An NCF Column for Inquiring Patients
By Alan Cocchetto
Copyright 2014

From Summer 2014 Forum

The “Just Ask” column is intended to act as a means for patients to inquire about issues related to the NCF’s research activities. This column is NOT intended to act as medical advice in any way, shape or form! The National CFIDS Foundation assumes no responsibilities for any action or treatment undertaken by readers. For medical advice, please consult your own personal healthcare providers.

Q: How real is the patient risk for cancer and ME/CFIDS?

A: The first study, published in 1998, was conducted by the Division of Cancer Epidemiology and Genetics at the National Institutes of Health and was titled "Cancer and a fatiguing illness in Northern Nevada — a causal hypothesis ^[1]." NIH scientists investigated the possibility that chronic fatigue syndrome (CFS) predisposes to cancer by comparing the cancer pattern in an area in northern Nevada, where an outbreak of a fatiguing illness, which included cases of CFS, was reported, to an area in southern Nevada, where no such illness was reported. Data from the computerized Nevada Cancer Registry were utilized to compare incidence rates of four malignancies — brain cancer, non-Hodgkin lymphoma (NHL), lung cancer, and breast cancer — in Washoe and Lyon Counties, where an unexplained fatiguing illness was reported during 1984-86, with comparably sized Clark County, where no such illness was reported. The study results indicated that higher incidences of NHL and primary brain tumors were noted in the two northern Nevada counties (Washoe and Lyon) in 1986 and 1987 respectively, compared to the southern Nevada (Clark) county. Similar patterns were not seen for breast or lung cancer.

The second and newer study, published in 2012, was conducted by the Division of Cancer Epidemiology and Genetics at the National Cancer Institute ^[2]. According to NCI scientists, "The cause of chronic fatigue syndrome (CFS) is unknown but is thought to be associated with immune abnormalities or infection. Because cancer can arise from similar conditions, associations between CFS and cancer were examined in a population-based case-control study among the US elderly." Using linked Surveillance, Epidemiology, and End Results (SEER) - Medicare registry data, approximately 1.2 million cancer cases and 100,000 controls (age range, 66-99 years; 1992-2005) were evaluated. CFS was identified in the period more than 1 year prior to selection, using linked Medicare claims. Unconditional logistic regression was used to estimate the odds ratios (ORs) comparing the CFS prevalence in cases and controls, adjusting for age, sex, and selection year. CFS was present in 0.5% of cancer cases overall and 0.5% of controls. CFS was associated with an increased risk of non-Hodgkin lymphoma (NHL). Among NHL subtypes, CFS was associated with diffuse large B cell lymphoma, marginal zone lymphoma and B-cell NHL not otherwise specified. CFS associations with NHL overall and NHL subtypes remained elevated after excluding patients with medical conditions related to CFS or NHL, such as autoimmune conditions. CFS was also associated with cancers of the pancreas, kidney, breast, and oral cavity and pharynx. The study authors concluded that chronic immune activation or an infection associated with CFS may play a role in explaining the increased risk of NHL.

Though these are but two cancer epidemiologic studies, ME/CFIDS patients should be aware of these potential associations with their disease process.

References:

1. Cancer and a fatiguing illness in Northern Nevada - a causal hypothesis; Levine PH, Fears TR, Cummings P, Hoover RN; Ann Epidemiol. 1998 May;8(4):245-9.

2. Chronic fatigue syndrome and subsequent risk of cancer among elderly US adults; Chang CM, Warren JL, Engels EA; Cancer. 2012 Dec 1;118(23):5929-36.