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Association between Hepatitis B and C Virus Infection and Extrahepatic Bile Duct Cancer

It is well known that chronic infection with hepatitis B virus (HBV) or hepatitis C virus (HCV) can lead to advanced liver disease, including hepatocellular carcinoma (a form of primary liver cancer) over the course of years or decades. Now, a new study published in the April 15, 2008 International Journal of Cancer indicates that viral hepatitis may also promote development of cancer of the extrahepatic bile duct, which transports bile from the liver to the small intestine, joining with a similar duct from the gall bladder.

Ann Hsing of the National Cancer Institute and colleagues examined the association between HBV and/or HCV infection and risk of biliary tract cancer and biliary stones in a population-based case-control study in Shanghai, China.

Serum samples from 417 patients with biliary tract cancer and 517 with biliary stones were compared with those from 762 healthy control subjects randomly selected from the population. Samples were tested for HBV antigens and antibodies and for HCV antibodies.


• Hepatitis B surface antigen (HBsAg) seroprevalence was 7.3% among the population control subjects compared with 14.2% among patients with extrahepatic bile duct cancer.

This represented a 2.4-fold increased risk of extrahepatic bile duct cancer among individuals with HBV.

No association was found between HBV and cancers of the gallbladder (prevalence 8.2%) or the ampulla of Vater (6.1%).

There was also no observed association between HBV status and gallbladder stones (10.1%) or bile duct stones (9.3%).

Adjustment for other factors including smoking, body mass index, diabetes, and gallstones did not significantly change the results.

The prevalence of HCV infection among the study population, at 2%, was too low to allow the researchers to detect an association with biliary cancer or stones.

In conclusion, the study authors wrote, "In Shanghai, an HBV endemic area, chronic HBV infection was associated with a 2.4-fold risk of extrahepatic bile duct cancer. These results should be confirmed in other populations with varying risks of HBV and HCV infection."



AW Hsing, M Zhang, A Rashid, and others. Hepatitis B and C virus infection and the risk of biliary tract cancer: a population-based study in China. International Journal of Cancer 122(8): 1849-53. April 15, 2008.