QJM vol. 97 no. 10 © Association of Physicians 2004; all rights reserved.
Correspondence |
Cancer and hereditary haemochromatosis
Sir,In their recent review,1 Limdi et al. appear to have understated the frequency of cancer in patients with hereditary haemochromatosis (HH). While everybody is aware of the risks of hepatocellular cancer in male patients with haemochromatosis and cirrhosis, the risks of non-hepatic malignancies are not widely appreciated. In one study,2 the relative risk for non-liver malignancies was 1.8 compared to non-HH liver diseases, even after exclusion of confounding factors such as alcohol, hepatitis B and C and family history, and 20 compared to the general population. A direct causal role for iron in triggering malignancy has been postulated. Even patients who are simple carriers of C282Y or H63D mutation or those who have raised ferritin but negative for the HH mutations also have higher risks of malignancy compared to the healthy population.3,4
With the wide availability of genetic screening for HH, the coming years will see many new cases of HH coming to light. This may become a major service issue in the face of non-existent liver services in many DGHs.
At our hospital, all patients with HH are entered in a database and are followed up by a specialist nurse in a clinic that runs parallel to a consultant-led liver clinic. Through this clinic, services are provided for family screening, counselling, introduction to the HH website and venesection. We hope that this will facilitate early detection of alarm symptoms, which, hopefully, will then trigger appropriate action.
Stepping Hill Hospital Stockport
References
1. Limdi JK, Crampton JR. Hereditary haemochromatosis. Q J Med 2004; 97:315–24.
2. Fracanzani AL et al. Increased cancer risk in a cohort of 230 patients with HH in comparison to matched control patients with non-iron-related chronic liver disease. Hepatology 2001; 33:647–51.[CrossRef][Web of Science][Medline]
3. Nelson RL, Davis FG, Persky V, Becker E. Risk of neoplastic and other diseases among people with heterozygosity for hereditary hemochromatosis. Cancer 1995; 76:875–9.[CrossRef][Web of Science][Medline]
4. Stevens RG, Jones DY, Micozzi MS, Taylor PR. Body iron stores and the risk of cancer. N Engl J Med 1988; 319:1047–52.[Abstract]
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