Non-pulmonary cancer risk following tuberculosis: a nationwide retrospective cohort study in Lithuania

Abstract

BackgroundLithuania remains one of the highest tuberculosis burden countries in Europe. Epidemiological studies have long pointed to infections as important factors of cancer aetiology, but the association between tuberculosis and the risk of non-pulmonary cancers has rarely been tested and results have been inconsistent. The aim of this population-based cohort study was to examine the risk of cancer among patients diagnosed with tuberculosis using data from Lithuanian Tuberculosis, Cancer and Resident’s Registries.MethodsThe study cohort included 21,986 tuberculosis patients yielding 1583 cancers diagnosed during follow-up (1998–2012). Standardized incidence ratios (SIRs) and 95% confidence intervals (95% CIs) were calculated to compare the incidence of cancer among cohort participants with the general population for overall, non-pulmonary, site-specific cancers, as well as for subgroups of smoking-related, alcohol-related, hormone-related and haematological cancers.ResultsThe SIRs of all cancers combined were 1.89, 95% CI: 1.79–2.00 in men and 1.34, 95% CI: 1.19–1.50 in women. Risk was increased 3-fold within the first year following diagnosis; it decreased during later years, although remained significantly elevated for ≥5 years. Elevated long-term increased risks persisted for non-pulmonary cancers overall, and for cancers of mouth and pharynx, oesophagus, stomach, larynx, cervix uteri and leukaemias. Tuberculosis was associated with a decreased risk of melanoma. Increased risks were observed for smoking-related cancers in men (SIR 1.95, 95% CI: 1.79–2.13) and women (SIR 1.46, 95% CI: 1.22–1.73), alcohol-related cancers in men (SIR 2.40; 95% CI: 2.14–2.68) and haematological cancers in men (SIR 1.73, 95% CI: 1.33–2.23). The risk of hormone-related cancers was 18% lower (SIR = 0.82, 95% CI: 0.66–0.997) among women, the inverse association was weaker among men (SIR = 0.95, 95% CI: 0.84–1.07).ConclusionsThe risk of total and several non-pulmonary cancers was elevated in a cohort of tuberculosis patients. The recommendation for the awareness of this association among physicians is warranted. Analysis suggests a reduction in risk of hormone-related cancers and melanoma.

Cancer risk in tuberculosis patients in a high endemic area

“…Prior TB might increase the risks of lung cancer and some extrapulmonary cancers, including hematologic malignancies, esophageal cancer, genitourinary cancers, head and neck cancer, breast cancer, and “other” cancers. In accord with several prior studies [ 9 , 11 , 13 , 15 , 21 ], our results indicate an association between TB and certain cancer types (Table 3 ).…”

“…TB may induce a chronic inflammatory state and impair T-cell-mediated immunity, contributing to the development of cancer [8][9][10]. Indeed, a number of epidemiologic studies have shown that the risk of cancer is the greatest in the first 2 years after the diagnosis of TB [9][10][11][12][13] but remains elevated for long periods [12,[14][15][16][17][18]. Understanding the risk of the development of cancer after TB in a highly endemic area has some practical clinical significance, such as improving the prevention and diagnosis of cancer.…”

Cancer Risk in Tuberculosis Patients in A High Endemic Area

“…In accord with several prior studies [2,6,8,10,14], our results indicate an association between TB and certain cancer types (Table 3). Notably, prior TB has been consistently found to be associated with a subsequent high risk of hematological malignancies, including non-Hodgkin's lymphoma, Hodgkin's lymphoma, multiple myeloma, and leukemia.…”

“…[4] In addition, the burden of multidrug-resistant and extensively drug-resistant TB cases was also found to be substantial in the Xinjiang area. [5] A number of epidemiologic studies have shown that the risk of cancer is the greatest in the rst two years after the diagnosis of TB diagnosis [2,3,[6][7][8] but remains elevated for long periods. [7,[9][10][11][12][13] However, limited data are available from western China to support the link between cancer and TB.…”

Appearance and morphologic features of laryngeal tuberculosis using laryngoscopy

“…Although no coexisting tumors were identified in this study, there have been many reports showing the coexistence of LTB infections and cancers, which suggest that one disease could facilitate the other. [ 29 , 31 , 32 ] Biopsies were often selected at exophytic or ulcerative lesions. We found that exophytic lesions usually consisted of epithelioid granulomas, accompanied by decreased areas of caseous necrosis.…”