Liver cirrhosis, other liver diseases, pancreatitis and subsequent cancer: record linkage study

Objective To determine the risk of cancer in cohorts of patients with alcoholic cirrhosis, other alcoholic liver diseases, other and unspecified cirrhosis, primary biliary cirrhosis, viral hepatitis, acute pancreatitis and chronic pancreatitis compared with the risk in a control cohort. Methods Analysis of statistical database of linked hospital and mortality data in an area in southern England. Results Compared with the control cohort, rate ratios were elevated for cancer overall and were particularly high for liver cancer in patients with alcoholic cirrhosis (rate ratio for cancer overall 2.4, 95% confidence interval 2.0-3.0 and 27.8, 17.7-41.7 for liver cancer); with other and unspecified cirrhosis (3.1, 2.7-3.6 and 35.1, 25.4-47.6); with other alcoholic liver diseases (2.3, 2.0-2.7 and 17.7, 11.5-26.0); with primary biliary cirrhosis (1.4, 0.9-2.0 and 19.6, 8.4-39.1) and with viral hepatitis (1.5,1.2-1.9 and 18.6, 9.8-32.2). Pancreatic cancer risk was significantly and substantially elevated in all cohorts except that with primary biliary cirrhosis. Lung cancer risk was significantly high in all cohorts except those with primary biliary cirrhosis and viral hepatitis. Oral cavity cancers were elevated in alcoholic cirrhosis cohort (8.6; 3.1-18.9) and the other alcoholic liver diseases cohort (10.1; 5.9-16.2), as was colon cancer (2.8; 1.4-5.0 and 2.0; 1.2-3.3, respectively). Non-Hodgkin's lymphoma was significantly elevated in the group of 'other and unspecified cirrhosis' (111.4; 7.2-17.3). Conclusion All seven conditions carry an increased risk cancer, but each condition has a somewhat different profile of cancer risk associated with it.