Possible side effect of HCV - Kidney Cancer

[mikesimon]

Hepatitis C Infection Doubles Risk for Kidney Cancer
By Henry Ford Hospital
Apr 6, 2010 - 9:39:11 AM


(HealthNewsDigest.com) - DETROIT – Physicians at Henry Ford Hospital have found that infection with the hepatitis C virus increases the risk for developing kidney cancer.

Using administrative data from more than 67,000 Henry Ford Health System patients, physicians found that over the period 1997-2008, 0.6% (17/3057) patients with hepatitis C infection developed kidney cancer whereas only 0.3% (17/64006) patients without the disease developed kidney cancer.

After controlling for age, gender, race and underlying kidney disease, hepatitis C infected patients had nearly double the risk of developing kidney cancer.

“These results add to growing literature that shows that the hepatitis C virus causes disease that extends beyond the liver, and in fact most of our HCV-infected kidney cancer patients had only minimal liver damage,” says Stuart C. Gordon, M.D., director of Hepatology at Henry Ford Hospital and lead author of the study.

The study was published in this month’s Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research.

Dr. Gordon explains that the results suggest a more careful surveillance of newly diagnosed kidney cancer patients for the presence of hepatitis C infection, one of the few cancers with a rising global incidence. He adds that it is premature to recommend more comprehensive screening of HCV-positive patients.

“However, a heightened awareness of an increased kidney cancer risk should dictate more careful follow-up of incidental renal defects when detected on imaging procedures in patients with chronic hepatitis C,” says Dr. Gordon.

The researchers also found that the average age of HCV-positive patients with kidney cancer was significantly younger than those HCV-negative patients with kidney cancer, a cancer that generally affects older individuals.

Dr. Gordon explains that hepatitis C is curable in more than 50 percent of cases and that newer and better treatment regimens are being developed. Henry Ford Hospital is participating in a number of these trials.

[merryBe]

which came first, the chicken or the egg?

I guess the next question is the one I posed 2 years ago...how much of that is related to gandolinium....MRI's are the scan of choice for HCC...gando=kidney fibrosis=cancer...

not something we are ever told...(they only ask, do you have kidney disease or diebetes before the scans....but that is code for "this stuff could destroy your kidneys".

which is a real conundrum, since US doesn't really catch HCC most of the time and MRI's do...

shucks, what's a girl to do!!!!!!

[Mr Liver]

"Hepatitis C Infection Doubles Risk for Kidney Cancer "

The lifetime incidence rate of kidney cancer according to The National Cancer Institiute is 14 in 100,000. If you have HCV acquiring kidney cancer according to the study posted above would be 28 in 100,000. Its important to note this is the 'incidence' rate . The mortality rate is 1/3 of the incidence rate or 9 in 100,000. I don't think this warrants the alarmism expressed by some in this thread. Treating will not necessarily protect you from kidney cancer. If successful it may put you in the same statistical group of the general population.

"in fact most of our HCV-infected kidney cancer patients had only minimal liver damage, says Stuart C. Gordon, M.D., director of Hepatology at Henry Ford Hospital and lead author of the study."

This is a finding from the posted study and strongly suggests that if you are going to develop kidney cancer it will most likely be in the earlier stages of liver disease. Of course this is generally long before the average person with HCV has become aware of their infection and consequently most have not yet treated.  In all, the chances of developing kidney cancer are extremely small and the time of highest risk for it to occur has already passed in most of those with HCV who are aware of their infection. Pointing to the insignificant difference between HCV and non-HCV in the pathogenesis of kidney cancer is about as ludicrous as pointing to the decreased risk of heart attack due to the weight loss created by IFN treatment. --- ML

[child24angel]

Excellent article and information here Mike....!!!
Plain and simple.  Thank you !!!

[dointime]

I just got on to my nurse and asked her to include my kidneys in my annual liver ultrasound scan.

Thank goodness for you and others posting research like this or how could we ever stay on top of it.  

Good one,
dointime

[Trish77]

Thanks Willy.  I have never taken it that you were not supportive of treatment, simply supportive of the right of people to choose their own journey with HCV and to ask for and receive the support that is relevant to them regardless if others would choose differently.  It rankled me some to see it suggested not only that you like posts about side effects for treatment but you like them "the best".  Still rankles me but you're good so I'll leave it at that.  The actual original post/thread contains valuable information aside from that so I'll stfu and let it get back to focus.  I can be a little too fiesty sometimes.  That Celtic blood of mine perhaps.

Take care, Willy.

Trish

[Willy50]

Hey, I'm fine.  Mike was teasing me a little, I teased him back a little too...
We're fine in my book.

It is also fair to characterize some of my posts as being less than supportive of TX.

I post such stuff to end up providing an opposing view, just as I did in this thread.  I think that we all learn more when we don't always agree with each other 100%.  No one is claiming to be right and the other person wrong..

Back on point I hope, but thanks for the gesture Trish.  No offense was taken by me...

Willy

[mikesimon]

????
Mike

[Trish77]

Stars mean absolutely nothing for anyone and it has no relevance to anything.  Silly to even suggest that it does other than someone posts alot or has been here awhile and neither has any bearing on value or quality of posts.    

mikesimon:  " I know you like the side effects from treatment stuff the best. If I see anything about that I promise to post it too."  

As for being petty - it's a low blow to suggest that Willy likes posts about side effects for treatment.  Willy has thrown support behind people doing treatment as well and I haven't seen any evidence that he gets any pleasure out of reading about the side effects that people have to endure.  He didn't deserve that and it adds no value whatsoever to this thread or to the valuable information you posted.

[mikesimon]

You'll be OK if it does Bill. You came by yours honestly.
Mike

[Bill1954]

It looks like this thread is leading into star wars…

[mikesimon]

Must you always appear so petty.
Now, you go out of your way to take a potshot at me but really T - you don't have enough cred............ despite your stars.
Mike

[nygirl7]

Thank you Mike.  I am not undone by this report whatsoever and consider it good form to be aware of potential problems that may arise that my doctor might not be familiar with just as good precautionary measure.

It's a fool that buries their head in the sand in fear of reading the truth.

[Trinity4]

Very nicely said Willy.  I didn't view Michael's posts as criticism for those for the watch and wait camp.  

[Willy50]

You've got me pegged Mike.  Drawn, as it were like a moth to the flame.  ; )

I posted because I wasn't sure if I was grasping the numbers correctly, or maybe I was assuming that others were not.  It looks like a solid 1/4 to 1/3 of a percent increase in risk.  I have a hard enough time sleeping; now this.  ; )

I was just thinking of the Albuferon trial and the several percent difference in  the SVR rates compared to SOC as either being called non-superior or of statistically insignificant difference.  When we get down to 1/4 of a percent I kind of wonder if we are in that range.

Makes me think of the Peggy Lee song; "Is that all there is?"  ; )

I'm not trying to run the study down, I think it may have validity.  I myself wondered if being on TX, which is said to be hard on the kidneys (riba, I think) could cause inflamation and hence kidney issues or increase in cancer rates.  

Them's a lot of drugs and a long TX time for many people.  As mentioned, they may have such stats at their disposal.  Were it the case however, it would be the height of irony to use that fear of HCV to push people to TX with current SOC, when in fact it could be a culprit in the increase in kidney cancer.  I'm not alleging that it is, just that it would be good to know if treating could either save some people from this kidney issue, or whether it could be a co-factor which could promote the cancer issue itself.  It would not take many people to skew the curve.  It would seem to be an easy question to answer.

BTW.....one of Vertex's pushes to treat people is that there are studies that show an increased mortality rate after one fails TX.  It would be interesting to see the breakdown in specifically what types of issues one has following TX failure.  

Also....thank you for posting the article.  Just because I offered some contrasting comment does not mean that I don't appreciate it or you.

best,
Willy

[Trish77]

I read your post very carefully and they did say that they adjusted for even underlying kidney disease.  I do think it's important to illustrate the realities of living with HCV.

[mikesimon]

What the article said was that HCV may double the risk of Kidney Cancer- although a small risk it is twice what it is in the non-HCV population.

Mike

[Willy50]

Banner headline;

Hepatitis C Infection Doubles Risk for Kidney Cancer
______________________________________________

Another possible equally true headline;

HCV infection presence may increase risk of kidney Cancer under 1/3rd of a percent.

(per the article)
"0.6% (17/3057) patients with hepatitis C infection developed kidney cancer whereas only 0.3% (17/64006) patients without the disease developed kidney cancer."
(isn't this a bit under a 1/3rd of a percent?)
______________________

Now......somehow that headline just doesn't seem as scary........

They may have the stats, but do not mention whether TX has any effect on the kidney cancer rates.  On one hand TX may *prevent* kidney cancer, on the other hand, TX could precipitate the higher increase in risk for cancer.  The HCV infected are treated as a group and so no distinctions are made. (one supposes that they have those records and could formulate some stats for those groups, however).

I wonder what percentage would be considered *statistically insignificant* in such a study?  If I am understanding the numbers presented they are talking about fractions of a percent.

I also wonder exactly what this may mean, and what it may not mean;

"After controlling for age, gender, race and underlying kidney disease, hepatitis C infected patients had *nearly* (my emphasis-willy) double the risk of developing kidney cancer. "

Am I missing something here?  It seems pretty underwhelming to me.  Inconclusive?

Willy

[pKinCA]

I tend to agree with robo229's comments, that the increase may be due to the HCV patients having more diagnostic procedures than the average person.

I've been doing some research myself about having a CT Colonoscopy and was quite surprised to learn that the test also picks up a lot of other cancers on organs outside the colon.

Here's an article I just found... You can google "ct colonography other cancers" and find a lot more info that substantiates this claim.  

Hope it gives you a little peace of mind...

pK

PS  I've had a few ultrasounds in the last few years (one right after HCV diagnosis) and I did pester the technician to go outside of the intended area to look for anything else suspicious  :-)


CT Colonoscopy Detects More Than Colon Cancer

By Jeff Minerd,
Published: July 26, 2005
Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine .  


SAN FRANCISCO, July 26-A substantial number of patients undergoing so-called virtual colonoscopy were found to have significant medical problems outside the colon, a finding that enthusiasts say underscores the benefit of screening with this method. Action Points  
--------------------------------------------------------------------------------

Advise patients that a potential benefit of colon cancer screening with computed tomography is that it may detect other diseases at an early and treatable stage.

Explain that many extracolonic abnormalities will be found and a much smaller percentage, approximating 8% to 10%, will be clinically significant.
In 9% of patients undergoing the screening procedure, also known as CT colonoscopy, investigators detected clinically important extracolonic problems ranging from kidney cancer to aortic aneurysm, said Judy Yee, M.D., and colleagues at the San Francisco Veterans Affairs Medical Center in the August 2005 issue of Radiology.

"That's a fairly large percentage," said Dr. Yee, "Depending on the patient population you look at, this finding suggests that it may be more common to find something significant outside of the colon than in the colon with this technique, because there is more likely to be a problem outside the colon."

The study was conducted on 500 male patients with an average age of 62.5 years. Of these, there were 39% at average risk for colon cancer and had routine screening. The other 61% were referred for screening because of possible colon cancer symptoms and were considered at high risk. The participants were followed for more than three years after screening.

Although 63% of the extracolonic lesions found by CT colonoscopy turned out not to be clinically significant, the investigators argued that the cost of follow up on these was relatively low. The additional cost for follow-up work-ups was $14,058.43 for 48 studies adding about $28 to the cost per CT colonographic exam for the patients in the study, and resulted in no increased morbidity. The average cost for follow-up per patient studied at follow-up for clinically significant lesions was approximately $562.

There were no significant differences in extracolonic findings between the patients at high-risk and those at average risk for colon cancer. The study did not address findings in the colon.

Because a CT colonoscopy views the entire abdomen and pelvis, including solid organs such as the liver, kidneys, pancreas, and spleen, it has the potential to detect a variety of medical problems at an early stage when they are more amenable to treatment, Dr. Yee and colleagues concluded.

In addition, the procedure is less invasive and time-consuming than standard colonoscopy or a lower GI series, the investigators noted. However, the preparation for the studies is similar and if a colonic lesion is found with CT colonoscopy, standard colonoscopy will be necessary.

"The message here is, go out and get screened for colon cancer," Dr. Yee said. "If you have a virtual colonoscopy, we will find clinically significant lesions in the colon and can find significant disease outside of the colon as well." Only about 30% of Americans older than 50 have regular screening for colon cancer.


(http://www.medpagetoday.com/HematologyOncology/ColonCancer/1423?pfc=101&spc=/)

[mikesimon]

I didn't take it that way Susan.
I saw this article and I posted it because I thought it was worth reading. I'm not undone by the article and I hope that others won't be either. I can understand why you reacted as you did after reading that short account of your family history. I have familial issues too and I guess all we can do is try to take care of ourselves and make sure that we're monitored  closely. And hope and pray too.
Be well,
Mike

[Marcia2202]

That is some scary stuff.

Articles like this reassure me that I took the right decision to treat as soon as I found out that I had this disease. I'm so thankful that I actually made SVR.

[Trish77]

"I see so many threads about the side effects of SOC that I thought people should be reminded that there really are some possible side effects from HCV too.
But, you can bet that this will not attract nearly as much attention as a thread about that other stuff. People flock to that like moths to a flame. They love it!
Mike "

That's great info, Mike.  For those people where treatment is successful this is one more thing to add to the list of things they get to avoid and things to consider when determining if one will do treatment and when.

For those where treatment has failed them can add this to the list of items they should be diligent about.  Does the good doc have anything to say about options for those where treatment has failed them who have to live with this risk or those with kidney disease who are unable to do treatment for HCV like my buddy's mom?  Any preventative measures that can be employed for these people?  Bet there would be moths to the flame of a discussion on these things for those who fall into this category.

[Magnum]

Opinions, opinions, opinions... Variables to the left of me, variables to the right. Here I am, stuck in the middle of doubt...

They said caffeine was no good for you. Now they say it is...
They said wine was not good for you. Now a glass a day is... (except Heppies)
They said vitamin E was great for you. Now you have to moderate...
They said chocolate rots your teeth. Now dark chocolate daily is good for you...
When you were a child, they said 4 glasses of milk a day was good for you. Now you're cautioned that that much milk can raise your cholesterol...
And on and on and on and on...

I say take care of your body, watch what you eat, and have as much fun while the clock is ticking. Tick tock tick tock tick tock....

Magnum

[eureka254]

Interesting stuff, and a significant population size too, even if retrospective.  I'm certainly of the mind that current bare-bones knowledge about hcv makes it difficult to definitively rule out or rule in hcv as a contributing cause for other conditions, but there seems to be more and more data of late pointing to possible oncogenic potential of hcv core protein.  Thanks for posting. ~eureka