title: A prospective study of blood transfusion history and liver cancer in a high-endemic area of Japan.
abstract: BACKGROUND
  The high prevalence of liver cancer in Japan may be owing to infection with hepatitis C virus (HCV), for which the major transmission route is blood transfusion. However, among the general population, there have been few follow-up studies of people with a history of transfusion. The purpose of this study was to examine whether such a history correlates with the development of liver cancer among the general population of this high-endemic area.
  
  
  METHODS
  The baseline survey was conducted between 1986 and 1991 among the population (15,597 people, aged 30-79) of Fukuoka prefecture, Japan. The participants were assessed for their transfusion history and other covariates using a baseline questionnaire. The relative risk (RR) of blood transfusion for liver cancer was estimated using the Cox proportional hazard model.
  
  
  RESULTS
  The RRs of transfusion for subsequent liver cancer were 1.86 (95% confidence interval (CI) = 1.05-3.29) in men and 4.20 (95% CI = 1.83-9.61) in women, after adjusting for covariates. Transfusion was associated with an increased risk of liver cancer, mainly in the group without hepatitis and cirrhosis (RR = 1.81, 95% CI = 0.84-3.91 - men; RR = 4.39, 95% CI = 1.37-14.02 - women).
  
  
  CONCLUSIONS
  A history of blood transfusion carried a significant risk of developing liver cancer in the study region. The people with a history of transfusion should be monitored more aggressively for viral infections and liver disease, as they may not report the infection or they may be unaware that they are infected.
authors.affiliation: Department of Clinical Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan. zenq@med.uoeh-u.ac.jp
authors.forename: Y
authors.initials: Y
authors.lastname: Fujino
authors.forename: T
authors.initials: T
authors.lastname: Mizoue
authors.forename: N
authors.initials: N
authors.lastname: Tokui
authors.forename: T
authors.initials: T
authors.lastname: Yoshimura
mesh_terms: D000328:Adult; D000368:Aged; D001803:Blood Transfusion / Q000706:statistics & numerical data; D019353:Endemic Diseases; D005260:Female; D006505:Hepatitis / Q000453:epidemiology; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008019:Life Style; D008103:Liver Cirrhosis / Q000453:epidemiology; D008113:Liver Neoplasms / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D011795:Surveys and Questionnaires; D065227:Transfusion Reaction