study involved patients with newly diagnosed cancer (ie, identified within 120 days of cancer diagnosis) at 9 academic and 9 community oncology institutions affiliated with SWOG Cancer Research Network (a member of the National Clinical Trials Network) with enrollment from August 2013 through February 2017. Patients with previous knowledge of viral infection and those with unknown viral status were included in the analysis. Among 3,051 evaluable patients, the median age was 60.6 years (range = 18.2–93.7 years), 60.4% were female, 74.8% were white, 18.1% were black, and 18.3% were of Hispanic ethnicity.
Prevalence of Infection
The observed infection rates were 6.5% (n = 197) for previous HBV infection, 0.6% for chronic HBV (n = 19), 2.4% for HCV (n = 71), and 1.1% for HIV (n = 34). Among those with infection, 8 (42.1%) with chronic HBV, 22 (31.0%) with HCV, and 2 (5.9%) with HIV were newly diagnosed with the viral infection in the study. Also among those with infection, 4 with chronic HBV (21.1%), 23 with HCV (32.4%), and 7 with HIV (20.6%) had no identifiable risk factors.
The investigators concluded, “Results of this study found that a substantial proportion of patients with newly diagnosed cancer and concurrent HBV or HCV are unaware of their viral infection at the time of cancer diagnosis, and many had no identifiable risk factors for infection. Screening patients with cancer to identify HBV and HCV infection before starting treatment may be warranted to prevent viral reactivation and adverse clinical outcomes. The low rate of undiagnosed HIV infection may not support universal screening of newly diagnosed cancer patients.”
Scott D. Ramsey, MD, PhD, of the Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, is the corresponding author for the JAMA Oncology article.
Disclosure: The study was supported by grants from the National Cancer Institute. The study authors’ full disclosures can be found at jamanetwork.com.
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