Issue 45 September 2009

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Puffing

Smoking with hepatitis C raises liver cancer risk

New research demonstrates that a man with hepatitis C who smokes has a significantly greater chance of getting liver cancer than those who are able to steer clear of cigarettes.

In order to prevent the worsening of liver disease, those living with chronic hepatitis C often seriously consider making some lifestyle changes. Since alcoholic drinks are a known liver toxin and have been shown to accelerate liver damage from hepatitis C, alcohol abstinence is the most obvious change that can positively affect liver health. However, smoking is now believed to be one of the worst things you can do when living with the virus. New research shows that, especially in men, cigarette smoking can dramatically increase the likelihood of hepatitis C leading to liver cancer.

smoking---by-Jim-OConnell

(image © Jim O'Connell)

Liver Disease Progression

Only about half of those infected with the most common type of hepatitis C in America, genotype 1, can eliminate the virus with the current standard of therapy. The other 50% learn to live with hepatitis C, and hope that the health of their liver does not worsen. Positive lifestyle changes that include alcohol abstinence, quitting smoking, avoiding toxins, eating a healthy diet and regular exercise appear to significantly minimise the risks of liver damage. When it does advance, liver damage is progressive, and so may escalate from fibrosis to one of the following final stages of liver disease:

  1. Cirrhosis - a worsening of fibrosis, when the liver becomes irreversibly scarred and blood can no longer flow through this organ
  2. Liver Cancer - when damage to the liver alters the genes inside the liver’s cells, the cells can become cancerous

Smoking and Liver Disease Progression

Because cigarette smoke contains so many toxins and known carcinogens, its cessation has been advised to people with hepatitis C for many years. However, proof of liver damage from smoking has been slow to accrue. Nonetheless, several previous studies have examined the relationship between hepatitis C and cigarette smoking:

  • A French study published in the January 2003 edition of Gut found that smoking, independent of alcohol, could aggravate the histological activity of chronic hepatitis C.
  • In the June 2006 issue of Clinical Gastroenterology & Hepatology, California researchers found that smokers with chronic hepatitis C may be more likely than non-smokers to develop liver fibrosis.

Smoking and Liver Cancer

While there has been evidence pointing to cigarette smoke’s ability to injure the liver, there is now proof that it increases a man with hepatitis C’s risk for developing liver cancer. Published in the October 2008 edition of the International Journal of Cancer, researchers from Texas investigated smoking and other behaviors as risk factors for the most common type of liver cancer, hepatocellular carcinoma (HCC), with men and women who have chronic hepatitis C. The researchers found the following:

  • Differences between men and women were observed in smokers with hepatitis C who develop HCC.
  • Men with hepatitis C who smoke have a more than 136-fold increased risk of HCC.
  • Women with hepatitis C who consume large amounts of alcohol have a more than 13-fold increased risk of HCC.

The researchers concluded that there appears to be a significant link between smoking and hepatitis C infection in men, leading to a more than 136-fold increased risk of developing HCC. Since increasing the risk of liver cancer by over 100 times is so dramatic, there is no doubt of the risks of cigarettes.

For men with hepatitis C who have the intent of preventing their liver disease from progressing to cancer, abstaining from smoking cigarettes should lie at the top of their to-do list. Of course, this is easier said than done. A good first step is to contact Quit SA’s Quitline on 13 78 48. Their website, at www.quitsa.org.au, has plenty of good advice on how to proceed.

Nicole Cutler

Nicole Cutler is a neuroscientist and acupuncture therapist in the US who specialises in hepatitis treatment and liver disease. See www.joyousmedicine.com for more information. This article was adapted from her article in The Hep C Review, June 2009.


More information:
www.hcvadvocate.org/news/newsRev/2008/NewsRev-284.html#_
Cigarette_Smoking,_hepatitis, Cigarette Smoking, hepatitis C Virus Synergistic in Raising Liver Cancer Risk, Reuters Health, Retrieved November 23, 2008, medscape.com, hepatitis C Support Project, 2008.
www.hivandhepatitis.com/hep_c/news/2006/070706_a.html, Smoking May Worsen Liver Fibrosis in Patients with Hepatitis C, Retrieved November 23, 2008, hivandhepatitis.com, July 2006.
www.medicinenet.com/script/main/art.asp?articlekey=18104, Smoking With Liver Disease - A No-No, Jay W. Marks, MD, Retrieved November 23, 2008, MedicineNet Inc., 2008.
www.ncbi.nlm.nih.gov/sites/entrez, Effect of different types of smoking and synergism with hepatitis C virus on risk of hepatocellular carcinoma in American men and women: case-control study, Hassan MM, et al, Retrieved November 23, 2008, International Journal of Cancer, October 2008.
www.ncbi.nlm.nih.gov/sites/entrez, Impact of smoking on histological liver lesions in chronic hepatitis C, Hezode C, et al, Retrieved November 23, 2008, Gut, January 2003.

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