Hepatitis C Complication: Breast Cancer
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Considering how many people are diagnosed with chronic Hepatitis C, along with the likelihood of someone developing breast cancer, treatment for these two illnesses must be compatible. Because Texan researchers have discovered that Hepatitis C infection may impair breast cancer treatment and increase the complications of chemotherapy, improved communication between hepatologists and oncologists is crucial.
Gender and Breast Cancer
Although predominantly occurring in women, breast cancer can also affect men. Many do not realize that just like women, men have breast tissue. At puberty, a girl’s ovaries make female hormones (estrogen), causing breast ducts to grow, lobules to form at the ends of ducts and the amount of stroma to increase. During a boy’s puberty, male hormones (testosterone) made by the testicles typically prevent further growth of breast tissue. Although men’s breast tissue is mostly composed of ducts, these cells can undergo cancerous changes. In addition, each individual produces varying amounts of hormones that can encourage breast cancer development; women produce varying amounts of testosterone and men produce varying amounts of estrogen.
Breast Cancer Prevalence
Excluding cancers of the skin, breast cancer is the most common type of cancer in women in the United States, accounting for one of every three cancers diagnosed. The chance of developing invasive breast cancer at some time in a woman’s life is about one in seven. It is one of the leading causes of cancer mortality among women in the United States.
One in every 100 people with breast cancer is a man. Unfortunately, breast cancer’s gender preference typically leads to dangerously late detection in men.
Aside from the gap between men and women in initial diagnosis, early detection, intervention and postoperative treatment have decreased breast cancer mortality. The use of mammography for screening has largely contributed to early detection, and aggressive treatments have allowed many people to survive breast cancer.
Hepatitis C Prevalence
Most Hepatitis C diagnoses come as a surprise because of how long a person can live without any indication of this illness. A study by the Centers for Disease Control and Prevention suggests that 4.1 million individuals in the United States are infected with Hepatitis C, and most have chronic infections. However, most academics agree that the current Hepatitis C statistics are underestimated due to the number of new diagnoses that occur each day.
University of Texas Research
Assistant Professor at the University of Texas department of breast medical oncology, P. K. Morrow, MD is a medical oncologist specializing in the treatment of breast cancer patients. As the lead researcher in a study presented at the 2007 American Society of Clinical Oncology Breast Cancer Symposium, Morrow warned, “Hepatitis has wide-ranging effects on treatment of breast cancer.” The researchers indicated in their presentation that poor outcomes of breast cancer treatment are endemic to those also infected with Hepatitis C.
In the small retrospective study of breast cancer patients, Texan researchers found chemotherapy dose delays or required dose reductions in those with Hepatitis C:
- Neoadjuvant Chemotherapy – Given prior to a surgical procedure to shrink the cancer, neoadjuvant chemotherapy effectiveness was reduced by 27 percent in the study’s participants with Hepatitis C.
- Adjuvant Chemotherapy – Given to destroy leftover (microscopic) cells that may be present after the known tumor is removed by surgery, adjuvant chemotherapy effectiveness was reduced by 30 percent in the study’s participants with Hepatitis C.
Although the reason for this effect is not fully understood, Morrow postulated two reasons for a poorer outcome in breast cancer treatment in those dually affected by chronic Hepatitis C:
- Poor drug metabolism – A person with chronic Hepatitis C is likely to have decreased liver function, thereby making it more difficult to metabolize the toxic chemotherapy drugs used in breast cancer treatment.
- Myelosuppression – A common side effect of chemotherapy, myelosuppression occurs when bone marrow activity is decreased, resulting in fewer red blood cells, white blood cells, and platelets. The current treatment standard for Hepatitis C, interferon and ribavirin combination therapy is also known to initiate myelosuppression. With a decrease in bone marrow activity, recovery becomes an immense challenge.
In addition, participants with Hepatitis C undergoing chemotherapy for breast cancer had a drastically increased likelihood of treatment complications.
Study Analysis
It makes sense that chemotherapy would be the ultimate challenge for a person with chronic liver disease. Essentially, chemotherapy is the administration of toxic medications to kill cancerous cells. Of course, a person with chronic Hepatitis C must do all they can to protect their liver from any additional toxic burdens. This is likely to explain why a prior study demonstrated that breast cancer treatment for patients with Hepatitis B increased the chance of viral reactivation, early discontinuation of chemotherapy, and treatment delay.
Dr. Morrow urged doctors who treat breast cancer to closely monitor their patients living with Hepatitis C. She even suggests that oncologists do a full hepatitis panel on their patients with elevated liver enzymes. It is important to note that there is hope for those dually diagnosed with breast cancer and Hepatitis C. When extra cautionary measures are taken, these individuals have the potential for regaining their health.
With so many people being diagnosed with breast cancer and Hepatitis C, the primary item needing attention in such cases is the integration between the fields of hepatology and oncology. According to Morrow, “I think what we need to do is to cooperate with hepatologists to see if we can act at the onset and see if we can reduce the type of risks that we’re seeing in these patients’ therapy.” Although modern medicine is often fragmented into specialties, this research urges healthcare workers to work together in search of their common goal – patient wellness.
References:
P.K.H. Morrow, et al., Clinical outcomes of breast cancer patients with hepatitis C: A case series, Journal of Clinical Oncology, June 2005.
http://jama.ama-assn.org, Hepatitis C Prevalence, Tracy Hampton, PhD, Journal of the American Medical Association, June 2006.
www.cancer.org, What is Breast Cancer in Men?, American Cancer Society, Inc., 2007.
www.chemocare.com, Chemotherapy Terms, The Cleveland Clinic Foundation, 2007.
www.docguide.com, Breast Cancer Patients With Hepatitis C Require Surveillance to Avoid Poor Outcomes, P/S/L Consulting Group Inc., September 2007.
www.emedicine.com, Breast Cancer, Mammography, Nagwa Dongola, MD, FRCR, WebMD, 2007.
www.mdanderson.org, Who We Are, The University of Texas M. D. Anderson Cancer Center, 2007.
www.medpagetoday.com, ASCO Breast: Hepatitis C Impacts Breast Cancer Treatment, Crystal Phend, MedPage Today, LLC, September 2007.
www.websters-online-dictionary.org, Myelosuppression, Philip M. Parker, INSEAD, 2007.
www.menstuff.org, Breast Cancer in Men, Gordon Clay, 2007.
