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The importance of blood-borne viruses in elevated cancer risk among opioid-dependent people: a population-based cohort study
  1. Alexander Swart1,
  2. Lucinda Burns2,
  3. Limin Mao3,
  4. Andrew E Grulich4,
  5. Janaki Amin4,
  6. Dianne L O'Connell5–8,
  7. Nicola S Meagher1,
  8. Deborah A Randall9,
  9. Louisa Degenhardt2,10,
  10. Claire M Vajdic1
  1. 1Prince of Wales Clinical School, Adult Cancer Program, Lowy Cancer Research Centre, University of New South Wales, Sydney, New South Wales, Australia
  2. 2National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
  3. 3National Centre in HIV Social Research, University of New South Wales, Sydney, New South Wales, Australia
  4. 4Kirby Institute, University of New South Wales, New South Wales, Australia
  5. 5Cancer Epidemiology Research Division, Cancer Council NSW, Kings Cross, Sydney, New South Wales, Australia
  6. 6School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
  7. 7School of Public Health and Community Medicine, University of New South Wales, Sydney,  New South Wales, Australia
  8. 8Sydney Medical School – Public Health, University of Sydney, Sydney,  New South Wales, Australia
  9. 9School of Medicine, University of Western Sydney, Penrith, New South Wales, Australia
  10. 10Centre for Health Policy, Programs and Economics, School of Population Health, University of Melbourne, Melbourne, Victoria, Australia
  1. Correspondence to: Prof Claire M Vajdic; claire.vajdic{at}


Objective To quantify cancer risk in opioid dependence and the association with infection by the oncogenic blood-borne viruses (BBVs) hepatitis C (HCV), hepatitis B (HBV) and HIV.

Design Cohort study.

Setting New South Wales, Australia.

Participants All 45 412 adults aged 16 years or over registered for opioid substitution therapy (OST) between 1985 and 2007. Notifications of cancer, death and infection with HCV, HBV and HIV were ascertained by record linkage with registries.

Main outcome measures The ratios of observed to expected number of cancers, standardised incidence ratios (SIRs), and the average annual per cent change (AAPC) in overall age and sex-standardised cancer incidence.

Results Overall cancer risk was modestly increased compared to the general population (SIR 1.15, 95% CI 1.07 to 1.23). Excess risk was observed for 11 cancers, particularly lung (4.02, 95% CI 3.32 to 4.82), non-Hodgkin's lymphoma (1.51, 95% CI 1.20 to 1.88) and liver (8.04, 95% CI 6.18 to 10.3). Reduced risk was observed for six cancers, including prostate (0.16, 95% CI 0.06 to 0.32) and breast (0.48, 95% CI 0.35 to 0.62). Individuals notified with HCV or HBV had a markedly increased risk of liver cancer; lung cancer risk was also increased in those with HCV. HIV was associated with an elevated risk of liver, anus and kidney cancer, non-Hodgkin lymphoma and Kaposi sarcoma. Cancer risk was not increased in individuals without a BBV notification, apart from pancreatic cancer (3.92, 95% CI 1.07 to 10.0). Cancer incidence increased significantly over time (AAPC 9.4%, 4.2% to 15%, p=0.001).

Conclusions BBVs play a major role in the cancer risk profile of opioid-dependent individuals registered for OST. To address the dramatic increasing trend in cancer incidence, the OST setting could be utilised for cancer prevention strategies.

  • Public Health

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