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Hepatitis B virus (HBV) infection might increase the risk of developing gastric cancer, according to the results of a new study. HBV infection has been known to be associated with hepatocellular carcinoma, but discovery of HBV viral DNA and antigens in other organs suggested that the infection could increase the risk of other cancers. “In 2002 came the association between HBV infection and nonHodgkin lymphoma, and then 6 years later, the first report about HBV infection and pancreatic cancer. Now, our study is the first to report a positive relationship between HBV infection and gastric cancer”, said lead author Ruihua Xu (Sun Yat-sen University Cancer Center, Guangzhou, China). The case-control study compared 580 patients diagnosed with gastric
cancer with 580 controls, matched by sex, age, and year of diagnosis. Information about infection with Helicobacter pylori, a known risk factor for gastric cancer, was available for only some cases and no controls. Taking into account family history of gastric cancer, chronic gastritis, age, sex, and year of diagnosis, the authors concluded that the presence of hepatitis B surface antigen was positively associated with gastric cancer in China (adjusted odds ratio [AOR] 1·49, 95% CI 1·06–2·10). HBV infection was also positively associated with gastric cancer in patients without a family history of gastric cancer (AOR 1·49, 95% CI 1·06–2·11). “The weak association may be one of the reasons for the delayed discovery of their association”, says Xu. He adds that the conclusions are not definitive. “Our study was not
perfect. It was a retrospective study, and information on Helicobacter pylori was not included.” Haejin In (Montefiore Einstein Center for Cancer Care, New York City, NY, USA) agrees. “It’s premature to see an association, but [this is] an interesting idea that I think will lead to some further questions.” Xu suggests that if the link is confirmed in future studies, people with HBV infection might consider periodic gastroscopy, especially if they have gastritis. But Angelo Zullo (Nuovo Regina Margherita Hospital, Rome, Italy) says that “the absolute increase of risk, if any, for gastric cancer in HBV patients is not sufficient to prompt a different screening programme or surveillance for gastric cancer”.
Science Picture Co/Science Photo Library
Possible link between hepatitis B infection and gastric cancer
Published Online February 27, 2015 http://dx.doi.org/10.1016/ S1470-2045(15)70077-X For the study by Wei and colleagues see Br J Cancer 2015; published online February 19. http://www.nature.com/bjc/ journal/vaop/ncurrent/abs/ bjc2014406a.html
Ricki Lewis
Long-lasting opioids and unintentional overdose Use of long-acting opioids is associated with a higher risk of unintentional overdose injury, according to results of a new study. The study used data gathered over a 10-year period and from more than 800 000 veterans with chronic pain conditions, including cancer, who relied on opioid analgesics during a period of about 10 years. According to the US National Center for Health Statistics, the number of cases of fatal poisoning involving opioid analgesics more than tripled between 1999 and 2006, raising concerns about the efficacy of current prescription protocols of opioids for treatment of moderate to severe pain. In the study, a total of 319 unintentional overdose injury events were included, and after adjusting for age, sex, opioid dose, and other clinical variables, the authors showed that the duration www.thelancet.com/oncology Vol 16 April 2015
of opioid action was associated with the risk of overdose injury (hazard ratio [HR] 2·33, 95% CI 1·26–4·32). “Patients who begin taking opioid painkillers that are long-acting, such as extended release preparations prescribed to be taken once or twice daily, appear to be more than twice as likely to overdose compared with patients who take an equivalent daily dose of immediate release preparations spread out more frequently throughout the day”, says Matthew Miller (Northeastern University, Boston, MA, USA), who led the study. The observed risk was significantly higher within the first 2 weeks of therapy (HR 5·25, 95% CI 1·88–14·72). If replicated in other patient cohorts, these findings might affect how clinicians weight the benefits and risks of opioid administration regimens, says Miller. “[Clinicians] should consider not only the daily
dose prescribed but also the duration of opioid action, favouring shortacting agents whenever possible, especially during the first 2 weeks of therapy”, he adds. According to Roger Chou (Oregon Health & Science University, Portland, OR, USA), the findings are consistent with APS/AAPM guidelines published in 2009. “Despite the teaching that patients on long-term opioid therapy for pain should be put on long-acting opioids, there was actually no evidence that long-acting opioids are any safer or more effective, and might be associated with additional risks”, he says. This is the first study to report estimates of the relative risk of unintentional overdose injury events related to the use of long-acting versus short-acting opioids.
Published Online February 27, 2015 http://dx.doi.org/10.1016/ S1470-2045(15)70078-1 For the study by Miller and colleagues see JAMA 2015; published online February 16. http://archinte.jamanetwork. com/article. aspx?articleid=2110997
Karl Gruber e159
Hepatitis B virus (HBV) infection might increase the risk of developing gastric cancer, according to the results of a new study. HBV infection has been known to be associated with hepatocellular carcinoma, but discovery of HBV viral DNA and antigens in other organs suggested that the infection could increase the risk of other cancers. “In 2002 came the association between HBV infection and nonHodgkin lymphoma, and then 6 years later, the first report about HBV infection and pancreatic cancer. Now, our study is the first to report a positive relationship between HBV infection and gastric cancer”, said lead author Ruihua Xu (Sun Yat-sen University Cancer Center, Guangzhou, China). The case-control study compared 580 patients diagnosed with gastric
cancer with 580 controls, matched by sex, age, and year of diagnosis. Information about infection with Helicobacter pylori, a known risk factor for gastric cancer, was available for only some cases and no controls. Taking into account family history of gastric cancer, chronic gastritis, age, sex, and year of diagnosis, the authors concluded that the presence of hepatitis B surface antigen was positively associated with gastric cancer in China (adjusted odds ratio [AOR] 1·49, 95% CI 1·06–2·10). HBV infection was also positively associated with gastric cancer in patients without a family history of gastric cancer (AOR 1·49, 95% CI 1·06–2·11). “The weak association may be one of the reasons for the delayed discovery of their association”, says Xu. He adds that the conclusions are not definitive. “Our study was not
perfect. It was a retrospective study, and information on Helicobacter pylori was not included.” Haejin In (Montefiore Einstein Center for Cancer Care, New York City, NY, USA) agrees. “It’s premature to see an association, but [this is] an interesting idea that I think will lead to some further questions.” Xu suggests that if the link is confirmed in future studies, people with HBV infection might consider periodic gastroscopy, especially if they have gastritis. But Angelo Zullo (Nuovo Regina Margherita Hospital, Rome, Italy) says that “the absolute increase of risk, if any, for gastric cancer in HBV patients is not sufficient to prompt a different screening programme or surveillance for gastric cancer”.
Science Picture Co/Science Photo Library
Possible link between hepatitis B infection and gastric cancer
Published Online February 27, 2015 http://dx.doi.org/10.1016/ S1470-2045(15)70077-X For the study by Wei and colleagues see Br J Cancer 2015; published online February 19. http://www.nature.com/bjc/ journal/vaop/ncurrent/abs/ bjc2014406a.html
Ricki Lewis
Long-lasting opioids and unintentional overdose Use of long-acting opioids is associated with a higher risk of unintentional overdose injury, according to results of a new study. The study used data gathered over a 10-year period and from more than 800 000 veterans with chronic pain conditions, including cancer, who relied on opioid analgesics during a period of about 10 years. According to the US National Center for Health Statistics, the number of cases of fatal poisoning involving opioid analgesics more than tripled between 1999 and 2006, raising concerns about the efficacy of current prescription protocols of opioids for treatment of moderate to severe pain. In the study, a total of 319 unintentional overdose injury events were included, and after adjusting for age, sex, opioid dose, and other clinical variables, the authors showed that the duration www.thelancet.com/oncology Vol 16 April 2015
of opioid action was associated with the risk of overdose injury (hazard ratio [HR] 2·33, 95% CI 1·26–4·32). “Patients who begin taking opioid painkillers that are long-acting, such as extended release preparations prescribed to be taken once or twice daily, appear to be more than twice as likely to overdose compared with patients who take an equivalent daily dose of immediate release preparations spread out more frequently throughout the day”, says Matthew Miller (Northeastern University, Boston, MA, USA), who led the study. The observed risk was significantly higher within the first 2 weeks of therapy (HR 5·25, 95% CI 1·88–14·72). If replicated in other patient cohorts, these findings might affect how clinicians weight the benefits and risks of opioid administration regimens, says Miller. “[Clinicians] should consider not only the daily
dose prescribed but also the duration of opioid action, favouring shortacting agents whenever possible, especially during the first 2 weeks of therapy”, he adds. According to Roger Chou (Oregon Health & Science University, Portland, OR, USA), the findings are consistent with APS/AAPM guidelines published in 2009. “Despite the teaching that patients on long-term opioid therapy for pain should be put on long-acting opioids, there was actually no evidence that long-acting opioids are any safer or more effective, and might be associated with additional risks”, he says. This is the first study to report estimates of the relative risk of unintentional overdose injury events related to the use of long-acting versus short-acting opioids.
Published Online February 27, 2015 http://dx.doi.org/10.1016/ S1470-2045(15)70078-1 For the study by Miller and colleagues see JAMA 2015; published online February 16. http://archinte.jamanetwork. com/article. aspx?articleid=2110997
Karl Gruber e159
