Herpes Zoster and Subsequent Risk of Cancer: A Population-Based Study

Hui-Fen Chiu,Chun-Yuh Yang,Brian K. Chen

doi:10.2188/jea.je20120155

Hui-Fen Chiu, Chun-Yuh Yang + Show 1 more

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https://doi.org/10.2188/jea.je20120155

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Abstract

BackgroundIn this cohort study, we investigated whether a diagnosis of herpes zoster (HZ) was associated with a higher risk of subsequent cancer as compared with the Taiwanese general population.MethodsData were obtained from the Taiwan National Health Insurance Research Database. In total, 38 743 patients who were aged 50 years or older and had received ambulatory care for HZ between 1997 and 2006 were identified as the study cohort; 116 229 age- and sex-matched patients without HZ were included as the comparison cohort. We used Cox proportional hazards regression models to estimate the hazard ratios (HRs) for subsequent cancer, after controlling for potential confounders.ResultsThe HR for subsequent cancer varied according to time since HZ diagnosis. The HR was 1.58 (95% CI, 1.38–1.80) within the first year, 1.30 (95% CI, 1.15–1.46) between 1 and 2 years, 1.10 (95% CI, 0.98–1.24) between 2 and 3 years, 1.02 (95% CI, 0.91–1.15) between 3 and 4 years, and 1.08 (95% CI, 0.96–1.21) between 4 and 5 years. The risk of subsequent cancer, particularly lung cancer, was significantly higher during the first 2 years after initial diagnosis of HZ.ConclusionsOur findings suggest that an HZ diagnosis is a marker of occult malignancy, particularly in lung cancer. The HRs for cancer decreased gradually over time and were no longer significant after 2 years of follow-up, which indicates that the association between HZ and cancer is likely due to detection bias.

Highlights

Herpes zoster (HZ), or shingles, is a dermatologic manifestation of varicella infection and erupts after activation of varicella-zoster virus (VZV) previously latent in the sensory ganglia and dorsal nerve roots.[1]
We investigated whether patients with herpes zoster (HZ) had a higher incidence of subsequent cancer, as compared with the general population, during the first year of follow-up and whether the risk changed according to time since HZ diagnosis
Patients with HZ were more likely than patients in the comparison cohort to develop cancer during the first year of follow-up, and this increase in risk remained significant after adjustment (HR, 1.58; 95% CI, 1.38–1.80)

Summary

Introduction

Herpes zoster (HZ), or shingles, is a dermatologic manifestation of varicella infection and erupts after activation of varicella-zoster virus (VZV) previously latent in the sensory ganglia and dorsal nerve roots.[1]. In a comparison of malignancy rates among patients hospitalized for HZ and those expected based on the Danish Cancer Registry, Sorensen et al found that the relative risk of a cancer diagnosis during the first year of follow-up was 1.3 (95% CI, 1.1–1.5) They detected a high risk for hematologic cancer in this group (relative risk, 3.4; 95% CI, 2.3–4.9).[9]. In this cohort study, we investigated whether a diagnosis of herpes zoster (HZ) was associated with a higher risk of subsequent cancer as compared with the Taiwanese general population. The HRs for cancer decreased gradually over time and were no longer significant after 2 years of follow-up, which indicates that the association between HZ and cancer is likely due to detection bias

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