Risk of Active Tuberculosis in Patients With Cancer: A Systematic Review and Metaanalysis

Background. Cancer is a known risk factor for developing active tuberculosis. We determined the incidence and relative risk of active tuberculosis in cancer patients compared to the general population. Methods. Medline, Medline InProcess, EMBASE, PubMed, the Cochrane Database of Systematic Reviews, Cancerlit, and Web of Science were searched up to December 1, 2015. Studies of pathologically confirmed cancer cases were included if active tuberculosis was identified concurrently or after diagnosis. Cumulative incidence rate/100 000 population (CIR) of new cases of tuberculosis occurring in cancer patients and comparative incidence rate ratios (IRRs) to the general population from the same country of origin were estimated. A random effect meta-analysis was conducted on the CIR and IRR. Results. A total of 23 studies reporting 593 tuberculosis cases occurring in 324 041 cancer patients between 1950 and 2011 were identified. In a meta-analysis of 6 studies conducted in the United States in 317 243 cancer patients (98% of all patients), the CIR of tuberculosis decreased by 3-fold and 6.5-fold in hematologic and solid cancers, respectively, before and after 1980. After 1980 the CIR of tuberculosis was highest in hematologic (219/100 000 population; IRR = 26), head and neck (143; 16), lung cancers (83; 9) and was lowest in breast and other solid cancers (38; 4). Conclusions. Individuals living in the United States with hematologic, head and neck, and lung cancers had a 9-fold higher rate of developing active tuberculosis compared to those without cancer and would benefit from targeted latent tuberculosis screening and therapy.