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. 1999 Nov;45(5):756–760. doi: 10.1136/gut.45.5.756

Cancer risk in primary biliary cirrhosis: a study in northern England

D Howel 1, J Metcalf 1, J Gray 1, W Newman 1, D Jones 1, O James 1
PMCID: PMC1727737  PMID: 10517916

Abstract

BACKGROUND—Suggestions that breast cancer may be more common in patients with primary biliary cirrhosis (PBC) have been challenged. It has recently been proposed that total cancer rates may be higher in patients with PBC, as well as liver cancers.
AIMS—To investigate these proposals on a strictly defined case series.
SUBJECTS—A total of 769 prevalent or incident PBC patients with "definite" or "probable" disease detected in a defined area of the north-east of England during 1987-94.
METHODS—Cancer events and deaths were identified by obtaining information from one or more of the following sources: Office for National Statistics (ONS) Central Registers, Regional Cancer Registry, and clinical case records. Standardised cancer incidence (SIR) and mortality ratios (SMR) were calculated using the local region as the standard population.
RESULTS—There were 97 cancer events during 1987-96. SIR from cancer registrations for all cancers was 1.7 (95% confidence interval (CI) 1.3 to 2.2), for liver cancer was 74 (95% CI 32 to 146), and for breast cancer was 1.1 (95% CI 0.4 to 2.4). SMR for all cancers was 1.8 (95% CI 1.4 to 2.4), for liver cancer was 39 (95% CI 20 to 68), and for breast cancer was 0.4 (95% 0.1 to 1.6). The results were similar after excluding the first year of follow up after PBC diagnosis.
CONCLUSIONS—There was some evidence of a small increase in overall cancer incidence and mortality in PBC patients. With the exception of liver cancer, it is unlikely that there is a high excess incidence for PBC patients from any cancer at a particular site, and specifically breast cancer.


Keywords: primary biliary cirrhosis; cancer

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Selected References

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  1. Bergasa N. V. Primary biliary cirrhosis in patients with breast cancer: studying the link. Med Hypotheses. 1998 Jun;50(6):465–472. doi: 10.1016/s0306-9877(98)90263-8. [DOI] [PubMed] [Google Scholar]
  2. Floreani A., Biagini M. R., Chiaramonte M., Milani S., Surrenti C., Naccarato R. Incidence of hepatic and extra-hepatic malignancies in primary biliary cirrhosis (PBC). Ital J Gastroenterol. 1993 Nov-Dec;25(9):473–476. [PubMed] [Google Scholar]
  3. Goudie B. M., Burt A. D., Boyle P., Macfarlane G., Birnie G. G., Mills P. R., Gillis C. R., MacSween R. N., Watkinson G. Breast cancer in women with primary biliary cirrhosis. Br Med J (Clin Res Ed) 1985 Dec 7;291(6509):1597–1598. doi: 10.1136/bmj.291.6509.1597. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Jones D. E., Metcalf J. V., Collier J. D., Bassendine M. F., James O. F. Hepatocellular carcinoma in primary biliary cirrhosis and its impact on outcomes. Hepatology. 1997 Nov;26(5):1138–1142. doi: 10.1002/hep.510260508. [DOI] [PubMed] [Google Scholar]
  5. Kaplan M. M. Primary biliary cirrhosis. N Engl J Med. 1996 Nov 21;335(21):1570–1580. doi: 10.1056/NEJM199611213352107. [DOI] [PubMed] [Google Scholar]
  6. Krasner N., Johnson P. J., Portmann B., Watkinson G., Macsween R. N., Williams R. Hepatocellular carcinoma in primary biliary cirrhosis: report of four cases. Gut. 1979 Mar;20(3):255–258. doi: 10.1136/gut.20.3.255. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Löf L., Adami H. O., Sparén P., Danielsson A., Eriksson L. S., Hultcrantz R., Lindgren S., Olsson R., Prytz H., Ryden B. O. Cancer risk in primary biliary cirrhosis: a population-based study from Sweden. Hepatology. 1994 Jul;20(1 Pt 1):101–104. [PubMed] [Google Scholar]
  8. McCurley T. L., Collins R. D., Ball E., Collins R. D. Nodal and extranodal lymphoproliferative disorders in Sjogren's syndrome: a clinical and immunopathologic study. Hum Pathol. 1990 May;21(5):482–492. doi: 10.1016/0046-8177(90)90004-o. [DOI] [PubMed] [Google Scholar]
  9. Melia W. M., Johnson P. J., Neuberger J., Zaman S., Portmann B. C., Williams R. Hepatocellular carcinoma in primary biliary cirrhosis: detection by alpha-fetoprotein estimation. Gastroenterology. 1984 Sep;87(3):660–663. [PubMed] [Google Scholar]
  10. Metcalf J. V., Bhopal R. S., Gray J., Howel D., James O. F. Incidence and prevalence of primary biliary cirrhosis in the city of Newcastle upon Tyne, England. Int J Epidemiol. 1997 Aug;26(4):830–836. doi: 10.1093/ije/26.4.830. [DOI] [PubMed] [Google Scholar]
  11. Mills P. R., Boyle P., Quigley E. M., Birnie G. G., Jarrett F., Watkinson G., MacSween R. N. Primary biliary cirrhosis: an increased incidence of extrahepatic malignancies? J Clin Pathol. 1982 May;35(5):541–543. doi: 10.1136/jcp.35.5.541. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Moreno-Otero R., Lisker-Melman M., Jones E. A. Primary biliary cirrhosis. Med Clin North Am. 1989 Jul;73(4):911–929. doi: 10.1016/s0025-7125(16)30645-9. [DOI] [PubMed] [Google Scholar]
  14. Sorensen H. T., Friis S., Olsen J. H., Thulstrup A. M., Mellemkjaer L., Linet M., Trichopoulos D., Vilstrup H., Olsen J. Risk of liver and other types of cancer in patients with cirrhosis: a nationwide cohort study in Denmark. Hepatology. 1998 Oct;28(4):921–925. doi: 10.1002/hep.510280404. [DOI] [PubMed] [Google Scholar]
  15. Sørensen H. T., Friis S., Olsen J. H., Thulstrup A. M., Mellemkjaer L., Linet M., Trichopoulos D., Vilstrup H., Olsen J. Risk of breast cancer in men with liver cirrhosis. Am J Gastroenterol. 1998 Feb;93(2):231–233. doi: 10.1111/j.1572-0241.1998.00231.x. [DOI] [PubMed] [Google Scholar]
  16. Turissini S. B., Kaplan M. M. Hepatocellular carcinoma in primary biliary cirrhosis. Am J Gastroenterol. 1997 Apr;92(4):676–678. [PubMed] [Google Scholar]
  17. Van Dam G. M., Gips C. H. Primary biliary cirrhosis in The Netherlands. An analysis of associated diseases, cardiovascular risk, and malignancies on the basis of mortality figures. Scand J Gastroenterol. 1997 Jan;32(1):77–83. doi: 10.3109/00365529709025067. [DOI] [PubMed] [Google Scholar]
  18. Wolke A. M., Schaffner F., Kapelman B., Sacks H. S. Malignancy in primary biliary cirrhosis. High incidence of breast cancer in affected women. Am J Med. 1984 Jun;76(6):1075–1078. doi: 10.1016/0002-9343(84)90861-1. [DOI] [PubMed] [Google Scholar]

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