Incidence of Hepatitis B and C Infections in Early Breast Cancer Patients and Impact on Systemic Treatments

ABSTRACT Background few data are available about the prevalence of hepatitis B (HB) and C (HC) infections in early breast cancer patients and its impact on systemic treatments. Methods we retrospectively reviewed hepatitis B or C serology in 746 consecutive early breast cancer patients treated at National Institute for Cancer Research between January 2009 and March 2011. All patients were screened for hepatitis Bs antigen (HBsAg), HBc antibodies (HBcAb), HBs antibodies (HBsAb) and HC (HCV) antibodies. Data collected included patients and tumour characteristics, treatment received, changes in aminotransferases and impact on systemic treatment (delay or discontinuation). A comparison between patients with positive serology (cases) and patients with negative serology or vaccinated for HBV (controls) was performed. Results 371 patients were excluded because serology was not available. Among 375 evaluable patients we indentified 312 controls (83.2%) and 63 patients (16.8%) with positive serology defined as cases: 16 patients (4.2%) with HCV infection, 8 (2.1%) with occult HBV (HBsAg negative, HBsAg Ab negative, HBcAg Ab positive), 36 (9.6%) with cleared HBV (HBsAg negative, HBsAg Ab positive, HBcAg Ab positive) and 4 (1%) with chronic HBV (HBsAg positive, HBsAg Ab negative, HBcAg Ab positive). Because of the lack of serum HBV DNA and HCV RNA evaluation, we adopted only a clinical definition of hepatitis, i.e. at least threefold increase in serum ALT level. Hepatitis, according to this definition, during systemic treatments occurred in 9 (20.4%) of 44 evaluable cases and in 14 (5.9%) of the 234 evaluable controls. The increase in transaminases resulted in discontinuation of systemic treatment in 3 patients (6.8%) among cases and in 2 patients (0.85%) in the control group. Conclusion Nearly 16% of newly diagnosed breast cancer patients have positive serology for viral hepatitis and about 20% of them may develop hepatitis during systemic treatment. Pretreatment serum detection of viral hepatitis B and C antigen and antibodies may be useful for adeguate monitoring of liver function during anti-cancer therapy. Disclosure All authors have declared no conflicts of interest.