Increased cancer risk in a cohort of 230 patients with hereditary hemochromatosis in comparison to matched control patients with non-iron-related chronic liver disease

It has been suggested that excess iron may facilitate the occurrence of can cer. Patients with hereditary hemochromatosis (HH) are at high risk of deve loping liver cancer, and studies of limited series reported a high frequenc y of nonhepatic cancers. To verify whether patients with HH are at higher r isk of liver cancer and other malignancies as compared with patients with n on-iron-related chronic liver disease (CLD), we analyzed the occurrence of neoplasms in 230 patients with HH and 230 with non-iron-related CLD. The pa tients were matched by sex, age, duration of followup (+/-5 years), and sev erity of liver disease. On enrollment, the following variables were conside red: hepatitis B virus (HBV) and hepatitis C virus (HCV) infections, alcoho l abuse, smoking, and a family history of cancer (first-degree relatives). The diagnosis of primary cancers was confirmed by histology. During the fol low-up, hepatocellular carcinoma (HCC) developed in 49 and 29 patients (all cirrhotic patients) with HH and non-iron-related CLD, respectively, with a relative risk of 1.8 (95% confidence interval [CI] 1.1-2.9); nonhepatic ca ncers occurred in 20 and 11 patients, respectively, with a relative risk of 1.8 (95% CI 0.8-4). Four patients with HH and 1 with non-iron-related CLD developed 2 different primary cancers during follow-up. The risk of cancer after adjustment for alcohol abuse, smoking, and family history of cancer w as 1.9 (95% CI 1.1-3.1) in the patients with HH. In conclusion, patients wi th HH are at high risk of both liver cancer and other malignancies, which s hould be carefully sought during follow-up.