Chronic Sinusitis Linked to Head and Neck Cancers in Elderly

Chronic sinusitis is associated with three rare types of head and neck cancer, including nasopharyngeal cancer, human papillomavirus (HPV)-related oropharyngeal cancer, and nasal cavity and paranasal sinus cancers, according to a new study published in JAMA Otolaryngology–Head & Neck Surgery.

Chronic sinusitis is local inflammation caused by either a virus or bacteria that lasts for longer than 12 weeks.

Either the chronic inflammation from the sinusitis, the immunodeficiency that can accompany chronic sinusitis, or both may contribute to the development of these head and neck cancers. The effect is modest, however, wrote the study authors.

“There are currently no general US guidelines for head and neck cancer screening, but given the low absolute risk, our findings do not support a need for head and neck cancer screening in individuals with chronic sinusitis,” wrote study authors Daniel C. Beachler, PhD, MHS, and Eric A. Engels, MD, MPH, of the infections and immunoepidemiology branch of the National Cancer Institute in Bethesda, Maryland.

The absolute risk of these cancer types was low. At 8 years after a chronic sinusitis diagnosis, they had a cumulative incidence of less than 0.07%.

The authors conducted a case-cohort study using the Surveillance, Epidemiology, and End Results (SEER)–Medicare database to assess this link among elderly individuals in the United States.

The authors included 483,546 Medicare beneficiaries and an additional 826,436 individuals from the database who developed cancer, including 21,716 individuals who developed head and neck cancer.

The mean age of individuals in the cohort was 72.6 years and the majority were women (57.7%). About 83% percent of the individuals in the cohort were white.

Among the 483,546 Individuals, those with chronic sinusitis were more likely to be younger, female, white, and to have other upper airway conditions compared with individuals who did not receive a chronic sinusitis diagnosis (P < .001).

Chronic sinusitis was associated with a risk of developing head and neck cancer (adjusted hazard ratio [aHR], 1.37). The risk was highest for nasopharyngeal cancer (aHR, 3.71), HPV-related oropharyngeal cancer (aHR, 1.33), and nasal cavity and paranasal sinus cancer (aHR, 5.49).

This increased risk was weakened over time, the study authors found. Most of the increased risk was limited to within a year of a chronic sinusitis diagnosis. After 1 year or more, the associations decreased (aHRs of 1.60 for nasopharyngeal cancer, 1.07 for HPV–related oropharyngeal cancer, and 2.47 for nasal cavity and paranasal sinus cancer).

Overall, the risk of any cancer type was 8% higher among individuals diagnosed with chronic sinusitis compared to those with no chronic sinusitis (aHR, 1.08).

In an editorial accompanying the study, Elisabeth H. Ference, MD, MPH, and Jeffrey D. Suh, MD, of the department of head and neck surgery at the University of California–Los Angeles, noted that the current study may underestimate the link between chronic sinusitis and cancer risk because the authors analyzed an older age cohort while most inflammatory and infection-related cancers tend to occur at a younger age. “Future studies are necessary to consider whether inflammation in patients with sinusitis contributes to tumorigenesis, especially in middle-aged adults,” concluded the editorial authors.