Harrys A Torres1,2, Anna S Lok3, Maria E Suarez-Almazor4, Carla L Warneke5, Ahmed Kaseb6, Ethan Miller2, Erich M Sturgis7, Jessica T Foreman8, Georgios Angelidakis1, Sairah Ahmed9, Alessandra Ferrajoli10, Felipe Samaniego9, Ernest T Hawk11, Jessica P Hwang12. 1. Department of Infectious Diseases, Infection Control & Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 2. Department of Gastroenterology, Hepatology & Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 3. Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA. 4. Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 5. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 6. Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 7. Department of Head & Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 8. Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 9. Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 10. Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 11. Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 12. Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. jphwang@mdanderson.org.
Abstract
BACKGROUND: Optimal hepatitis C virus (HCV) screening strategies for cancer patients have not been established. We compared the performance of selective HCV screening strategies. METHODS: We surveyed patients presenting for first systemic anticancer therapy during 2013-2014 for HCV risk factors. We estimated the prevalence of positivity for HCV antibody (anti-HCV) and examined factors associated with anti-HCV status using Fisher's exact test or Student's t test. Sensitivity was calculated for screening patients born during 1945-1965, patients with ≥ 1 other risk factor, or both cohorts ("combined screening"). RESULTS: We enrolled 2122 participants. Median age was 59 years (range, 18-91); 1138 participants were women. Race/ethnicity distribution was white non-Hispanic, 76% (n = 1616); Hispanic, 11% (n = 233); black non-Hispanic, 8% (n = 160); Asian, 4% (n = 78); and other, 2% (n = 35). Primary cancer distribution was non-liver solid tumor, 78% (n = 1664); hematologic cancer, 20% (n = 422); and liver cancer, 1% (n = 28). Prevalence of anti-HCV was 1.93% (95% CI, 1.39%-2.61%). Over 28% of patients with detectable HCV RNA were unaware of infection. Factors significantly associated with anti-HCV positivity included less than a bachelor's degree, birth in 1945-1965, chronic liver disease, injection drug use, and blood transfusion or organ transplant before 1992. A total of 1315 participants (62%), including 39 of 41 with anti-HCV, reported ≥ 1 risk factor. Sensitivity was 80% (95% CI, 65-91%) for birth-cohort-based, 68% (95% CI, 52-82%) for other-risk-factor-based, and 95% (95% 83-99%) for combined screening. CONCLUSION: Combined screening still missed 5% of patients with anti-HCV. These findings favor universal HCV screening to identify all HCV-infected cancer patients.
BACKGROUND: Optimal hepatitis C virus (HCV) screening strategies for cancer patients have not been established. We compared the performance of selective HCV screening strategies. METHODS: We surveyed patients presenting for first systemic anticancer therapy during 2013-2014 for HCV risk factors. We estimated the prevalence of positivity for HCV antibody (anti-HCV) and examined factors associated with anti-HCV status using Fisher's exact test or Student's t test. Sensitivity was calculated for screening patients born during 1945-1965, patients with ≥ 1 other risk factor, or both cohorts ("combined screening"). RESULTS: We enrolled 2122 participants. Median age was 59 years (range, 18-91); 1138 participants were women. Race/ethnicity distribution was white non-Hispanic, 76% (n = 1616); Hispanic, 11% (n = 233); black non-Hispanic, 8% (n = 160); Asian, 4% (n = 78); and other, 2% (n = 35). Primary cancer distribution was non-liver solid tumor, 78% (n = 1664); hematologic cancer, 20% (n = 422); and liver cancer, 1% (n = 28). Prevalence of anti-HCV was 1.93% (95% CI, 1.39%-2.61%). Over 28% of patients with detectable HCV RNA were unaware of infection. Factors significantly associated with anti-HCV positivity included less than a bachelor's degree, birth in 1945-1965, chronic liver disease, injection drug use, and blood transfusion or organ transplant before 1992. A total of 1315 participants (62%), including 39 of 41 with anti-HCV, reported ≥ 1 risk factor. Sensitivity was 80% (95% CI, 65-91%) for birth-cohort-based, 68% (95% CI, 52-82%) for other-risk-factor-based, and 95% (95% 83-99%) for combined screening. CONCLUSION: Combined screening still missed 5% of patients with anti-HCV. These findings favor universal HCV screening to identify all HCV-infected cancer patients.
Entities:
Keywords:
Drug therapy; Hepatitis C virus; Neoplasms; Virus activation
Authors: Minas P Economides; Moran Amit; Parag S Mahale; Jeff J Hosry; Ying Jiang; Uddalak Bharadwaj; Erich M Sturgis; Harrys A Torres Journal: Cancer Date: 2017-11-17 Impact factor: 6.860
Authors: Parag Mahale; Dimitrios P Kontoyiannis; Roy F Chemaly; Ying Jiang; Jessica P Hwang; Marta Davila; Harrys A Torres Journal: J Hepatol Date: 2012-08-04 Impact factor: 25.083
Authors: Harrys A Torres; Jeff Hosry; Parag Mahale; Minas P Economides; Ying Jiang; Anna S Lok Journal: Hepatology Date: 2017-11-13 Impact factor: 17.425
Authors: Harrys A Torres; Terri Lynn Shigle; Nassim Hammoudi; James T Link; Felipe Samaniego; Ahmed Kaseb; Vincent Mallet Journal: CA Cancer J Clin Date: 2017-07-06 Impact factor: 508.702
Authors: Carlos A Ramos; Rima M Saliba; Leandro de Pádua; Ola Khorshid; Elizabeth J Shpall; Sergio Giralt; Poliana A Patah; Chitra M Hosing; Uday R Popat; Gabriela Rondon; Issa F Khouri; Yago L Nieto; Richard E Champlin; Marcos de Lima Journal: Haematologica Date: 2009-01-14 Impact factor: 9.941